P782 A new compatibility test for donor selection for faecal microbiota transplantation in ulcerative colitis

Fecal microbiota transplantation (FMT) is an effective procedure against Clostridioides difficile infection (CDI), with promising but still suboptimal performance in other diseases, such as ulcerative colitis (UC). The recipient’s mucosal immune response against the donor’s microbiota could be relevant factor in the effectiveness of FMT. Our aim was to design and validate an individualized immune-based test to optimize the fecal donor selection for FMT. First, we performed an in vitro validation of the test by co-culturing lymphocytes obtained from the small intestine mucosa of organ donor cadavers (n=7) and microbe-associated molecular patterns (MAMPs) obtained from the feces of 19 healthy donors. The inflammatory response was determined by interleukin supernatant quantification using the Cytometric Bead Array kit (B&D). We then conducted a clinical pilot study with 4 patients with UC using immunocompetent cells extracted from rectal biopsies and MAMPs from 3 donor candidates. We employed the test results to guide donor selection for FMT, which was performed by colonoscopy followed by 4 booster instillations by enema in the following month. The microbiome engraftment was assessed by 16S rDNA massive sequencing in feces, and the patients were clinically followed-up for 16 weeks. The results demonstrated that IL-6, IL-8, and IL-1ß were the most variable markers, although we observed a general tolerance to the microbial insults. Clinical and colonoscopy remission of the patients with UC was not achieved after 16 weeks, although FMT provoked enrichment of the Bacteroidota phylum and Prevotella genus, with a decrease in the Actinobacteriota phylum and Agathobacter genus. The most relevant result was the lack of Akkermansia engraftment in UC. In summary, the clinical success of FMT in patients with UC appears not to be influenced by donor selection based on the explored recipient’s local immunological response to FMT, suggesting that this approach would not be valid for FMT fecal donor optimization in such patients.

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P328 Faecal microbiota transplantation as treatment for recurrent Clostridiodes difficile infection in patients with inflammatory bowel disease: Experiences of the Netherlands donor faeces bank

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.457 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S317-S318

Author(s):

E Van Lingen ◽

A E van der Meulen-de Jong ◽

K E W Vendrik ◽

E J Kuijper ◽

E M Terveer ◽

...

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

The Netherlands ◽

Bowel Disease ◽

Working Group ◽

Indeterminate Colitis ◽

Cure Rate ◽

Faecal Microbiota ◽

Faecal Microbiota Transplantation ◽

Inflammatory Bowel

Abstract Background In recent years Faecal Microbiota Transplantation (FMT) is effectively implemented as an approved treatment approach of refractory Clostridiodes difficile infection (rCDI). In patients with inflammatory bowel disease (IBD) the prevalence of co-infection with CDI is higher than in the general population due to the use of immunosuppressive medication and dysbiosis of the bacteria in the colon. Just a small percentage of IBD patients do have an active CDI infection, not to be confused with carriership. Here we report the treatment course and efficacy of FMT provided by the Netherlands Donor Faeces Bank (NDFB) for IBD patients with rCDI. Methods The NDFB was founded to facilitate FMT by providing ready to use donor faeces suspensions for treatment of patients with rCDI in hospitals throughout The Netherlands. A request for FMT is evaluated by the working group (specialists in the fields of Medical Microbiology, Gastroenterology, and Infectious Diseases) to assess the indication of FMT and to formulate a treatment advice for each individual patient taking the comorbidity into account. Prior to FMT, all patients were pre-treated with vancomycin 250 mg for at least 4 days and bowel lavage. In patients with ulcerative colitis as comorbidity, prednisone was added when there was an IBD flare simultaneous. The results of FMT were monitored by prospective collection of outcome data by the NDFB. Results Since the start of NDFB in March 2016 until August 2019, 186 FMT requests to treat 176 (r)CDI patients were reviewed within the NDFB working group including 26 patients with rCDI and IBD. In total, 129 patients (of which 14 suffered from IBD) were treated with 143 FMTs for CDI with a cure rate of 89.9% after a single FMT (116/129). FMT was deemed not suitable in 12 of 26 patients with IBD because patients had C. Difficile carriership instead of an active CDI infection. Fourteen IBD patients were treated with FMT (9 ulcerative colitis, 2 Crohn’s disease and 2 indeterminate colitis). 3/14 patients suffered from rCDI with an active episode of IBD. Of the 14 IBD patients treated with FMT, only one patient developed a relapse of a CDI infection within 2-months (total cure rate 92%). This cure rate does not differ from CDI patients without IBD. Conclusion In IBD patients with rCDI, FMT is equally effective compared with other patients with rCDI. In case of concurrent activity of IBD, pre-treatment with prednisolone in combination with vancomycin appears to be effective.

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