Fecal Transplant Could Be Accomplished in Pill Form

Gel caps containing concentrated fecal microbes help stop recurrent Clostridium difficile infection and they are well tolerated by recipients, according to a new study.

Researchers at the University of Calgary (Alberta, Canada) conducted a study to examine the effectiveness of fecal transplant administered through gel caps in a population of 32 patients who were unable to tolerate a jejunal catheter and/or were unable to retain a fecal enema to treat their recurrent C. difficile infection. All participants had more than three episodes of infection, were referred for fecal microbe transplant therapy, and had their infection controlled with oral vancomycin.

The capsules were assembled the day of the transplant. Donors provided roughly 100 grams of feces, which was suspended in 600–800 mL of saline, and then centrifuged, decanted, and resuspended to allow for micropipetting into 0.47 mL capsules, which were then each overcapsuled with #0- and #00-sized gelatin capsules. The feces were collected mostly from related donors, and both donors and recipients were tested for blood-borne infections, parasites, and other invasive disease prior to transplant.

The patients discontinued vancomycin treatment the day before the procedure and received a colonic cleansing the morning of the procedure. They received 24–34 fecal microbe capsules on an empty stomach, and were followed-up at 1 week, 1 month, 3 months, and 6 months after therapy, with additional follow-ups occurring up to 3 years. The results showed that a single dose of fecal microbes delivered through the gel capsules resolved all but one of the recurrent infections, with no instances of vomiting after capsule ingestion. The study was presented at IDWeek 2013, held during October 2013 in San Francisco (CA, USA).

“Your gut flora is part of your identity; anti-C. difficile treatments don't necessarily wipe out the bug, but rather reestablish microbiome diversity. The reason recurrence occurs in many patients who receive antibiotic treatments is that the antibiotics may scramble that diversity,” said lead author and study presenter Thomas Louie, MD. “The future is to know which bacteria are the kingpins of gut flora, with which healthcare professionals or possibly even pharmaceutical companies can make true probiotic pills.”

C. difficile is a bacterium that causes infection leading to diarrhea and is most often related to antibiotic use during medical treatment. It is especially dangerous for patients with weakened immune systems such as the elderly and those with inflammatory bowel disease (IBD). Treatment include antibiotics, probiotics, toxin-binding medications, active vaccination, intravenous immunoglobulin, and fecal microbiota transplant, for which the evidence has been mounting as an effective rescue for recurrent and refractory cases of C. difficile associated diarrhea.

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