BacterioFiles 339 - Medical Microbiota Measurement

Clostridium difficile bacteria

This episode: Fecal microbiota transplants work just as well when taken in pill form as when delivered through a tube!

Download Episode (10.5 MB, 11.5 minutes)

Show notes:
Microbe of the episode: Halobacterium halobium

News item

Journal Paper:
Kao D, Roach B, Silva M, Beck P, Rioux K, Kaplan GG, Chang H-J, Coward S, Goodman KJ, Xu H, Madsen K, Mason A, Wong GK-S, Jovel J, Patterson J, Louie T. 2017. Effect of Oral Capsule- vs Colonoscopy-Delivered Fecal Microbiota Transplantation on Recurrent Clostridium difficile Infection: A Randomized Clinical Trial. J Am Med Assoc 318:1985–1993.

Other interesting stories:

Protein that can form prions important for protecting mice from influenza (paper)

Figuring out how bacteria in fruit flies kill only males

Healthy skin microbes could help treat eczema

Good gut microbe is very comfortable with immune system

Archaea in bogs could be good microbes for plants too (paper)

Post questions or comments here or email to bacteriofiles@gmail.com. Thanks for listening!

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Episode outline:

• Background: C. diff, or Clostridium difficile
• Dangerous gut infection
• Antibiotics kill off microbes not resistant
• Then resistant pathogen takes over and throws into chaos
• Some expensive targeted therapies like antibody, but not super effective
• Most effective thing so far: fecal microbiota transplant
• Take microbes from healthy gut and put into infected
• Reestablishes community and kicks out invader
• Balance restored
• Trick is, giving someone poop is unappealing
• Could deliver by tube from either end, but has risks and inconvenience
• What’s new: Now, scientists publishing in the Journal of the American Medical Association have tested out how effective microbe transplants can be when given in pill form!
• Methods: Recruited patients with recurrent C.diff
• Without other complications like cancer, bowel surgery, etc
• Randomized and gave transplant by either pill or colonoscopy
• Too hard to blind, so not blinded
• Could give each colonoscopy and pills, with or without microbes? Prob not ethical 
• Took antibiotic and cleansing for colonoscopy
• Then either received 360mL of fecal slurry from healthy donors, or took 40 capsules (!)
• Tested for microbes, health questionnaires, rating of experience unpleasantness
• Results: both groups had ~93% cure
• So pills just as good
• 2 patients in each group had recurrence, but 2nd treatment cured
• Groups also improved similar amount in physical/emotional health questionnaires
• Both treatments helped increase gut microbe diversity
• But more rated pills as “not unpleasant” vs. colonoscopy, 66% vs. 44%
• Adverse events – one in each group died, but of heart failure/pneumonia seemingly unrelated to treatment
• Otherwise no infections or colonic perforation
• Minor events in 5% capsules vs. 12% colonoscopy
• Stuff like nausea, vomiting, fever, abdominal discomfort
• Did cost calc too: colonoscopy ~$900 US vs. ~$300 capsules
• Doesn’t include costs common to both kinds though
• Cost of procedures different in other countries (US vs. Canada)
• Summary: Fecal transplant in pill form just as good, cheaper, easier, more pleasant than colonoscopy
• Maybe a little safer
• Applications and implications: Good option for important treatment
• Better in some ways – less unpleasant, convenient, cheaper
• Colonoscopy has advantage of usual routine procedure – screening
• Some studies don’t show pills as effective
• Details of effective treatment need worked out conclusively
• Overall pretty good – no placebo, but not the point
• Not blinded, but blinding wouldn’t allow some comparisons (like unpleasantness)
• Fecal transplant keeps getting more a good option – microbial ecology applied!