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

By E. Petrof, G. Gloor, S. Vanner, S. Weese, David Carter, M. Daigneault, Eric Michael Brown, Kathleen Schroeter, Emma Allen-Vercoe. Microbiome, 2013

710 citations recorded by the source corpus.

BackgroundFecal 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.ResultsBoth 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.ConclusionThis 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.Trial registrationClinical trial registration number: CinicalTrials.gov NCT01372943

Subfields: Food Science, Gastroenterology, Infectious Diseases

View Paper: https://www.semanticscholar.org/paper/de01341acba9887bcbd623e1dce66ecd152e2d58

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Food Science

1. Curtis Huttenhower
2. Nicola Segata
3. Xochitl C. Morgan
4. I. Zilber-Rosenberg
5. Eugene Rosenberg
6. W. Garrett

In Gastroenterology

1. I. Zilber-Rosenberg
2. Curtis Huttenhower
3. Eugene Rosenberg

In Infectious Diseases

1. Curtis Huttenhower
2. I. Zilber-Rosenberg
3. Eugene Rosenberg
4. Xochitl C. Morgan
5. W. Garrett
6. Nicola Segata

Citations in the corpus

• The Hologenome Concept: Human, Animal and Plant Microbiota (2014, background): “…used to treat allergy (Bjorksten 2009), obesity (Turnbaugh et al. 2009), autism (Finegold et al. 2010), inflammatory bowel disease (Jonkers et al. 2012), diabetes (Qin et al. 2012; Vrieze et al. 2012), celiac disease (Ray 2012), and severe diarrhea (Khoruts and Sadowsky 2011; Petrof et al. 2013).”
• Computational meta'omics for microbial community studies (2013, background): “Recent clinical translation of in vitro communities has demonstrated success as a treatment for chronic C. difficile (Petrof et al , 2013).”