Introduction. Fecal bacteriotherapy or microbiota transplantation is becoming very effective treatment method for Clostridium difficile infection [Rohlke and ...
Fecal Bacteriotherapy: Treatment Strategy for Clostridium difficile infection A report by
Huseyin Kilili 4th Year Students and Student Assistant, Program of Molecular Biology and Genetics, Department of Biological Sciences, Eastern Mediterranean University, Famagusta, North Cyprus.
Introduction Fecal bacteriotherapy or microbiota transplantation is becoming very effective treatment method for Clostridium difficile infection [Rohlke and Stollman, 2012].This method did not standardised yet,but success cure rate is very high, around 92% , in contrast to conventional treatment strategies [Zainah and Silverman, 2012]. Fecal bacteriotherapy can be used in different diseases as a treatment such as metabolic syndromes, neurological disorders and gastrointestinal diseases [Kellermayer, 2013].
Clostridium difficile Infection Clostridium difficile is an anaerobe, gram-positive and toxin producing bacterium which can cause antibiotic associated diarrhae [Lübbert et al. 2013; Lawley et al. 2012; Deshpande 2014]. Clostridium difficile can found in water, soil, air, animal feces and food products [Mayo Clinic, 2013]. Generally, people do not have this bacteria in their microbiome. However, when they touch area or consume foods that have Clostridium difficile, than they may infected with this bacteria. This bacteria laces in intestines of people after infection but after infection person is still healthy. Because, it is an antibiotic associated diarrhea. There are too many ‘good and helpful’ bacteria in microflora of intestines. 1 of 6
This helpful bacterias kill when people get an antibiotics. Therefore, Clostridium difficile can fine a place to growth and replicates it self faster [Mayo Clinic, 2013]. Some medical equipments are needed to observe this bacteria inside the intestine such as endoscopy, colonoscopy or surgery [Lübbert et al. 2014]. Also, some toxin assay are exist to check fecal if it has Clostridium difficile or not [Rohlke and Stollman, 2012].
Conventional Therapy Versus Non-conventional Therapy Antibiotics, such as metronidazole and vancomycin are used in conventional treatment. Probiotic treatment is another conventional therapy method that helps to cure Clostridium difficile infection. Patients are taking bacterias as a pills in this treatment strategy to cover the helpful bacterias which are dead because of the antibiotics [Rohlke and Stollman, 2012; Kellermayer, 2013]. Non-conventional therapy is fecal bacteriotherapy or fecal microbiota transplantation. Researchers developed fecal transplantation to replace disrupted microflora with natural intestine microflora which is taken from another health people [Rohlke and Stollman, 2012; Kellermayer, 2013]. In 4th century fecal bacteriotherapy have been used in Chinese medicine to cure different disorders [Lübbert et al. 2014]. Average success rate of fecal therapy for Clostridium difficile is 92% according to studies [Zainah and Silverman, 2012]. Transplantation method is more sufficient and effective than conventional treatment method [Gough et al. 2011].
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Basic Steps of Transplantation Firstly, patient’s fecal should be screening for Clostridium difficile bacteria with Toxic Assays. If bacteria toxins are exist, donor founded to take natural microflora from donor and transplant it into patient intestine. Donor should be screening also for parasites and ova, other bacterias, Clostridium difficile toxin, HIV, Hepatitis A, Hepatitis B, Hepatitis C and some other things. Transplantation can be done with either surgery or colonoscopy. Surgery is used in severe patients [Rohlke and Stollman, 2012].
Genetic Method of Transplantation Genes and their sequences are known for Clostridium difficile bacteria. However, genetic method of transplantation is still studying by researchers in animal models such as Mus musculus and Macaca mulatta [Lawley et al. 2012; Ferrechia and Hobbs, 2013]. Because, of genetic variant and different strains of Clostridium difficile bacteria [Lawley et al. 2012]. First, we need to sequence all possible variations, collect them in a bank than start genetic treating methods such as RNAi or genetic detection method such as PCR and microarrays. There is simple protocol to collect all and study with all of variations. Extraction of gDNA from stool can be done with E.Z.N.A. Stool DNA Kit and V6 rRNA regions amplified via Polymerase Chain Reaction (PCR). Then, this region sequenced using Ion Torrent platform and this sequences should collect in a database [Petrof et al. 2013]. 3 of 6
Conclusions Using conventional treatment strategy, metronidazole - vancomycin probiotics, is not always successful for Clostridium difficile infection. Studies showed that using Fecal Bacteriotherapy gives us more than 90% successful result for treatment. Making more experiments and studies we can increase this rate. Also, genetic method for this treatment will help to increase this rate.
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KELLERMAYER, R. Prospects and challenges for intestinal microbiome therapy in pediatric gastrointestinal disorders. World J Gastrointest Pathophysiol, v. 4, n. 4, p. 91-3, Nov 2013. ISSN 2150-5330. Available at: < http://www.ncbi.nlm.nih.gov/pubmed/24244876 >. LAWLEY, T. D. et al. Targeted restoration of the intestinal microbiota with a simple, defined bacteriotherapy resolves relapsing Clostridium difficile disease in mice. PLoS Pathog, v. 8, n. 10, p. e1002995, 2012. ISSN 1553-7374. Available at: < http:// www.ncbi.nlm.nih.gov/pubmed/23133377 >. LEWIS, R. Human Genetics:Concepts and Applications. New York: McGraw-Hill 2012. LÜBBERT, C.; JOHN, E.; VON MÜLLER, L. Clostridium difficile infection. Dtsch Arztebl Int, v. 111, n. 43, p. 723-31, Oct 2014. ISSN 1866-0452. Available at: < http://www.ncbi.nlm.nih.gov/pubmed/25404529 >. MUNRO, M. ‘C. diff’ detectives track a murderous global microbe – to Canada: PostMedia 2013. PETROF, E. O. et al. Stool substitute transplant therapy for the eradication of Clostridium difficile infection: 'RePOOPulating' the gut. Microbiome, v. 1, n. 1, p. 3, 2013. ISSN 2049-2618. Available at: < http:// www.ncbi.nlm.nih.gov/pubmed/24467987 >. ROHLKE, F.; STOLLMAN, N. Fecal microbiota transplantation in relapsing Clostridium difficile infection. Therap Adv Gastroenterol, v. 5, n. 6, p. 403-20, Nov 2012. ISSN 1756-2848. Available at: < http:// www.ncbi.nlm.nih.gov/pubmed/23152734 >.
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RUSSELL, G. et al. Fecal bacteriotherapy for relapsing Clostridium difficile infection in a child: a proposed treatment protocol. Pediatrics, v. 126, n. 1, p. e239-42, Jul 2010a. ISSN 1098-4275. Available at: < http:// www.ncbi.nlm.nih.gov/pubmed/20547640 >. STAFF, M. C. C. difficile Infection. 2013. Avaialble at: < http://www.mayoclinic.org/diseases-conditions/cdifficile/basics/causes/con-20029664 >. Accessed on: 12/25/2014. ZAINAH, H.; SILVERMAN, A. Fecal Bacteriotherapy: A Case Report in an Immunosuppressed Patient with Ulcerative Colitis and Recurrent Clostridium difficile Infection. Case Rep Infect Dis, v. 2012, p. 810943, 2012. ISSN 2090-6633. Available at: < http:// www.ncbi.nlm.nih.gov/pubmed/22593832 >.
Hüseyin Kilili is a 4th year student in Molecular Biology and Genetics Program, Department of Biological Sciences, Faculty of Arts and Sciences, Eastern Mediterranean University (EMU), Famagusta, North Cyprus. He is also working in the department as a Student Assistant.
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