Synthetic fecal transplants

Stool substitute transplant therapy for the eradication of Clostridium difficile infection: ‘RePOOPulating’ the gut

Abstract
Background
Fecal bacteriotherapy (‘stool transplant’) can be effective in treating recurrent Clostridium difficile infection, but concerns of donor infection transmission and patient acceptance limit its use. Here we describe the use of a stool substitute preparation, made from purified intestinal bacterial cultures derived from a single healthy donor, to treat recurrent C. difficile infection that had failed repeated standard antibiotics. Thirty-three isolates were recovered from a healthy donor stool sample. Two patients who had failed at least three courses of metronidazole or vancomycin underwent colonoscopy and the mixture was infused throughout the right and mid colon. Pre-treatment and post-treatment stool samples were analyzed by 16 S rRNA gene sequencing using the Ion Torrent platform.

Results
Both patients were infected with the hyper virulent C. difficile strain, ribotype 078. Following stool substitute treatment, each patient reverted to their normal bowel pattern within 2 to 3 days and remained symptom-free at 6 months. The analysis demonstrated that rRNA sequences found in the stool substitute were rare in the pre-treatment stool samples but constituted over 25% of the sequences up to 6 months after treatment.

Conclusion
This proof-of-principle study demonstrates that a stool substitute mixture comprising a multi-species community of bacteria is capable of curing antibiotic-resistant C. difficile colitis. This benefit correlates with major changes in stool microbial profile and these changes reflect isolates from the synthetic mixture.

It worked. This seems important: C. difficile infection is quite common in hospitalized patients, and fecal transplants have been successful. But, they must be treated like any other transplant in that the donor must be tested for HIV, hepatitis B and C, and others. With this synthetic transplant, doctors could have an off-the-shelf treatment available whenever needed. Costs could drop significantly.

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3 comments
Steve Parker, M.D. says January 10, 2013

If this bacterial therapy pans out, it should just be a matter of time before someone figures out how to put the bacterial into an oral pill that will dissolve and release the bacteria where needed. That would save the cost, risk, and hassle of colonoscopy.

-Steve

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eah says January 10, 2013

Of course when you first hear about this — as I did some time ago — it strikes you as disgusting. Then you realize it does make sense. Especially when it seems to work in cases where little else has or presumably would.

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The Best Probiotic - Rogue Health and Fitness says February 1, 2016

[…] of occasions. When doctors prescribe antibiotics, they’re concerned lest their patient get a Clostridium difficile infection, a serious side effect of oral antibiotics which in debilitated people can even be fatal. Hence […]

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