Faeces a cure?

Faeces transplantation in Clostridium Difficile 

At this moment, the current treatment of Clostridium difficile is the antibiotic drug Vancomycin. The only problem with this drug is the low efficacy of it, resulting in a re-infection. The change of a C. difficile reinfection increases with 20 percent in patients who already had one recurrence. After two recurrences the chance increases up to 40%, this percentage even increases after more recurrences [1]. This phenomenon could be due to the fact that the use of vancomycin impairs the resistance to colonization, and so it facilitates recurrent infection [1]. 

FMT and its proven effectiveness
A study by van Nood et al. [2] looked into another solving strategy, namely duodenal infusion of donor faeces. As mentioned earlier changes of the microbiome can cause disease or several returns of a disease like Clostridium difficile. The idea behind the faeces transplantation is that the intestinal microbiome is, will be reset which leads to a normal balance of micro-organisms in the intestine. This means that there is less abundance of one specific micro-organism, like in this case Clostridium difficile. 

This open-label, randomized, controlled trial compared three treatments: A standard vancomycin regimen, a standard vancomycin regimen with bowel lavage and an infusion of donor faeces preceded by an abbreviated regimen of vancomycin and bowel lavage. 41 subjects (≥ 18 years) with a relapse of C. difficile after at least one course of adequate antibiotic therapy were enrolled. 16 subjects got the infusion, 13 subjects got the standard vancomycin treatment and 13 subjects were placed in the vancomycin regimen with bowel lavage. Van Nood et al. [2] found a resolution of Clostridium difficile in 81% of the patients in the faeces infusion group, 13 of them showed remission after the first infusion and 2 of them showed this after the second infusion. Only 4 of the 13 (31%) patients got cured in the standard vancomycin treatment and only 3 of the 13 (23%) showed remission in the combined group. This survey indicates a significantly more effective eradication of C. difficile with faeces infusion than the other treatments. There were also no significant differences in adverse events among the three groups. The only adverse effects of infusion would be diarrhoea, cramping and belching immediately after the transplantation. Luckily these symptoms resolved after three hours in all patients.

Van Nood et al. [2] also looked into the differences of the faecal microbiota between transplanted patients and the faecal donors. She obtained the faecal microbiota before transplantation and after transplantation in the transplantation group. Before transplantation there was a much larger difference in faecal microbiota than after transplantation between the donors and transplanted patients. Two weeks after the transplantation the faecal microbiota diversity level of the transplanted patients became even undistinguishable from the faecal microbiota of the donors. Besides this, the researchers observed quantitative changes in intestinal bacteria. In conclusion, the outcome of this research proves that the microbiome plays a major role in developing diseases and more frequent recurrences of a disease.

Smits, WK. Lyras, D. Lacy, B. Wilcox, M. Kuijper, E.J. Clostridium difficile infection. HHS Public Acces 2017 june 01. Available via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453186/pdf/nihms857742.pdf 

Further developments - NDFB (Nederlandse Donor Feces Bank)
The treatment of C. difficile with faeces transplantation has provided evidence for the importance of the microbiome. The NDFB is an initiative of doctors and researchers to carry out further research into FMT (fecal microbiota transplant) and the influence of the microbiome on certain conditions such as IBD and MS [3]. Furthermore the NDFB also provides the faecal treatment for C. difficile. Because the studies to other disorders are still ongoing or have to be set up, there is currently no possibility to use FMT for other disorders than C. difficile. 

                                                                                                                                                                                                                                                                                                                                     Written by Mirre Verstegen
                                                                                                                                                       Posted on 11 oct 2018

[1] Kelly, C. LaMont J. Clostridium difficile - More difficult than ever. In: The New England Journal of Medicine. N Engl J Med 2008; 359:1932-1940

[2] Nood, E. Vrieze, A. Nieuwendorp, M. Fuentes, S. Zoetendal, E. Vos, W. Visser, C. Kuijper, E. Bartelsman, J. Tijssen, J. Speelman, P. Dijkgraaf, M. Keller, J. Duodenal infusion of Donor Feces for Recurrent Clostridium Difficile. In: The new England Journal of Medicine. N Engl J Med 2013; 368:407-415

[3] NDFB. FMT voor clostridium difficile infecties. Available via: https://www.ndfb.nl/