Fresh, Frozen or Lyophilized Fecal Microbiota Transplantation for Multiple Recurrent C. Difficile Associated Diarrhea

The University of Texas System (UT)

Status and phase: Completed; Phase 2; Phase 1

Conditions: Recurrent C. Difficile Associated Diarrhea

Treatments: Biological: Fecal Microbiota

Study type: Interventional

Funder types: Other

Identifiers

NCT02318992

HSC-SPH-13-0119

Details and patient eligibility

About

The objective of the study is to investigate the efficacy of fresh, frozen or lyophilized fecal microbiota transplantation (FMT) via colonoscopy in patients with recurrent C. difficile associated diarrhea (RCDAD). Frozen, lyophilized or fresh fecal microbiota transplantation (FMT) inoculum will be generated from well-screened healthy volunteer donors of ≥150 gram/sample. Delivery of FMT will be performed colonoscopically. Fecal samples from donors and recipients will be saved for later metagenomic studies to characterize the microbiome of the gut in patients before and after FMT.

Enrollment: 79 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

Recipients

• Male and female patients ≥ 18 years of age
• Sexually active male and female patients of child-bearing potential must agree to use an effective method of birth control during the treatment and follow-up period
• Female patients of child-bearing potential must have a negative pregnancy test in the 72 hours before the procedure
• Required to sign an informed consent form
• Deemed likely to survive for ≥ 3 months after enrolment
• Diagnosis of ≥ 3 recurrent CDAD (RCDAD) bouts in outpatients or ≥ 2 bouts of CDAD in an inpatient without other explanation for diarrhea and with ≥ 2 positive fecal tests for C. difficile toxin
• Referred by subjects attending physician who will provide non-transplant care for the subject and follow up at 1, 7, 14, 30 days after FMT
• Received at least one course of adequate antibiotic therapy for CDAD (≥ 10 days of vancomycin at a dose of ≥125 mg four times per day, ≥ 10 days of metronidazole at a dose of 500mg three times per day or fidaxomixin 200mg twice a day for 10 days
• Anti-Clostridium difficile infection (CDI) antibiotic treatment stopped 2-4 days before the transplantation

Donors

• Able to provide and sign informed consent
• Able to complete and sign the donor questionnaire
• Able to adhere to fecal transplantation stool collection requirements

Exclusion criteria

Recipients

• Patients with neutropenia with absolute neutrophil count <0.5 x 109/L
• Evidence of toxic megacolon or gastrointestinal perforation on abdominal x-ray
• Peripheral white blood cell count > 15.0 x 109/L AND temperature > 38.0 °C
• Active gastroenteritis due to Salmonella, Shigella, E. coli 0157:H7, Yersinia or Campylobacter, and Norovirus
• Presence of colostomy
• Unable to tolerate human biotherapy (HBT) for any reason
• Requiring systemic antibiotic therapy for more than 7 days
• Actively taking Saccharomyces boulardii or other probiotic
• Severe underlying disease such that the patient is not expected to survive for one or more years or unstable medical condition requiring daily change in treatments
• Prolonged compromised immunity due to cytotoxic chemotherapy or HIV infection

Donors

• Test positive for any of variables
• History of any type of active cancer or autoimmune disease
• History of risk factors for acquisition of HIV, syphilis, Hepatitis B, Hepatitis C, prion or any neurological disease as determined by the donor questionnaire
• History of gastrointestinal disorder, e.g., inflammatory bowel disease, irritable bowel syndrome, chronic constipation or diarrhea
• Antibiotic use or any systemic immunosuppressive agents in the 3 months prior to stool donation
• Receipt of any type of live vaccine within 3 months prior to stool donation
• Current or previous medical or psychosocial condition
• Body mass index over 30

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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79 participants in 3 patient groups

Fecal Microbiota_Fresh

Active Comparator group

Description:

Donor stool (greater than 150 grams) was collected \<4 hours prior to the procedure and then mixed in a homogenizer with 1500 milliliters (mL) (1:10 dilution) sterilized 0.9% sodium chloride (NaCl) in a large sterilized suction canister until a smooth consistency was reached. The suspension was filtered using a coffee filter twice. The microbiota suspension (250mL) was used within 2 hours of preparation (Fresh).

Treatment:

Biological: Fecal Microbiota

Fecal Microbiota_Frozen

Active Comparator group

Description:

Donor stool (greater than 150 grams) was collected \<4 hours prior to the procedure and then mixed in a homogenizer with 1500 milliliters (mL) (1:10 dilution) sterilized 0.9% NaCl in a large sterilized suction canister until a smooth consistency was reached. The suspension was filtered using a coffee filter twice. The microbiota suspension (250mL) was kept at -80 degrees Celsius (C) freezer labeled with identity (ID) and expiration date which was 6 months after preparation day (Frozen).

Treatment:

Biological: Fecal Microbiota

Fecal Microbiota_Lyophilized

Active Comparator group

Description:

Donor stool (greater than 150 grams) was collected \<4 hours prior to the procedure and then mixed in a homogenizer with 1500 milliliters (mL) (1:10 dilution) sterilized 0.9% NaCl in a large sterilized suction canister until a smooth consistency was reached. The suspension was filtered using a coffee filter twice. The microbiota suspension (250mL) was starting lyophilization process within 30 minutes after completion of stool filtration (Lyophilized). Lyophilized microbiota products were kept at 4 degrees celsius (C) and were used within 6 months after preparation day.

Treatment:

Biological: Fecal Microbiota