Monday, May 21, 2018

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)

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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!

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