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Investigation of the Gut Microbiome and Statin Response (INGEST)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT04098003
Recruitment Status : Recruiting
First Posted : September 20, 2019
Last Update Posted : December 24, 2019
Information provided by (Responsible Party):
Sony Tuteja, University of Pennsylvania

Tracking Information
First Submitted Date  ICMJE September 13, 2019
First Posted Date  ICMJE September 20, 2019
Last Update Posted Date December 24, 2019
Estimated Study Start Date  ICMJE January 6, 2020
Estimated Primary Completion Date April 2022   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: September 18, 2019)
Change in bacterial abundance [ Time Frame: 8 weeks ]
as measured by operational taxonomic units (OTUs)
Original Primary Outcome Measures  ICMJE Same as current
Change History Complete list of historical versions of study NCT04098003 on Archive Site
Current Secondary Outcome Measures  ICMJE
 (submitted: September 18, 2019)
Change in LDL-C [ Time Frame: 8 weeks ]
low density lipoprotein cholesterol levels (mg/dl)
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures
 (submitted: September 18, 2019)
  • Change in fecal bile acid concentrations [ Time Frame: 8 weeks ]
    concentration of bile acids (nM)
  • Change in serum FGF19 levels [ Time Frame: 8 weeks ]
    Fibroblast growth factor 19 levels (pg/mL)
Original Other Pre-specified Outcome Measures Same as current
Descriptive Information
Brief Title  ICMJE Investigation of the Gut Microbiome and Statin Response
Official Title  ICMJE INvestigation of the Gut microbiomE and STatin Response (INGEST)
Brief Summary There is evidence that the bacteria that naturally reside in the gut can influence how well we respond to medications. Therefore this study will look at how rosuvastatin, a medication used to lower cholesterol levels, may change the bacteria in the gut. Investigators will also examine how the gut bacteria will affect the ability of rosuvastatin to lower cholesterol levels. There will be 4 study visits over the course of about 16 weeks.The expected duration of the study is 2 years. Investigators plan to enroll 100 healthy volunteers during that time.
Detailed Description

The gut microbiome plays an important role in the metabolism of xenobiotics and contributes to the variation in drug response. Atorvastatin, simvastatin and rosuvastatin, three of the most commonly prescribed statin medications, also display evidence for modulation by the gut microbiome.The objective of this study is to understand the interaction between the gut microbiome and host drug response to statin therapy using 16S rRNA sequencing, metagenomics sequencing and bile acid metabolomics.

Aim 1: To compare changes in the gut microbiome in healthy volunteers randomized to an 8-week intervention with rosuvastatin 10mg daily or placebo.

Aim 2: To determine the relationship with gut microbiome, fecal bile acid composition, serum FGF19 levels and the change in plasma LDL-C with rosuvastatin.

This is a randomized, placebo controlled trial to investigate the effects of rosuvastatin on the gut microbiome, fecal bile acids and FGF19 levels. Healthy volunteers will be randomized to rosuvastatin 20 mg daily or placebo for eight weeks in a 2:1 ratio. Participants will be blinded to treatment assignment. Stool and blood will be collected at baseline, 8 weeks, and 12 weeks for 16S sequencing, plasma lipid assays, bile acid metabolites and FGF19 assays. A subgroup of participants at the tails of LDL-C response will undergo metagenomics sequencing.

Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 4
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description:
This is a randomized, placebo controlled, double blind (participant and outcomes assessor) trial to investigate the effects of rosuvastatin on the gut microbiome. Healthy volunteers will be randomized to rosuvastatin 20 mg daily or placebo for eight weeks in a 2:1 ratio.
Masking: Double (Participant, Outcomes Assessor)
Masking Description:
Matching placebo capsules will be formulated
Primary Purpose: Basic Science
Condition  ICMJE Healthy Volunteers
Intervention  ICMJE
  • Drug: Rosuvastatin
    rosuvastatin 20 mg daily or placebo for eight weeks
    Other Name: Crestor
  • Drug: Placebo
    Matched placebo control
Study Arms  ICMJE
  • Experimental: Rosuvastatin
    rosuvastatin 20 mg daily for eight weeks
    Intervention: Drug: Rosuvastatin
  • Placebo Comparator: Placebo
    placebo daily for eight weeks
    Intervention: Drug: Placebo
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
Recruitment Information
Recruitment Status  ICMJE Recruiting
Estimated Enrollment  ICMJE
 (submitted: September 18, 2019)
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE April 2022
Estimated Primary Completion Date April 2022   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  1. Participant is capable of giving informed consent
  2. Participant is aged 18 to 65 years. The gut microbiome has been shown to change gradually with time, although there is no cut-off in age when this occurs.

Exclusion Criteria:

  1. Participants with cardiovascular disease such as a history of heart failure (New York Heart Association class II-IV), myocardial infarction, stroke, coronary artery bypass graft, hypertension, and hyperlipidemia as these conditions are associated with altered gut microbiome composition.74 Hypertension is defined as blood pressure greater than 160/110 or on any anti-hypertensive medications. LDL-C >190 mg/dl or <100 mg/dl and triglycerides > 400 mg/dl.
  2. Participants with a history of cancer.
  3. Kidney disease (serum creatinine >1.5 mg/dl).
  4. Liver dysfunction (alanine aminotransferase > 2 times the upper limit of normal).
  5. Diabetes mellitus (DM) - Diabetes itself may affect the gut microbiome although this has not been extensively studied. In addition to a prior diagnosis of diabetes mellitus other than that related to pregnancy, a fasting glucose level of greater than 125mg/dL will be used to exclude participation.
  6. Clinical diagnosis of hypothyroidism
  7. History of inflammatory disorders of the intestinal tract (i.e. IBD, celiac sprue).
  8. Use of antibiotics in the prior 6 months.
  9. Use of pre-, pro-, or synbiotics.
  10. Chronic medication use (including over the counter medications and herbal supplements) with the exception of oral contraceptives. Since we are evaluating the impact of rosuvastatin on the gut microbiome we would like to exclude the potential impact of confounding medications.
  11. Current smoker. The effect of smoking on the microbiome of the gut is unknown.
  12. Known history of alcohol or substance abuse.
  13. Body Mass Index (BMI) <18.5 or >30 kg/m2. Volunteers with BMI below normal will be excluded to prevent inclusion of subjects with a subclinical systemic disease that may influence the gut microbiome. Volunteers with moderate or severe obesity will be excluded as obesity may be associated with altered gut microbiome composition.31
  14. Unable to abstain from consumption of illicit drugs during the study period.
  15. Prior bowel resection surgery other than appendectomy. It is unknown how prior bowel resection surgery may influence the microbiome composition; hence we will exclude these participants.
  16. Baseline bowel frequency less than every 2 days or greater than 3 times daily. Normal bowel frequency is every 3rd day to 3 times per day. Although unknown, stool frequency could be related to the microbiome composition. To avoid the need for use of antidiarrheal medications or laxatives, which themselves could alter the microbiome composition, these patients will be excluded.
  17. Participant has experienced diarrhea within the two weeks prior to entry. Diarrhea is defined as a change in bowel habits with an increased frequency or loose stools such that the stool could not be lifted with a fork.
  18. Vegans and Vegetarians.
  19. Known intolerance to statin medications.
  20. Unwilling to obtain from grapefruit containing foods or drinks.
  21. Pregnant women. To avoid any risk to an unborn fetus from study drug exposure.
  22. Refusal to use two medically accepted method of birth control while participating in the study, such as a barrier method, hormonal contraceptives, implanted birth control devices, permanent methods (such as a vasectomy), and/or abstinence.
  23. Nursing mothers
  24. Any condition that the investigator feels may limit the volunteer's ability to complete the study protocol.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 65 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE Yes
Contacts  ICMJE
Contact: Sony Tuteja, PharmD, MS 215-573-7834
Contact: Karen Terembula, BS 215-615-3423
Listed Location Countries  ICMJE United States
Removed Location Countries  
Administrative Information
NCT Number  ICMJE NCT04098003
Other Study ID Numbers  ICMJE 832874
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: Yes
IPD Sharing Statement  ICMJE Not Provided
Responsible Party Sony Tuteja, University of Pennsylvania
Study Sponsor  ICMJE Sony Tuteja
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Principal Investigator: Sony Tuteja, PharmD, MS University of Pennsylvania Perelman School of Medicine
PRS Account University of Pennsylvania
Verification Date December 2019

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP