xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT06021535</url>
    </required_header>
    <id_info>
      <org_study_id>BASEC Nr (2023-01173)</org_study_id>
      <nct_id>NCT06021535</nct_id>
    </id_info>
    <brief_title>Involvement of the Gut Microbiota in Calcified Aortic Stenosis</brief_title>
    <acronym>Gut-CAS</acronym>
    <official_title>Involvement of the Gut Microbiota and Its Metabolites in the Pathophysiology of Calcified Aortic Stenosis</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>Insel Gruppe AG, University Hospital Bern</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
    </sponsors>
    <source>Insel Gruppe AG, University Hospital Bern</source>
    <oversight_info>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        Calcific aortic stenosis (CAS) is a disease characterized by progressive calcification of the&#xD;
        aortic valve, obstructing the passage of blood from the left ventricle into the general&#xD;
        circulation. It is the most frequent cause of valve disease in the elderly. To date, no means&#xD;
        of preventing the disease has been discovered, and the only treatment available is valve&#xD;
        replacement during cardiac surgery, or percutaneous implantation of a valve prosthesis when&#xD;
        the narrowing becomes severe and causes symptoms.&#xD;
  &#xD;
        The intestinal flora or microbiota, the reservoir of all the microorganisms in the gut, is&#xD;
        implicated in numerous diseases, particularly of the intestine. But to date, no study has&#xD;
        established a link between CAS and microbiota. The intestinal microbiota acts through&#xD;
        molecules produced by itself or the host and passing into the bloodstream. In the&#xD;
        pathophysiology of CAS, the valve leaflets are breached and do not heal. These molecules can&#xD;
        enter and have beneficial or deleterious effects, in particular promoting calcification of&#xD;
        aortic valve cells.&#xD;
  &#xD;
        Concrete objectives:&#xD;
  &#xD;
        Improve understanding of calcific aortic stenosis in humans Study the composition of&#xD;
        intestinal flora in patients with aortic stenosis and compare it with healthy subjects Study&#xD;
        the molecules in the intestinal flora likely to be involved in the development of aortic&#xD;
        stenosis in humans.&#xD;
      </textblock>
    </brief_summary>
    <overall_status>Not yet recruiting</overall_status>
    <start_date type="Anticipated">January 1, 2024</start_date>
    <completion_date type="Anticipated">December 31, 2028</completion_date>
    <primary_completion_date type="Anticipated">December 31, 2025</primary_completion_date>
    <study_type>Observational</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <observational_model>Case-Control</observational_model>
      <time_perspective>Prospective</time_perspective>
    </study_design_info>
    <primary_outcome>
      <measure>Richness of the gut microbiota</measure>
      <time_frame>The sample will be collected at the time of inclusion (with a margin of two additional days depending on the patient's ability to pass stools). The analysis will be performed at the end of the sample collection (an average of 2 years)</time_frame>
      <description>The primary endpoint is the evaluation (16S ribosomal ribonucleic acid (rRNA) sequencing) of the species richness using alpha diversity parameters such as the Shannon and Simpson index and diversity between samples using beta diversity with Bray-Curtis dissimilarity approach. The investigators will then identify the bacteria with taxonomy analysis and statistical differences will be done using MaAsLin (Microbiome Multivariable Association with Linear Models) for patients with and without CAS.</description>
    </primary_outcome>
    <secondary_outcome>
      <measure>Comparison of the levels of the tryptophane metabolites of the gut microbiota in the blood, feces and the aortic valve between patients with and without CAS</measure>
      <time_frame>The full analysis will be performed at the end of the sample collection. One intermediate analysis is scheduled when half of the samples are collected (one year and two years)</time_frame>
      <description>The metabolites being studied include tryptophan metabolites (kynurenine pathway, serotonin pathway).</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Comparison of the levels of the short chain fatty acids (SCFA) metabolites of the gut microbiota in the blood, feces and the aortic valve between patients with and without CAS</measure>
      <time_frame>The full analysis will be performed at the end of the sample collection. One intermediate analysis is scheduled when half of the samples are collected (one year and two years)</time_frame>
      <description>The metabolites being studied include SCFA (acetate, propionate and butyrate).</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Comparison of the levels of the trimethylamine N oxide (TMAO) metabolites of the gut microbiota in the blood, feces and the aortic valve between patients with and without CAS</measure>
      <time_frame>The full analysis will be performed at the end of the sample collection. One intermediate analysis is scheduled when half of the samples are collected (one year and two years)</time_frame>
      <description>TMAO is derived from trimethylamine (TMA), itself generated by the action of the gut microbiota on dietary choline and phosphatidylcholine contained in red meat, eggs, dairy products and saltwater fish. TMAO and its derivatives (L Carnitine) are measured in blood, stool and valves.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Comparison of the levels of the bile acids metabolites of the gut microbiota in the blood, feces and the aortic valve between patients with and without CAS</measure>
      <time_frame>The full analysis will be performed at the end of the sample collection. One intermediate analysis is scheduled when half of the samples are collected (one year and two years)</time_frame>
      <description>The metabolites being studied include 4 bile acids and their derivatives (Cholic, Chenodeoxycholic, Deoxycholic and Lithocholic acid)</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Diversity of bacteria families in men and women</measure>
      <time_frame>The sample will be collected at the time of inclusion (with a margin of two additional days depending on the patient's ability to pass stools). The analysis will be performed at the end of the sample collection (an average of 2 years)</time_frame>
      <description>Primary endpoint: The primary endpoint is the evaluation (16S rRNA sequencing) of the species richness using alpha diversity parameters such as the Shannon and Simpson index and diversity between samples using beta diversity with Bray-Curtis dissimilarity approach.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Prevalence of bacterial families or species in the microbiota of patients with CAS over the course of time and disease progression.</measure>
      <time_frame>The sample will be collected at the time of inclusion (with a margin of two additional days depending on the patient's ability to pass stools). The analysis will be performed at the end of each year of follow up (an average of 2 years)</time_frame>
      <description>Primary endpoint: The primary endpoint is the evaluation (16S rRNA sequencing) of the species richness using alpha diversity parameters such as the Shannon and Simpson index and diversity between samples using beta diversity with Bray-Curtis dissimilarity approach.</description>
    </secondary_outcome>
    <secondary_outcome>
      <measure>Prevalence of bacterial families or species in the microbiota of men versus women with CAS over the course of time and disease progression.</measure>
      <time_frame>The sample will be collected at the time of inclusion (with a margin of two additional days depending on the patient's ability to pass stools). The analysis will be performed at the end of each year of follow up (an average of 2 years)</time_frame>
      <description>Primary endpoint: The primary endpoint is the evaluation (16S rRNA sequencing) of the species richness using alpha diversity parameters such as the Shannon and Simpson index and diversity between samples using beta diversity with Bray-Curtis dissimilarity approach.</description>
    </secondary_outcome>
    <number_of_groups>2</number_of_groups>
    <enrollment type="Anticipated">100</enrollment>
    <condition>Aortic Stenosis</condition>
    <condition>Gastrointestinal Microbiome</condition>
    <condition>Metabolomics</condition>
    <arm_group>
      <arm_group_label>Calcified Aortic Stenosis</arm_group_label>
      <description>Patients with calcified aortic valve or aortic stenosis will be enrolled Stool, blood samples and aortic valve of operated patients will be retrieved to evaluate the composition of the gut microbiota and its metabolites A follow up is planned for patients with no intervention on the aortic valve to assess the evolution of the aortic stenosis and the change in the gut microbiota.</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Control</arm_group_label>
      <description>Patients without calcified aortic valve will be enrolled Stool and blood samples will be retrieved to evaluate the composition of the gut microbiota and its metabolites No follow up is scheduled.</description>
    </arm_group>
    <intervention>
      <intervention_type>Other</intervention_type>
      <intervention_name>No intervention</intervention_name>
      <description>No intervention</description>
      <arm_group_label>Calcified Aortic Stenosis</arm_group_label>
      <arm_group_label>Control</arm_group_label>
    </intervention>
    <biospec_retention>Samples Without DNA</biospec_retention>
    <biospec_descr>
      <textblock>
        Stool, blood sample, aortic valve&#xD;
      </textblock>
    </biospec_descr>
    <eligibility>
      <study_pop>
        <textblock>
          In this study the investigators aim at enrolling patients with calcified aortic stenosis as&#xD;
          well as a control group (patients without calcified aortic stenosis) and aim for an even&#xD;
          distribution between female and male participants.&#xD;
        </textblock>
      </study_pop>
      <sampling_method>Non-Probability Sample</sampling_method>
      <criteria>
        <textblock>
          Inclusion Criteria:&#xD;
  &#xD;
            -  Group of patients with CAS:&#xD;
  &#xD;
            -  Calcified aortic stenosis diagnosed on a cardiac ultrasound or CT not older than 3&#xD;
               months&#xD;
  &#xD;
            -  Severe aortic stenosis: surgical indication based on symptoms and ultrasound data&#xD;
               (high gradient aortic stenosis : Vmax&gt; 4m/s, mean gradient &gt; 40mmHg, area &lt; 1cm², low&#xD;
               flow low-gradient CAS: left ventricular ejection fraction (LVEF) &lt; 40%, Vmax&lt; 4m/s,&#xD;
               mean gradient &lt; 40mmHg, area &lt; 1cm², paradoxical low-gradient CAS: LVEF &gt; 55%, Vmax&lt;&#xD;
               4m/s, mean gradient &lt; 40mmHg, area &lt; 1cm²)&#xD;
  &#xD;
            -  Moderate CAS: 3m/s &lt;Vmax&lt; 4m/s, 20mmHg &lt; mean gradient &lt; 40mmHg&#xD;
  &#xD;
            -  Mild CAS: 2,6m/s &lt; Vmax &lt; 2.9m/s, mean gradient &lt; 20mmHg&#xD;
  &#xD;
            -  Aortic sclerosis: calcified remodeling of the aortic valve visible on ultrasound or&#xD;
               CT.&#xD;
  &#xD;
          Control group - free of CAS:&#xD;
  &#xD;
          - No calcified aortic stenosis verified on a cardiac ultrasound or CT not older than 3&#xD;
          months&#xD;
  &#xD;
          Exclusion Criteria:&#xD;
  &#xD;
            -  Treatment interfering with the composition of the intestinal microbiota: local or&#xD;
               systemic corticosteroids within the last 3 months, antibiotics within the last 3&#xD;
               months, antiretrovirals, bile acid chelators (questran and colesevelam), HIV-targeted&#xD;
               antiretroviral therapies, selective serotonin reuptake inhibitor-type antidepressants&#xD;
  &#xD;
            -  Clinical criteria: history of cholecystectomy, documented chronic liver disease in the&#xD;
               patient, failure to fast on the day of the blood test, inflammatory bowel disease&#xD;
  &#xD;
            -  Patients requiring emergency intervention (myocardial infarction, acute aortic or&#xD;
               mitral insufficiency, cardiogenic shock).&#xD;
  &#xD;
            -  AS of rheumatic origin, infective endocarditis.&#xD;
        </textblock>
      </criteria>
      <gender>All</gender>
      <minimum_age>18 Years</minimum_age>
      <maximum_age>90 Years</maximum_age>
      <healthy_volunteers>No</healthy_volunteers>
    </eligibility>
    <overall_official>
      <last_name>Caroline Nguyen, MD</last_name>
      <role>Principal Investigator</role>
      <affiliation>Insel Gruppe AG</affiliation>
    </overall_official>
    <overall_contact>
      <last_name>Caroline Nguyen, MD</last_name>
      <phone>+41316325000</phone>
      <email>caroline.chong-nguyen@insel.ch</email>
    </overall_contact>
    <reference>
      <citation>Kocyigit D, Tokgozoglu L, Gurses KM, Stahlman M, Boren J, Soyal MFT, Canpinar H, Guc D, Saglam Ayhan A, Hazirolan T, Ozer N. Association of dietary and gut microbiota-related metabolites with calcific aortic stenosis. Acta Cardiol. 2021 Jul;76(5):544-552. doi: 10.1080/00015385.2020.1853968. Epub 2020 Dec 18.</citation>
      <PMID>33334254</PMID>
    </reference>
    <reference>
      <citation>Liu Z, Li J, Liu H, Tang Y, Zhan Q, Lai W, Ao L, Meng X, Ren H, Xu D, Zeng Q. The intestinal microbiota associated with cardiac valve calcification differs from that of coronary artery disease. Atherosclerosis. 2019 May;284:121-128. doi: 10.1016/j.atherosclerosis.2018.11.038. Epub 2018 Dec 4.</citation>
      <PMID>30897381</PMID>
    </reference>
    <reference>
      <citation>Agus A, Planchais J, Sokol H. Gut Microbiota Regulation of Tryptophan Metabolism in Health and Disease. Cell Host Microbe. 2018 Jun 13;23(6):716-724. doi: 10.1016/j.chom.2018.05.003.</citation>
      <PMID>29902437</PMID>
    </reference>
    <reference>
      <citation>Shan Y, Pellikka PA. Aortic stenosis in women. Heart. 2020 Jul;106(13):970-976. doi: 10.1136/heartjnl-2019-315407. Epub 2020 Mar 22.</citation>
      <PMID>32201373</PMID>
    </reference>
    <reference>
      <citation>Morvan M, Arangalage D, Franck G, Perez F, Cattan-Levy L, Codogno I, Jacob-Lenet MP, Deschildre C, Choqueux C, Even G, Michel JB, Back M, Messika-Zeitoun D, Nicoletti A, Caligiuri G, Laschet J. Relationship of Iron Deposition to Calcium Deposition in Human Aortic Valve Leaflets. J Am Coll Cardiol. 2019 Mar 12;73(9):1043-1054. doi: 10.1016/j.jacc.2018.12.042.</citation>
      <PMID>30846099</PMID>
    </reference>
    <reference>
      <citation>Yilmaz B, Fuhrer T, Morgenthaler D, Krupka N, Wang D, Spari D, Candinas D, Misselwitz B, Beldi G, Sauer U, Macpherson AJ. Plasticity of the adult human small intestinal stoma microbiota. Cell Host Microbe. 2022 Dec 14;30(12):1773-1787.e6. doi: 10.1016/j.chom.2022.10.002. Epub 2022 Oct 31.</citation>
      <PMID>36318918</PMID>
    </reference>
    <verification_date>August 2023</verification_date>
    <study_first_submitted>August 22, 2023</study_first_submitted>
    <study_first_submitted_qc>August 29, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">September 1, 2023</study_first_posted>
    <last_update_submitted>August 29, 2023</last_update_submitted>
    <last_update_submitted_qc>August 29, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">September 1, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Sponsor</responsible_party_type>
    </responsible_party>
    <condition_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Aortic Valve Stenosis</mesh_term>
      <mesh_term>Constriction, Pathologic</mesh_term>
    </condition_browse>
    <patient_data>
      <sharing_ipd>No</sharing_ipd>
    </patient_data>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT06021535
  org study id: BASEC Nr (2023-01173)
  nct id: NCT06021535
  lead sponsor: 
  is fda regulated drug: No
  is fda regulated device: No
  Calcific aortic stenosis (CAS) is a disease characterized by progressive calcification of the
        aortic valve, obstructing the passage of blood from the left ventricle into the general
        circulation. It is the most frequent cause of valve disease in the elderly. To date, no means
        of preventing the disease has been discovered, and the only treatment available is valve
        replacement during cardiac surgery, or percutaneous implantation of a valve prosthesis when
        the narrowing becomes severe and causes symptoms.
  
        The intestinal flora or microbiota, the reservoir of all the microorganisms in the gut, is
        implicated in numerous diseases, particularly of the intestine. But to date, no study has
        established a link between CAS and microbiota. The intestinal microbiota acts through
        molecules produced by itself or the host and passing into the bloodstream. In the
        pathophysiology of CAS, the valve leaflets are breached and do not heal. These molecules can
        enter and have beneficial or deleterious effects, in particular promoting calcification of
        aortic valve cells.
  
        Concrete objectives:
  
        Improve understanding of calcific aortic stenosis in humans Study the composition of
        intestinal flora in patients with aortic stenosis and compare it with healthy subjects Study
        the molecules in the intestinal flora likely to be involved in the development of aortic
        stenosis in humans.
  observational model: Case-Control
  time perspective: Prospective
  measure: Richness of the gut microbiota
  time frame: The sample will be collected at the time of inclusion (with a margin of two additional days depending on the patient's ability to pass stools). The analysis will be performed at the end of the sample collection (an average of 2 years)
  description: The primary endpoint is the evaluation (16S ribosomal ribonucleic acid (rRNA) sequencing) of the species richness using alpha diversity parameters such as the Shannon and Simpson index and diversity between samples using beta diversity with Bray-Curtis dissimilarity approach. The investigators will then identify the bacteria with taxonomy analysis and statistical differences will be done using MaAsLin (Microbiome Multivariable Association with Linear Models) for patients with and without CAS.
  measure: Comparison of the levels of the tryptophane metabolites of the gut microbiota in the blood, feces and the aortic valve between patients with and without CAS
  time frame: The full analysis will be performed at the end of the sample collection. One intermediate analysis is scheduled when half of the samples are collected (one year and two years)
  description: The metabolites being studied include tryptophan metabolites (kynurenine pathway, serotonin pathway).
  measure: Comparison of the levels of the short chain fatty acids (SCFA) metabolites of the gut microbiota in the blood, feces and the aortic valve between patients with and without CAS
  time frame: The full analysis will be performed at the end of the sample collection. One intermediate analysis is scheduled when half of the samples are collected (one year and two years)
  description: The metabolites being studied include SCFA (acetate, propionate and butyrate).
  measure: Comparison of the levels of the trimethylamine N oxide (TMAO) metabolites of the gut microbiota in the blood, feces and the aortic valve between patients with and without CAS
  time frame: The full analysis will be performed at the end of the sample collection. One intermediate analysis is scheduled when half of the samples are collected (one year and two years)
  description: TMAO is derived from trimethylamine (TMA), itself generated by the action of the gut microbiota on dietary choline and phosphatidylcholine contained in red meat, eggs, dairy products and saltwater fish. TMAO and its derivatives (L Carnitine) are measured in blood, stool and valves.
  measure: Comparison of the levels of the bile acids metabolites of the gut microbiota in the blood, feces and the aortic valve between patients with and without CAS
  time frame: The full analysis will be performed at the end of the sample collection. One intermediate analysis is scheduled when half of the samples are collected (one year and two years)
  description: The metabolites being studied include 4 bile acids and their derivatives (Cholic, Chenodeoxycholic, Deoxycholic and Lithocholic acid)
  measure: Diversity of bacteria families in men and women
  time frame: The sample will be collected at the time of inclusion (with a margin of two additional days depending on the patient's ability to pass stools). The analysis will be performed at the end of the sample collection (an average of 2 years)
  description: Primary endpoint: The primary endpoint is the evaluation (16S rRNA sequencing) of the species richness using alpha diversity parameters such as the Shannon and Simpson index and diversity between samples using beta diversity with Bray-Curtis dissimilarity approach.
  measure: Prevalence of bacterial families or species in the microbiota of patients with CAS over the course of time and disease progression.
  time frame: The sample will be collected at the time of inclusion (with a margin of two additional days depending on the patient's ability to pass stools). The analysis will be performed at the end of each year of follow up (an average of 2 years)
  description: Primary endpoint: The primary endpoint is the evaluation (16S rRNA sequencing) of the species richness using alpha diversity parameters such as the Shannon and Simpson index and diversity between samples using beta diversity with Bray-Curtis dissimilarity approach.
  measure: Prevalence of bacterial families or species in the microbiota of men versus women with CAS over the course of time and disease progression.
  time frame: The sample will be collected at the time of inclusion (with a margin of two additional days depending on the patient's ability to pass stools). The analysis will be performed at the end of each year of follow up (an average of 2 years)
  description: Primary endpoint: The primary endpoint is the evaluation (16S rRNA sequencing) of the species richness using alpha diversity parameters such as the Shannon and Simpson index and diversity between samples using beta diversity with Bray-Curtis dissimilarity approach.
  arm group label: Calcified Aortic Stenosis
  description: Patients with calcified aortic valve or aortic stenosis will be enrolled Stool, blood samples and aortic valve of operated patients will be retrieved to evaluate the composition of the gut microbiota and its metabolites A follow up is planned for patients with no intervention on the aortic valve to assess the evolution of the aortic stenosis and the change in the gut microbiota.
  arm group label: Control
  description: Patients without calcified aortic valve will be enrolled Stool and blood samples will be retrieved to evaluate the composition of the gut microbiota and its metabolites No follow up is scheduled.
  intervention type: Other
  intervention name: No intervention
  description: No intervention
  arm group label: Calcified Aortic Stenosis
  arm group label: Control
  Stool, blood sample, aortic valve
  study pop: 
  sampling method: Non-Probability Sample
  criteria: 
  gender: All
  minimum age: 18 Years
  maximum age: 90 Years
  healthy volunteers: No
  last name: Caroline Nguyen, MD
  role: Principal Investigator
  affiliation: Insel Gruppe AG
  last name: Caroline Nguyen, MD
  phone: +41316325000
  email: caroline.chong-nguyen@insel.ch
  citation: Kocyigit D, Tokgozoglu L, Gurses KM, Stahlman M, Boren J, Soyal MFT, Canpinar H, Guc D, Saglam Ayhan A, Hazirolan T, Ozer N. Association of dietary and gut microbiota-related metabolites with calcific aortic stenosis. Acta Cardiol. 2021 Jul;76(5):544-552. doi: 10.1080/00015385.2020.1853968. Epub 2020 Dec 18.
  PMID: 33334254
  citation: Liu Z, Li J, Liu H, Tang Y, Zhan Q, Lai W, Ao L, Meng X, Ren H, Xu D, Zeng Q. The intestinal microbiota associated with cardiac valve calcification differs from that of coronary artery disease. Atherosclerosis. 2019 May;284:121-128. doi: 10.1016/j.atherosclerosis.2018.11.038. Epub 2018 Dec 4.
  PMID: 30897381
  citation: Agus A, Planchais J, Sokol H. Gut Microbiota Regulation of Tryptophan Metabolism in Health and Disease. Cell Host Microbe. 2018 Jun 13;23(6):716-724. doi: 10.1016/j.chom.2018.05.003.
  PMID: 29902437
  citation: Shan Y, Pellikka PA. Aortic stenosis in women. Heart. 2020 Jul;106(13):970-976. doi: 10.1136/heartjnl-2019-315407. Epub 2020 Mar 22.
  PMID: 32201373
  citation: Morvan M, Arangalage D, Franck G, Perez F, Cattan-Levy L, Codogno I, Jacob-Lenet MP, Deschildre C, Choqueux C, Even G, Michel JB, Back M, Messika-Zeitoun D, Nicoletti A, Caligiuri G, Laschet J. Relationship of Iron Deposition to Calcium Deposition in Human Aortic Valve Leaflets. J Am Coll Cardiol. 2019 Mar 12;73(9):1043-1054. doi: 10.1016/j.jacc.2018.12.042.
  PMID: 30846099
  citation: Yilmaz B, Fuhrer T, Morgenthaler D, Krupka N, Wang D, Spari D, Candinas D, Misselwitz B, Beldi G, Sauer U, Macpherson AJ. Plasticity of the adult human small intestinal stoma microbiota. Cell Host Microbe. 2022 Dec 14;30(12):1773-1787.e6. doi: 10.1016/j.chom.2022.10.002. Epub 2022 Oct 31.
  PMID: 36318918
  responsible party type: Sponsor
  mesh term: Aortic Valve Stenosis
  mesh term: Constriction, Pathologic
  sharing ipd: No