Fedja Farowski1, Philipp Solbach2, Anastasia Tsakmaklis1, Susanne Brodesser3, M Rebeca Cruz Aguilar4, Oliver A Cornely5, Katja Dettmer6, Paul G Higgins7, Sebastian Suerbaum8, Nathalie Jazmati9, Peter J Oefner6, Maria J G T Vehreschild10. 1. Department I of Internal Medicine, University Hospital of Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Germany. 2. Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology, Hannover, Germany; Hannover Medical School, Institute of Medical Microbiology and Hospital Epidemiology, Hannover, Germany; German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Germany. 3. Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Germany. 4. Department I of Internal Medicine, University Hospital of Cologne, Germany. 5. Department I of Internal Medicine, University Hospital of Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Germany. 6. Institute of Functional Genomics, University of Regensburg, Germany. 7. Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Germany. 8. Hannover Medical School, Institute of Medical Microbiology and Hospital Epidemiology, Hannover, Germany; German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Germany; Chair of Medical Microbiology and Hospital Epidemiology, Max von Pettenkofer Institute, Faculty of Medicine, LMU Munich, Germany; German Center for Infection Research (DZIF), Partner Site Munich, Germany. 9. German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Germany; Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Germany. 10. Department I of Internal Medicine, University Hospital of Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Germany. Electronic address: maria.vehreschild@uk-koeln.de.
Abstract
BACKGROUND & AIMS: Faecal microbiota transplantation (FMT) has proven high clinical efficacy in the management of recurrent Clostridioides difficile infection (rCDI) with cure rates of over 80% after a single treatment. Nevertheless, the reasons for failure in the remaining 20% remain elusive. The aim of the present study was to investigate different potential predictors of response to FMT. METHODS: Faecal specimens of sixteen patients undergoing FMT for rCDI, as well as samples from the respective donors were collected and analyzed by 16S rRNA gene profiling, bile acid-inducible (baiCD) gene specific qPCR, and liquid chromatography tandem-mass spectrometry (LC-MS/MS) to quantify the concentrations of primary and secondary bile acids. RESULTS: Using the faecal concentration of the secondary bile acid lithocholic acid (LCA)within the patient specimens, we were able to predict response to FMT (accuracy 95.2%, sensitivity 100%, specificity 90.9%). By combining the faecal LCA concentration with the urinary pCS concentration, an accuracy of 100% was achieved. CONCLUSION: LCA appears to be a promising marker candidate for prediction of clinical response to FMT. Other makers, such as urinary concentration of pCS, but not 3-IS, might be used to improve accuracy of prediction. Further studies are warranted to validate these candidate markers.
BACKGROUND & AIMS: Faecal microbiota transplantation (FMT) has proven high clinical efficacy in the management of recurrent Clostridioides difficile infection (rCDI) with cure rates of over 80% after a single treatment. Nevertheless, the reasons for failure in the remaining 20% remain elusive. The aim of the present study was to investigate different potential predictors of response to FMT. METHODS: Faecal specimens of sixteen patients undergoing FMT for rCDI, as well as samples from the respective donors were collected and analyzed by 16S rRNA gene profiling, bile acid-inducible (baiCD) gene specific qPCR, and liquid chromatography tandem-mass spectrometry (LC-MS/MS) to quantify the concentrations of primary and secondary bile acids. RESULTS: Using the faecal concentration of the secondary bile acidlithocholic acid (LCA)within the patient specimens, we were able to predict response to FMT (accuracy 95.2%, sensitivity 100%, specificity 90.9%). By combining the faecal LCA concentration with the urinary pCS concentration, an accuracy of 100% was achieved. CONCLUSION: LCA appears to be a promising marker candidate for prediction of clinical response to FMT. Other makers, such as urinary concentration of pCS, but not 3-IS, might be used to improve accuracy of prediction. Further studies are warranted to validate these candidate markers.
Authors: Andreas Stallmach; Arndt Steube; Philip Grunert; Michael Hartmann; Lena M Biehl; Maria J G T Vehreschild Journal: Dtsch Arztebl Int Date: 2020-01-17 Impact factor: 5.594