Date Published: November 2, 2018
Publisher: Public Library of Science
Author(s): Zhi-Dong Jiang, Robert R. Jenq, Nadim J. Ajami, Joseph F. Petrosino, Ashley A. Alexander, Shi Ke, Tehseen Iqbal, Andrew W. DuPont, Kenneth Muldrew, Yushu Shi, Christine Peterson, Kim-Anh Do, Herbert L. DuPont, John Green.
Fecal microbiota transplantation (FMT) via colonoscopy or enema has become a commonly used treatment of recurrent C. difficile infection (CDI).
To compare the safety and preliminary efficacy of orally administered lyophilized microbiota product compared with frozen product by enema.
In a single center, adults with ≥ 3 episodes of recurrent CDI were randomized to receive encapsulated lyophilized fecal microbiota from 100–200 g of donor feces (n = 31) or frozen FMT from 100 g of donor feces (n = 34) by enema. Safety during the three months post FMT was the primary study objective. Prevention of CDI recurrence during the 60 days after FMT was a secondary objective. Fecal microbiome changes were examined in first 39 subjects studied.
Adverse experiences were commonly seen in equal frequency in both groups and did not appear to relate to the route of delivery of FMT. CDI recurrence was prevented in 26 of 31 (84%) subjects randomized to capsules and in 30 of 34 (88%) receiving FMT by enema (p = 0.76). Both products normalized fecal microbiota diversity while the lyophilized orally administered product was less effective in repleting Bacteroidia and Verrucomicrobia classes compared to frozen product via enema.
The route of delivery, oral or rectal, did not influence adverse experiences in FMT. In preliminary evaluation, both routes appeared to show equivalent efficacy, although the dose may need to be higher for lyophilized product. Spore-forming bacteria appear to be the most important engrafting organisms in FMT by the oral route using lyophilized product.
Fecal microbiota transplantation (FMT) has become widely used for the treatment of patients with ≥3 bouts of Clostridium difficile infection (CDI)  with durable response for at least 90 days . In most current settings, fresh or frozen fecal microbiota product have shown equal efficacy in the treatment of recurrent CDI. Frozen product has become preferred where available to fresh product because of advantages of convenience [3–5].
We have previously shown that freeze-drying fecal microbiota, without a cryoprotectant provided somewhat reduced efficacy compared with fresh microbiota, with frozen product in between, when administered by colonoscopy to subjects with recurrent CDI .