Safety and Gut Microbiota Analysis of an Oral Microbiotherapy in Patients With Amyotrophic Lateral Sclerosis

Prior treatment

• Active infection requiring systemic antimicrobial therapy within 2-week prior to screening visit
• Vulnerable subjects such as: persons deprived of liberty, persons in intensive care units unable to provide informed consent prior to the procedure

Other illness

• Known autoimmune diseases, inflammatory disorders (SLE, Rheumatoid arthritis, connective tissue disorder) or chronic infections (HIV, hepatitis B, or C infection, Tuberculosis)
• Known hypersensitivity to rifaximin or macrogol or any of its components
• Known allergy or intolerance to trehalose, maltodextrin or Polyethylene Glycol (PEG)
• Active infection requiring systemic antimicrobial therapy between screening and baseline
• Medical condition requiring proton pump inhibitors (PPIs)
• Gastrointestinal obstruction or perforation
• Any gastro-intestinal bleeding in the past 3 months
• Gastric emptying disorders (gastroparesis)
• Severe forms of inflammation of the intestinal tract, including Crohn's disease and ulcerative colitis
• Any condition that, in the opinion of the investigator, may interfere with full participation in the study, including administration of study drug (and its preparation procedure) and attendance at required study visits; represent a significant risk to the subject; or interfere with the interpretation of study data

Lab values

• Documented hepatic impairment (Alanine Transaminase/ Aspartate Transaminase \> 5N)
• Subject with white blood cells \< 4000/ mm3; Polynuclear neutrophils \< 1.5 G/ L

Other

• Subjects with a non-invasive ventilation, a tracheotomy and /or a gastrostomy
• Toxic megacolon
• Severe vital organ dysfunctions unrelated to ALS and not compatible with experimental treatment, as per the investigator's assessment
• Subjects with negative IgG serology for Epstein Barr virus (EBV)
• Women of childbearing potential1 without effective contraceptive protection
• Nursing or pregnant women
• Enrollment in another trial or expanded access program that may interfere with this study
• Guardianship/legal protection/curatorship of subjects

• Male or female subjects aged between18 and 80 years
• ALS meeting the revised El Escorial criteria for possible, probable, laboratory-supported probable, or definite ALS (familial or sporadic)
• Time since first motor deficit at screening: at least 6 months, up to 24 months
• Slope of progression of ALS Functional Rating Scale - revised (ALSFRS-R) from date of symptom onset to date of screening test (ΔFS/number of months) between \[0.4 and 1.1\]
• Able to swallow study treatments (including capsules without opening or chewing them) as per the investigator's assessment
• SVC (Slow Vital Capacity) equal to or greater than 70% of the predicted normal value for sex, height, and age at the screening visit
• If taking riluzole, subject must be on a stable dose for ≥30 days
• Signature of written informed consent by subject