Randomised clinical trial: faecal microbiota transplantation for recurrent Clostridum difficile infection – fresh, or frozen, or lyophilised microbiota from a small pool of healthy donors delivered by colonoscopy. Issue 7 (21st February 2017)

• Record Type: Journal Article
• Authors: Jiang, Z. D.; Ajami, N. J.; Petrosino, J. F.; Jun, G.; Hanis, C. L.; Shah, M.; Hochman, L.; Ankoma‐Sey, V.; DuPont, A. W.; Wong, M. C.; Alexander, A.; Ke, S.; DuPont, H. L.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 45:Issue 7(2017)
• Page Start: 899
• Page End: 908
• Publication Date: 2017-02-21
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.13969
• Languages: English
• ISSNs: 0269-2813

Abstract

Abstract : Summary: Background: Faecal microbiota transplantation (FMT) has become routine in managing recurrent C. difficile infection (CDI) refractory to antibiotics. Aim: To compare clinical response and improvements in colonic microbiota diversity in subjects with recurrent CDI using different donor product. Methods: Seventy‐two subjects with ≥3 bouts of CDI were randomised in a double‐blind study to receive fresh, frozen or lyophilised FMT product via colonoscopy from 50 g of stool per treatment from eight healthy donors. Recipients provided stools pre‐ and 7, 14 and 30 days post‐FMT for C. difficile toxin and, in a subset, microbiome composition by 16S rRNA gene profiling. Results: Overall resolution of CDI was 87% during 2 months of follow‐up after FMT. Stool samples before FMT had significantly decreased bacterial diversity with a high proportion of Proteobacteria compared to donors. Cure rates were highest for the group receiving fresh product seen in 25/25 (100%), lowest for the lyophilised product 16/23 (78%; P = 0.022 vs. fresh and 0.255 vs. frozen) and intermediate for frozen product 20/24 ( P = 0.233 vs. fresh). Microbial diversity was reconstituted by day 7 in the subjects receiving fresh or frozen product. Improvement in diversity was seen by day 7 in those randomised to lyophilised material with reconstitution by 30 days. Conclusions: Comparative efficacy in faecal microbiota transplantation was observed in subjects receiving fresh or frozen faecal product from the same donors. The lyophilised product had a slightly lowered efficacy compared with fresh product, but it resembled other treatments in microbial restoration 1 month after faecal microbiota transplantation.