Are spores the secret of the success of FMT in treating recurrent CDI?

Characteristic of the aimes strain of b anthracis is the smooth

I have been following the literature around the use of faecal microbiota transplantation (FMT) for the treatment of recurrent Clostridium difficile infection (CDI). FMT is spectacularly effective but rather crude – and may have some associated risks, not least the possibility of transmissing infectious organisms we have not yet discovered! There is also the issue of administration. Compared with recurrent CDI, a duodenal infusion (aka tube up the backside) isn’t so bad – but an oral delivery would be preferable. The ‘crapsule’ (oral FMT) has been tested and is effective, but it requires a large number of crapsules to reach the required dose. So, the search is on to distill the effective elements of FMT into a format that can be delivered more easily. Some work has been done on exploring various combinations of live bacteria – with variable success.

And so to today’s study: a clinical trial of bacterial spores to treat recurrent CDI, published in Journal of Infectious Diseases. The authors took stool specimens from healthy donors and extracted the spores. These were then used to treat 30 patients who had recurrent CDI, 29 (96.7%) of which resolved. This rate of resolution is higher than the landmark RCT of FMT for treating CDI.* The team also identified rapid diversification of the gut microbiota, which is consistent with addressing the root cause of the pathology of CDI.

This wasn’t an RCT (although one is underway), but the results are very promising indeed. Could it be that spores are the secret of the success of FMT in treating recurrent CDI?

* Sorry about the multitude of TLAs in this post!

Image: Public domain images.


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