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Basman C, Ong C, Kansara T, Kassam Z, Wutawunashe C, Conroy J, Kodra A, Trost B, Mehla P, Pirelli L, Scheinerman J, Singh VP, Kliger CA. Utility of Multidetector Computed Tomographic Angiography as an Alternative to Transesophageal Echocardiogram for Preoperative Transcatheter Mitral Valve Repair Planning. J Cardiovasc Imaging 2023; 31:18-23. [PMID: 36693340 PMCID: PMC9880348 DOI: 10.4250/jcvi.2022.0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/03/2022] [Accepted: 07/12/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) transesophageal echocardiogram (TEE) is the gold standard for the diagnosis of degenerative mitral regurgitation (dMR) and preoperative planning for transcatheter mitral valve repair (TMVr). TEE is an invasive modality requiring anesthesia and esophageal intubation. The severe acute respiratory syndrome coronavirus 2 pandemic has limited the number of elective invasive procedures. Multi-detector computed tomographic angiography (MDCT) provides high-resolution images and 3D reconstructions to assess complex mitral anatomy. We hypothesized that MDCT would reveal similar information to TEE relevant to TMVr, thus deferring the need for a preoperative TEE in certain situations like during a pandemic. METHODS We retrospectively analyzed data on patients who underwent or were evaluated for TMVr for dMR with preoperative MDCT and TEE between 2017 and 2019. Two TEE and 2 MDCT readers, blinded to patient outcome, analyzed: leaflet pathology (flail, degenerative, mixed), leaflet location, mitral valve area (MVA), flail width/gap, anterior-posterior (AP) and commissural diameters, posterior leaflet length, leaflet thickness, presence of mitral valve cleft and degree of mitral annular calcification (MAC). RESULTS A total of 22 (out of 87) patients had preoperative MDCT. MDCT correctly identified the leaflet pathology in 77% (17/22), flail leaflet in 91% (10/11), MAC degree in 91% (10/11) and the dysfunctional leaflet location in 95% (21/22) of patients. There were no differences in the measurements for MVA, flail width, commissural or AP diameter, posterior leaflet length, and leaflet thickness. MDCT overestimated the measurements of flail gap. CONCLUSIONS For preoperative TMVr planning, MDCT provided similar measurements to TEE in our study.
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Affiliation(s)
- Craig Basman
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Caroline Ong
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Tikal Kansara
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Zain Kassam
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Caleb Wutawunashe
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Jennifer Conroy
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Arber Kodra
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Biana Trost
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Priti Mehla
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Luigi Pirelli
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Jacob Scheinerman
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Varinder P Singh
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Chad A Kliger
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA
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Kassam Z, Lang R, Bates DDB, Chang KJ, Fraum TJ, Friedman KA, Golia Pernicka JS, Gollub MJ, Harisinghani M, Khatri G, Lall C, Lee S, Magnetta M, Nougaret S, Paspulati RM, Paroder V, Shaish H, Kim DH. SAR user guide to the rectal MR synoptic report (primary staging). Abdom Radiol (NY) 2023; 48:186-199. [PMID: 35754053 DOI: 10.1007/s00261-022-03578-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 01/21/2023]
Abstract
Rectal MR is the key diagnostic exam at initial presentation for rectal cancer patients. It is the primary determinant in establishing clinical stage for the patient and greatly impacts the clinical decision-making process. Consequently, structured reporting for MR is critically important to ensure that all required information is provided to the clinical care team. The SAR initial staging reporting template has been constructed to address these important items, including locoregional extent and factors impacting the surgical approach and management of the patient. Potential outputs to each item are defined, requiring the radiologist to commit to a result. This provides essential information to the surgeon or oncologist to make specific treatment deisions for the patient. The SAR Initial Staging MR reporting template has now been officially adopted by the NAPRC (National Accreditation Program for Rectal Cancer) under the American College of Surgery. With the recent revisions to the reporting template, this user guide has been revamped to improve its practicality and support to the radiologist to complete the structured report. Each line item of the report is supplemented with clinical perspectives, images, and illustrations to help the radiologist understand the potential implications for a given finding. Common errors and pitfalls to avoid are highlighted. Ideally, rectal MR interpretation should not occur in a vacuum but in the context of a multi-disciplinary tumor board to ensure that healthcare providers use common terminology and share a solid understanding of the strengths and weaknesses of MR.
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Affiliation(s)
- Z Kassam
- Western University, London, Canada
| | - R Lang
- Western University, London, Canada
| | | | | | - T J Fraum
- Mallinckrodt Institute of Radiology, St. Louis, USA
| | - K A Friedman
- University Hospitals Cleveland Medical Center, Cleveland, USA
| | | | | | | | - G Khatri
- University of Texas Southwestern, Dallas, USA
| | - C Lall
- University of Florida-Jacksonville, Jacksonville, USA
| | - S Lee
- University of California, Irvine, USA
| | | | - S Nougaret
- Montpellier Cancer Institute, U1194, Montpellier University, Montpellier, France
| | - R M Paspulati
- University Hospital, Case Western Reserve University, Cleveland, USA
| | - V Paroder
- Memorial Sloan Kettering, New York, USA
| | - H Shaish
- Columbia University Medical Center, New York, USA
| | - D H Kim
- Department of Radiology, University of Wisconsin Medical School, University of Wisconsin, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA.
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3
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Kassam Z, Lang R, Bates DDB, Chang KJ, Fraum TJ, Friedman KA, Golia Pernicka JS, Gollub MJ, Harisinghani M, Khatri G, Lall C, Lee S, Magnetta M, Nougaret S, Paspulati RM, Paroder V, Shaish H, Kim DH, Baheti A, Beets-Tan R, dePrisco G, Ernst R, Ganeshan D, Hope T, Horvat N, Jhaveri K, Kaur H, Korngold E, Lalwani N, Moreno C, Petkovska I, Pickhardt PJ, Rauche G, Sheedy S. Correction: SAR user guide to the rectal MR synoptic report (primary staging). Abdom Radiol (NY) 2023; 48:200. [PMID: 36114288 DOI: 10.1007/s00261-022-03656-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Z Kassam
- Western University, London, Canada
| | - R Lang
- Western University, London, Canada
| | | | | | - T J Fraum
- Mallinckrodt Institute of Radiology, St. Louis, USA
| | - K A Friedman
- University Hospitals Cleveland Medical Center, Cleveland, USA
| | | | | | | | - G Khatri
- University of Texas Southwestern, Dallas, USA
| | - C Lall
- University of Florida-Jacksonville, Jacksonville, USA
| | - S Lee
- University of California, Irvine, USA
| | | | - S Nougaret
- Montpellier Cancer Institute, U1194, Montpellier University, Montpellier, France
| | - R M Paspulati
- University Hospital, Case Western Reserve University, Cleveland, USA
| | - V Paroder
- Memorial Sloan Kettering, New York, USA
| | - H Shaish
- Columbia University Medical Center, New York, USA
| | - D H Kim
- Department of Radiology, University of Wisconsin Medical School, University of Wisconsin, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA.
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4
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Osman M, Budree S, Kelly CR, Panchal P, Allegretti JR, Kassam Z, Ramakrishna B, Dubois N, O'Brien K, Fischer M, Stollman N, Hays RA, Kelly CP, Amaratunga K, Qazi T, Crothers JW, Abend A, Bougas M, Burns L, Decaille-Hodge I, Dickens M, Edelstein C, Gabdrakhmanova D, Landry R, Ling K, Martin D, Medina G, Mendolia G, Muñoz R, Rao S, Seng M, Smith M, Stehler L, Yoder K, Zellmer C. Effectiveness and Safety of Fecal Microbiota Transplantation for Clostridioides Difficile Infection: Results From a 5344-Patient Cohort Study. Gastroenterology 2022; 163:319-322. [PMID: 35398345 DOI: 10.1053/j.gastro.2022.03.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/24/2022] [Indexed: 12/17/2022]
Affiliation(s)
| | - Shrish Budree
- Department of Pediatrics, University of Cape Town, Cape Town, South Africa; Finch Therapeutics, Somerville, Massachusetts
| | - Colleen R Kelly
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Jessica R Allegretti
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Zain Kassam
- Finch Therapeutics, Somerville, Massachusetts
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Asemota D, Kassam Z, Voto C, Mangla A, Coven D, Lasic Z. Pseudoaneurysm Formation After "Preclose"-Assisted Impella Insertion in a Patient With Cardiogenic Shock. J Med Cases 2022; 13:202-206. [PMID: 35655626 PMCID: PMC9119370 DOI: 10.14740/jmc3841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/08/2021] [Indexed: 11/11/2022] Open
Abstract
The use of mechanical support devices such as the Impella CP (Abiomed, Danvers, MA) is a growing form of treatment for patients with cardiogenic shock (CS). Despite the increase in usage, there remains a dearth in literature regarding potential complications. Vascular complications such as pseudoaneurysms (PAs) are rare but important potential complications that can occur with use of the Impella. We present Impella-assisted percutaneous coronary intervention (PCI) in a patient with CS, "Preclosed" with the Perclose ProGlide (Abbott, Plymouth, MN) device complicated by development of a PA. A 62-year-old male patient with a history of diabetes and hypertension presented to our emergency room (ER) with chest pain and electrocardiogram (ECG) findings consistent with an acute anterior wall ST-elevation myocardial infarction (STEMI). This was further complicated by refractory CS. The patient was urgently taken to the cardiac catherization laboratory. After exchange of sequential dilators, a single Perclose device was used prior to the insertion of the Impella sheath. The patient then underwent a successful Impella-assisted PCI of his left anterior descending artery. Upon stabilization of hemodynamics, the patient was taken to the catheterization laboratory for Impella removal. After removal of Impella, imaging detected extravasation of contrast, without development of hematoma, later confirmed to be a PA via computed tomography (CT) scans and ultrasound Doppler imaging. The PA was successfully managed with injection of thrombin. The PA was likely caused by shearing forces of the dilators, the 14-F Impella sheath and foot of the device. We propose deploying the Perclose device earlier in the process of dilating the access site to avoid such complication. This is one of the first case reports that detail the occurrence and management of a PA with Impella insertion.
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Affiliation(s)
- Daniel Asemota
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Zain Kassam
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Christian Voto
- Department of Medicine, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Aditya Mangla
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - David Coven
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Zoran Lasic
- Department of Cardiology, Jamaica Hospital Medical Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
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Remillard TC, Kassam Z, Coven M, Mangla A, Lasic Z. Pulmonary Embolism Complicated With Cardiopulmonary Arrest Treated With Combination of Thrombolytics and Aspiration Thrombectomy. JACC Case Rep 2022; 4:576-580. [PMID: 35615215 PMCID: PMC9125515 DOI: 10.1016/j.jaccas.2022.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/17/2022] [Accepted: 03/14/2022] [Indexed: 11/27/2022]
Abstract
Systemic thrombolytic therapy is frequently used in the treatment of massive pulmonary embolism. We describe a case of pulseless electrical activity arrest, refractory obstructive shock in the setting of massive pulmonary embolism despite tissue plasminogen activator that was successfully treated with catheter-directed aspiration thrombectomy. (Level of Difficulty: Intermediate.)
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Smith BJ, Piceno Y, Zydek M, Zhang B, Syriani LA, Terdiman JP, Kassam Z, Ma A, Lynch SV, Pollard KS, El-Nachef N. Strain-resolved analysis in a randomized trial of antibiotic pretreatment and maintenance dose delivery mode with fecal microbiota transplant for ulcerative colitis. Sci Rep 2022; 12:5517. [PMID: 35365713 PMCID: PMC8976058 DOI: 10.1038/s41598-022-09307-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/16/2022] [Indexed: 01/04/2023] Open
Abstract
Fecal microbiota transplant is a promising therapy for ulcerative colitis. Parameters maximizing effectiveness and tolerability are not yet clear, and it is not known how import the transmission of donor microbes to patients is. Here (clinicaltrails.gov: NCT03006809) we have tested the effects of antibiotic pretreatment and compared two modes of maintenance dose delivery, capsules versus enema, in a randomized, pilot, open-label, 2 × 2 factorial design with 22 patients analyzed with mild to moderate UC. Clinically, the treatment was well-tolerated with favorable safety profile. Of patients who received antibiotic pretreatment, 6 of 11 experienced remission after 6 weeks of treatment, versus 2 of 11 non-pretreated patients (log odds ratio: 1.69, 95% confidence interval: −0.25 to 3.62). No significant differences were found between maintenance dosing via capsules versus enema. In exploratory analyses, microbiome turnover at both the species and strain levels was extensive and significantly more pronounced in the pretreated patients. Associations were also revealed between taxonomic turnover and changes in the composition of primary and secondary bile acids. Together these findings suggest that antibiotic pretreatment contributes to microbiome engraftment and possibly clinical effectiveness, and validate longitudinal strain tracking as a powerful way to monitor the dynamics and impact of microbiota transfer.
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Affiliation(s)
- Byron J Smith
- Gladstone Institute of Data Science and Biotechnology, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | - Martin Zydek
- Division of Gastroenterology, University of California, San Francisco, CA, USA
| | - Bing Zhang
- Division of Gastroenterology, University of California, San Francisco, CA, USA.,Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lara Aboud Syriani
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA
| | - Jonathan P Terdiman
- Division of Gastroenterology, University of California, San Francisco, CA, USA
| | | | - Averil Ma
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Susan V Lynch
- Division of Gastroenterology, University of California, San Francisco, CA, USA.,Benioff Center for Microbiome Medicine, University of California, San Francisco, CA, USA
| | - Katherine S Pollard
- Gladstone Institute of Data Science and Biotechnology, San Francisco, CA, USA. .,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. .,Chan Zuckerberg Biohub, San Francisco, CA, USA.
| | - Najwa El-Nachef
- Division of Gastroenterology, University of California, San Francisco, CA, USA.
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8
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Liu CK, Seo J, Pravodelov V, Frazier S, Guy M, Concilio K, Lau-Ng R, Brandeis G, Watson J, van der Velde J, Olesen SW, Budree S, Njenga M, Kassam Z, Osman M. Pilot study of autologous fecal microbiota transplants in nursing home residents: Feasibility and safety. Contemp Clin Trials Commun 2022; 27:100906. [PMID: 35299780 PMCID: PMC8921299 DOI: 10.1016/j.conctc.2022.100906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 02/18/2022] [Accepted: 02/26/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Antibiotic resistant bacterial infections (ARBIs) are extremely common in nursing home residents. These infections typically occur after a course of antibiotics, which eradicate both pathological and beneficial organisms. The eradication of beneficial organisms likely facilitates subsequent ARBIs. Autologous fecal microbiota transplant (aFMT) has been proposed as a potential treatment to reduce ARBIs in nursing home residents. Our objective was to determine the feasibility and safety of aFMT in a nursing home population. Methods Pilot clinical trial. We evaluated feasibility as total number of stool samples collected for aFMT production and safety as the number and relatedness of serious (SAE) and non-serious adverse events (AE). Results We screened 468 nursing home residents aged ≥18 years for eligibility; 67 enrolled, distributed among three nursing homes. Participants were 62.7% female and 35.8% Black. Mean age was 82.2 ± 8.5 years. Thirty-three participants underwent successful stool collection. Seven participants received antibiotics; four participants underwent aFMT. There were 40 SAEs (17 deaths) and 11 AEs. In the aFMT group, there were 3 SAEs (2 deaths) and 10 AEs. All SAEs and AEs were judged unrelated to the study intervention. Conclusions In this pilot study of aFMT in nursing home residents, less than half were able to provide adequate stool samples for aFMT. There were no related SAEs or AEs during the study. In sum, we conclude aFMT has limited feasibility in a nursing home population due to logistic and technical challenges but is likely safe. Trial registration ClinicalTrials.gov Identifier: NCT03061097.
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Affiliation(s)
- Christine K. Liu
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
- Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
- Section of Geriatrics, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Geriatric Research and Education Clinical Center, Veteran Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Corresponding author. Section of Geriatrics, Division of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA, 94305, USA.
| | - Janet Seo
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vassiliki Pravodelov
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Susan Frazier
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Marsha Guy
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Katherine Concilio
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Rossana Lau-Ng
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Gary Brandeis
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Zhang S, Chen Q, Kelly CR, Kassam Z, Qin H, Li N, Tian H, Yang B, Zhao D, Ye C, Lin Z, Cui J, Zhou S, Chen X, Lv X, Yang R. Donor Screening for Fecal Microbiota Transplantation in China: Evaluation of 8483 Candidates. Gastroenterology 2022; 162:966-968.e3. [PMID: 34752816 DOI: 10.1053/j.gastro.2021.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/24/2021] [Accepted: 11/02/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Shaoyi Zhang
- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China
| | - Qiyi Chen
- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China.
| | - Colleen R Kelly
- Division of Gastroenterology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Zain Kassam
- Finch Therapeutics, Somerville, Massachusetts
| | - Huanlong Qin
- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China.
| | - Ning Li
- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China
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- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China; Jianyi Yin, Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hongliang Tian
- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China; Jianyi Yin, Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bo Yang
- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China; Jianyi Yin, Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Di Zhao
- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China; Jianyi Yin, Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chen Ye
- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China; Jianyi Yin, Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Zhiliang Lin
- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China; Jianyi Yin, Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jiaqu Cui
- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China; Jianyi Yin, Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shailan Zhou
- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China; Jianyi Yin, Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Xia Chen
- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China; Jianyi Yin, Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Xiaoqiong Lv
- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China; Jianyi Yin, Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rong Yang
- Department of Colorectal Disease, Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital, Tenth People's Hospital of Tongji University, Shanghai, China; Jianyi Yin, Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas
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Singh P, Alm EJ, Kelley JM, Cheng V, Smith M, Kassam Z, Nee J, Iturrino J, Lembo A. Effect of antibiotic pretreatment on bacterial engraftment after Fecal Microbiota Transplant (FMT) in IBS-D. Gut Microbes 2022; 14:2020067. [PMID: 35014601 PMCID: PMC8757476 DOI: 10.1080/19490976.2021.2020067] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Fecal microbiota transplantation (FMT) is an attractive strategy to correct microbial dysbiosis in diarrhea-predominant irritable bowel syndrome (IBS-D). Although the mechanism of FMT is thought to be bacterial engraftment, the best approach to achieve engraftment after FMT in IBS-D (and other diseases) is not clear. We evaluated the effect of FMT (with or without pretreatment with antibiotics) on gut microbiome and symptoms in patients with IBS-D. In this randomized, placebo-controlled, single-center study, 44 patients with IBS-D with a least moderate severity (IBS severity scoring system, i.e., IBS-SSS, ≥175) were randomly assigned to one of four groups: single-dose oral FMT alone, single-dose oral FMT following a 7-day pretreatment course of Ciprofloxacin and Metronidazole (CM-FMT) or Rifaximin (R-FMT), or Placebo FMT. Primary endpoint was engraftment post-FMT and secondary endpoints were changes in IBS-SSS, and IBS-quality of life (IBS-QOL) at week 10. Median engraftment was significantly different among the three FMT groups (P = .013). Engraftment post-FMT was significantly higher in the FMT alone arm (15.5%) compared to that in R-FMT group (5%, P = .04) and CM-FMT group (2.4%, P = .002). The mean change in IBS-SSS and IBS-QOL from baseline were not significantly different among the four groups or between the three FMT groups combined vs. placebo at week 10. In summary, antibiotic pretreatment significantly reduced bacterial engraftment after FMT in patients with IBS-D.
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Affiliation(s)
- Prashant Singh
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann, Arbor, Michigan,CONTACT Prashant Singh Division of Gastroenterology, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI48109
| | - Eric J Alm
- Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - John M. Kelley
- Department of Psychology, Endicott College, Beverly, MA, USA,Harvard Medical School, Boston, MA
| | - Vivian Cheng
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | | | | | - Judy Nee
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Johanna Iturrino
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Anthony Lembo
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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11
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Eansor P, D'Souza L, Norris M, Willmore K, Kassam Z, Leung E, Nichols A, Sharma M, Tay K, Velker V, Bauman G, Warner A, Campbell N, Palma D. Is Remote Learning as Effective as In-Person Learning for Contouring Education? A Comparison of Face-to-Face vs. Online Delivery of the Anatomy and Radiology Contouring Bootcamp. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Gupta S, Zhu J, McCarty TR, Pruce J, Kassam Z, Kelly C, Fischer M, Allegretti JR. Cost-effectiveness analysis of sequential fecal microbiota transplantation for fulminant Clostridioides difficile infection. J Gastroenterol Hepatol 2021; 36:2432-2440. [PMID: 33682170 DOI: 10.1111/jgh.15483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/28/2021] [Accepted: 02/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Fulminant Clostridioides difficile infections (FCDI) account for 8% of cases and substantial healthcare burden. Fecal microbiota transplantation is recommended for recurrent CDI, but emerging data support use for FCDI. We aimed to assess the cost-effectiveness of a sequential fecal microbiota transplantation (sFMT) protocol for FCDI compared with current standard therapy. METHODS A Markov model simulated patients with FCDI in a 1-year time horizon. The treatment algorithm for up to three sFMTs, clinical probabilities, and direct costs were used from published sources. Outcomes were quality-adjusted life years (QALYs) and costs. The healthcare sector perspective was used with a willingness-to-pay threshold of $100 000 per QALY. RESULTS Sequential fecal microbiota transplantation (FMT) for FCDI was associated with lower overall cost ($28 309 vs $33 980) and higher QALY (0.765 vs 0.686) compared with standard therapy. sFMT is cost-effective in 100% of iterations. sFMT remained cost-effective at cure rates > 44.8% for the first FMT and at stool preparation cost < $6944 per instillation. We find a wide range of efficacies for the first versus second FMT at which sFMT is still preferred. Value of information analysis estimates the expected value of perfect information to be low at $1.89 per person, quantified with net monetary benefit. CONCLUSIONS An sFMT strategy strongly dominates standard therapy, with lower cost and higher QALY. Sensitivity analysis demonstrates benefit even if FMT cure rates are lower than expected and when multiple FMTs are required. FMT material in 2020 was priced at $1695 per treatment but remains cost-effective at a much higher cost.
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Affiliation(s)
- Sanchit Gupta
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jinyi Zhu
- Center for Health Decision Science, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Thomas R McCarty
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jordan Pruce
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Zain Kassam
- Finch Therapeutics, Somerville, Massachusetts, USA
| | - Colleen Kelly
- Women's Medicine Collaborative, Lifespan, Providence, Rhode Island, USA.,Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Monika Fischer
- Division of Gastroenterology, Indiana University, Indianapolis, Indiana, USA
| | - Jessica R Allegretti
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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13
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Chu ND, Crothers JW, Nguyen LTT, Kearney SM, Smith MB, Kassam Z, Collins C, Xavier R, Moses PL, Alm EJ. Dynamic Colonization of Microbes and Their Functions after Fecal Microbiota Transplantation for Inflammatory Bowel Disease. mBio 2021; 12:e0097521. [PMID: 34281401 PMCID: PMC8406238 DOI: 10.1128/mbio.00975-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/09/2021] [Indexed: 12/26/2022] Open
Abstract
For fecal microbiota transplantation (FMT) to be successful in immune diseases like inflammatory bowel disease, it is assumed that therapeutic microbes and their beneficial functions and immune interactions must colonize a recipient patient and persist in sufficient quantity and for a sufficient period of time to produce a clinical benefit. Few studies, however, have comprehensively profiled the colonization and persistence of transferred microbes along with the transfer of their microbial functions and interactions with the host immune system. Using 16S, metagenomic, and immunoglobulin A (IgA) sequencing, we analyzed hundreds of longitudinal microbiome samples from a randomized controlled trial of 12 patients with ulcerative colitis who received fecal transplant or placebo for 12 weeks. We uncovered diverse competitive dynamics among donor and patient strains, showing that persistence of transferred microbes is far from static. Indeed, one patient experienced a dramatic loss of donor bacteria 10 weeks into the trial, coinciding with a bloom of pathogenic bacteria and worsening symptoms. We evaluated the transfer of microbial functions, including desired ones, such as butyrate production, and unintended ones, such as antibiotic resistance. By profiling bacteria coated with IgA, we identified bacteria associated with inflammation and found that microbial interactions with the host immune system can be transferred across people, which could play a role in gut microbiome therapeutics for immune-related diseases. Our findings shed light on the colonization dynamics of gut microbes and their functions in the context of FMT to treat a complex disease-information that may provide a foundation for developing more-targeted therapeutics. IMPORTANCE Fecal microbiota transplantation (FMT)-transferring fecal microbes from a healthy donor to a sick patient-has shown promise for gut diseases such as inflammatory bowel disease. Unlike pharmaceuticals, however, fecal transplants are complex mixtures of living organisms, which must then interact with the microbes and immune system of the recipient. We sought to understand these interactions by tracking the microbes of 12 inflammatory bowel disease patients who received fecal transplants for 12 weeks. We uncovered a range of dynamics. For example, one patient experienced successful transfer of donor bacteria, only to lose them after 10 weeks. We similarly evaluated transfer of microbial functions, including how they interacted with the recipient's immune system. Our findings shed light on the colonization dynamics of gut microbes, as well as their functions in the context of FMT-information that may provide a critical foundation for the development of more-targeted therapeutics.
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Affiliation(s)
- Nathaniel D. Chu
- Center for Microbiome Informatics and Therapeutics, Broad Institute, Cambridge, Massachusetts, USA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Graduate Program in Microbiology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | - Le T. T. Nguyen
- Center for Microbiome Informatics and Therapeutics, Broad Institute, Cambridge, Massachusetts, USA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Sean M. Kearney
- Center for Microbiome Informatics and Therapeutics, Broad Institute, Cambridge, Massachusetts, USA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | - Zain Kassam
- Finch Therapeutics, Somerville, Massachusetts, USA
| | - Cheryl Collins
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Ramnik Xavier
- Center for Microbiome Informatics and Therapeutics, Broad Institute, Cambridge, Massachusetts, USA
- Broad Institute, Cambridge, Massachusetts, USA
| | - Peter L. Moses
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Eric J. Alm
- Center for Microbiome Informatics and Therapeutics, Broad Institute, Cambridge, Massachusetts, USA
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Graduate Program in Microbiology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Broad Institute, Cambridge, Massachusetts, USA
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14
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Allegretti JR, Kelly CR, Grinspan A, Mullish BH, Hurtado J, Carrellas M, Marcus J, Marchesi JR, McDonald JAK, Gerardin Y, Silverstein M, Pechlivanis A, Barker GF, Miguens Blanco J, Alexander JL, Gallagher KI, Pettee W, Phelps E, Nemes S, Sagi SV, Bohm M, Kassam Z, Fischer M. Inflammatory Bowel Disease Outcomes Following Fecal Microbiota Transplantation for Recurrent C. difficile Infection. Inflamm Bowel Dis 2021; 27:1371-1378. [PMID: 33155639 PMCID: PMC8376126 DOI: 10.1093/ibd/izaa283] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recurrent Clostridioides difficile infection (CDI) in patients with inflammatory bowel disease (IBD) is a clinical challenge. Fecal microbiota transplantation (FMT) has emerged as a recurrent CDI therapy. Anecdotal concerns exist regarding worsening of IBD activity; however, prospective data among IBD patients are limited. METHODS Secondary analysis from an open-label, prospective, multicenter cohort study among IBD patients with 2 or more CDI episodes was performed. Participants underwent a single FMT by colonoscopy (250 mL, healthy universal donor). Secondary IBD-related outcomes included rate of de novo IBD flares, worsening IBD, and IBD improvement-all based on Mayo or Harvey-Bradshaw index (HBI) scores. Stool samples were collected for microbiome and targeted metabolomic profiling. RESULTS Fifty patients enrolled in the study, among which 15 had Crohn's disease (mean HBI, 5.8 ± 3.4) and 35 had ulcerative colitis (mean partial Mayo score, 4.2 ± 2.1). Overall, 49 patients received treatment. Among the Crohn's disease cohort, 73.3% (11 of 15) had IBD improvement, and 4 (26.6%) had no disease activity change. Among the ulcerative colitis cohort, 62% (22 of 34) had IBD improvement, 29.4% (11 of 34) had no change, and 4% (1 of 34) experienced a de novo flare. Alpha diversity significantly increased post-FMT, and ulcerative colitis patients became more similar to the donor than Crohn's disease patients (P = 0.04). CONCLUSION This prospective trial assessing FMT in IBD-CDI patients suggests IBD outcomes are better than reported in retrospective studies.
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Affiliation(s)
- Jessica R Allegretti
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Colleen R Kelly
- Division of Gastroenterology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ari Grinspan
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin H Mullish
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Jonathan Hurtado
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Madeline Carrellas
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jenna Marcus
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Julian R Marchesi
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- School of Biosciences, Cardiff University, Cardiff, UK
| | - Julie A K McDonald
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- MRC Centre for Molecular Bacteriology and Infection, Imperial College London, London, UK
| | | | | | - Alexandros Pechlivanis
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Center for Interdisciplinary Research and Innovation, School of Chemistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Grace F Barker
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Jesus Miguens Blanco
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - James L Alexander
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Kate I Gallagher
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | | | - Emmalee Phelps
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sara Nemes
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sashidhar V Sagi
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew Bohm
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Monika Fischer
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA
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15
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Crothers JW, Chu ND, Nguyen LTT, Phillips M, Collins C, Fortner K, Del Rio-Guerra R, Lavoie B, Callas P, Velez M, Cohn A, Elliott RJ, Wong WF, Vo E, Wilcox R, Smith M, Kassam Z, Budd R, Alm EJ, Mawe GM, Moses PL. Daily, oral FMT for long-term maintenance therapy in ulcerative colitis: results of a single-center, prospective, randomized pilot study. BMC Gastroenterol 2021; 21:281. [PMID: 34238227 PMCID: PMC8268596 DOI: 10.1186/s12876-021-01856-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 06/23/2021] [Indexed: 02/22/2023] Open
Abstract
Background Fecal microbiota transplantation (FMT) is a promising new strategy in the treatment of Inflammatory Bowel Disease, but long-term delivery systems are lacking. This randomized study was designed as a safety and feasibility study of long-term FMT in subjects with mild to moderate UC using frozen, encapsulated oral FMT (cFMT). Methods Subjects were randomized 1:1 to receive FMT induction by colonoscopy, followed by 12 weeks of daily oral administration of frozen encapsulated cFMT or sham therpay. Subjects were followed for 36 weeks and longitudenal clinical assessments included multiple subjective and objective markers of disease severity. Ribosomal 16S bacterial sequencing was used to assess donor-induced changes in the gut microbiota. Changes in T regulatory (Treg) and mucosal associated invariant T (MAIT) cell populations were evaluated by flow cytometry as an exploratory endpoint. Results Twelve subjects with active UC were randomized: 6 subjects completed the full 12-week course of FMT plus cFMT, and 6 subjects received sham treatment by colonic installation and longitudinal oral placebo capules. Chronic administration of cFMT was found to be safe and well-tolerated but home storage concerns exist. Protocol adherence was high, and none of the study subjects experienced FMT-associated treatment emergent adverse events. Two subjects that received cFMT achieved clinical remission versus none in the placebo group (95% CI = 0.38-infinity, p = 0.45). cFMT was associated with sustained donor-induced shifts in fecal microbial composition. Changes in MAIT cell cytokine production were observed in cFMT recipients and correlated with treatment response. Conclusion These pilot data suggest that daily encapsulated cFMT may extend the durability of index FMT-induced changes in gut bacterial community structure and that an association between MAIT cell cytokine production and clinical response to FMT may exist in UC populations. Oral frozen encapsulated cFMT is a promising FMT delivery system and may be preferred for longterm treatment strategies in UC and other chronic diseases but further evaluations will have to address home storage concerns. Larger trials should be done to explore the benefits of cFMT and to determine its long-term impacts on the colonic microbiome. Trial registration: ClinicalTrials.gov (NCT02390726). Registered 17 March 2015, https://clinicaltrials.gov/ct2/show/NCT02390726?term=NCT02390726&draw=2&rank=1. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01856-9.
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Affiliation(s)
- Jessica W Crothers
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA. .,Larner College of Medicine, The University of Vermont, 89 Beaumont Ave, Burlington, VT, 05401, USA.
| | - Nathaniel D Chu
- Department of Biological Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA.,Center for Microbiome Informatics and Therapeutics, Broad Institute, Cambridge, MA, USA
| | - Le Thanh Tu Nguyen
- Department of Biological Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA.,Center for Microbiome Informatics and Therapeutics, Broad Institute, Cambridge, MA, USA
| | - Magen Phillips
- Department of Medicine, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA
| | - Cheryl Collins
- Department of Medicine, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA
| | - Karen Fortner
- Department of Medicine, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA
| | - Roxana Del Rio-Guerra
- Flow Cytometry and Cell Sorting Facility, Department of Surgery, Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05401, USA
| | - Brigitte Lavoie
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05401, USA
| | - Peter Callas
- Department of Medical Biostatistics, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05401, USA
| | - Mario Velez
- Department of Medicine, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA
| | - Aaron Cohn
- Department of Medicine, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA
| | - Ryan J Elliott
- OpenBiome, 2067 Massachusetts Ave, Cambridge, MA, 02140, USA
| | - Wing Fei Wong
- OpenBiome, 2067 Massachusetts Ave, Cambridge, MA, 02140, USA
| | - Elaine Vo
- Finch Therapeutics, 200 Inner Belt Rd, Somerville, MA, 02143, USA
| | - Rebecca Wilcox
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA.,Larner College of Medicine, The University of Vermont, 89 Beaumont Ave, Burlington, VT, 05401, USA
| | - Mark Smith
- Finch Therapeutics, 200 Inner Belt Rd, Somerville, MA, 02143, USA
| | - Zain Kassam
- Finch Therapeutics, 200 Inner Belt Rd, Somerville, MA, 02143, USA
| | - Ralph Budd
- Department of Medicine, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401, USA.,Larner College of Medicine, The University of Vermont, 89 Beaumont Ave, Burlington, VT, 05401, USA
| | - Eric J Alm
- Department of Biological Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA.,Center for Microbiome Informatics and Therapeutics, Broad Institute, Cambridge, MA, USA
| | - Gary M Mawe
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05401, USA
| | - Peter L Moses
- Larner College of Medicine, The University of Vermont, 89 Beaumont Ave, Burlington, VT, 05401, USA.,Finch Therapeutics, 200 Inner Belt Rd, Somerville, MA, 02143, USA
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Basman C, Ong C, Kassam Z, Trost B, Pirelli L, Poon M, Patel N, Scheinerman S, Kliger C. UTILITY OF MULTIDETECTOR COMPUTED TOMOGRAPHIC ANGIOGRAPHY AS AN ALTERNATIVE TO TRANSESOPHAGEAL ECHOCARDIOGRAM FOR PREOPERATIVE TRANSCATHETER MITRAL VALVE REPAIR PLANNING. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02456-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Keller JJ, Ooijevaar RE, Hvas CL, Terveer EM, Lieberknecht SC, Högenauer C, Arkkila P, Sokol H, Gridnyev O, Mégraud F, Kump PK, Nakov R, Goldenberg SD, Satokari R, Tkatch S, Sanguinetti M, Cammarota G, Dorofeev A, Gubska O, Laniro G, Mattila E, Arasaradnam RP, Sarin SK, Sood A, Putignani L, Alric L, Baunwall SMD, Kupcinskas J, Link A, Goorhuis AG, Verspaget HW, Ponsioen C, Hold GL, Tilg H, Kassam Z, Kuijper EJ, Gasbarrini A, Mulder CJJ, Williams HRT, Vehreschild MJGT. A standardised model for stool banking for faecal microbiota transplantation: a consensus report from a multidisciplinary UEG working group. United European Gastroenterol J 2021; 9:229-247. [PMID: 33151137 PMCID: PMC8259288 DOI: 10.1177/2050640620967898] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Faecal microbiota transplantation is an emerging therapeutic option, particularly for the treatment of recurrent Clostridioides difficile infection. Stool banks that organise recruitment and screening of faeces donors are being embedded within the regulatory frameworks described in the European Union Tissue and Cells Directive and the technical guide to the quality and safety of tissue and cells for human application, published by the European Council. OBJECTIVE Several European and international consensus statements concerning faecal microbiota transplantation have been issued. While these documents provide overall guidance, we aim to provide a detailed description of all processes that relate to the collection, handling and clinical application of human donor stool in this document. METHODS Collaborative subgroups of experts on stool banking drafted concepts for all domains pertaining to stool banking. During a working group meeting in the United European Gastroenterology Week 2019 in Barcelona, these concepts were discussed and finalised to be included in our overall guidance document about faecal microbiota transplantation. RESULTS A guidance document for all domains pertaining to stool banking was created. This document includes standard operating manuals for several processes involved with stool banking, such as handling of donor material, storage and donor screening. CONCLUSION The implementation of faecal microbiota transplantation by stool banks in concordance with our guidance document will enable quality assurance and guarantee the availability of donor faeces preparations for patients.
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18
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Allegretti JR, Kassam Z, Hurtado J, Marchesi JR, Mullish BH, Chiang A, Thompson CC, Cummings BP. Impact of fecal microbiota transplantation with capsules on the prevention of metabolic syndrome among patients with obesity. Hormones (Athens) 2021; 20:209-211. [PMID: 33420959 PMCID: PMC8432937 DOI: 10.1007/s42000-020-00265-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Fecal microbiota transplantation (FMT) has been studied for the treatment of metabolic syndrome with varying success. However, the possibility of utilizing FMT to prevent metabolic syndrome is to date unknown. METHODS Secondary analysis of a previously published double-blind, randomized, placebo-controlled pilot trial of FMT in obese metabolically healthy patients was conducted. Post-prandial glucose and insulin levels were measured (NCT02741518). RESULTS A total of 22 patients were enrolled, 11 in each arm. There were no baseline differences in the area under the curve (AUC) of glucose or insulin in the FMT group compared to placebo. There was a significant change in glucose AUC at week 12 compared to baseline, and in the insulin AUC at week 6 compared to baseline in the FMT group vs. placebo (change in glucose AUC (mg/dl × 60 min): 579 vs 1978, p = 0.03) (change in insulin AUC (μU/ml × 60 min): 137 vs 2728, p = 0.01). CONCLUSIONS These data suggest that FMT may have a potential role in preventing the development of metabolic syndrome in patients with obesity.
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Affiliation(s)
- Jessica R Allegretti
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Zain Kassam
- Finch Therapeutics Group, Somerville, MA, USA
| | - Jonathan Hurtado
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Julian R Marchesi
- Division of Integrative Systems Medicine and Digestive Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Benjamin H Mullish
- Division of Integrative Systems Medicine and Digestive Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Austin Chiang
- Division of Gastroenterology, Jefferson University, Philadelphia, PA, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Bethany P Cummings
- Department of Biomedical Sciences, Cornell University, Ithaca, NY, 14853, USA.
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Ianiro G, Mullish BH, Hvas CL, Segal JP, Kuijper EJ, Costello SP, Kelly CR, Allegretti JR, Fischer M, Iqbal TH, Satokari R, Kao D, van Prehn J, Ng SC, Bibbò S, Baunwall SMD, Quraishi MN, Sokol H, Zhang F, Keller J, Masucci L, Quaranta G, Kassam Z, Sanguinetti M, Tilg H, Gasbarrini A, Cammarota G. SARS-CoV-2 vaccines and donor recruitment for FMT. Lancet Gastroenterol Hepatol 2021; 6:264-266. [PMID: 33571456 PMCID: PMC7906701 DOI: 10.1016/s2468-1253(21)00032-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 01/24/2021] [Accepted: 01/24/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Gianluca Ianiro
- Digestive Disease Center, Fondazione Policlinico Universitario "A Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Benjamin H Mullish
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Christian Lodberg Hvas
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathan P Segal
- Department of Gastroenterology, Hillingdon Hospital, Uxbridge, UK
| | - Ed J Kuijper
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, Netherlands; Netherlands Donor Feces Bank, Leiden University Medical Centre, Leiden, Netherlands
| | - Samuel P Costello
- Department of Gastroenterology, The Queen Elizabeth Hospital, University of Adelaide, Woodville, SA, Australia
| | - Colleen R Kelly
- Division of Gastroenterology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jessica R Allegretti
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Monika Fischer
- Department of Medicine, Indiana University, Indianapolis, IN, USA
| | - Tariq H Iqbal
- University of Birmingham Microbiome Treatment Centre, University of Birmingham, Birmingham, UK; Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Reetta Satokari
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Dina Kao
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Joffrey van Prehn
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, Netherlands; Netherlands Donor Feces Bank, Leiden University Medical Centre, Leiden, Netherlands
| | - Siew C Ng
- Center for Gut Microbiota Research, Institute of Digestive Disease, Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Stefano Bibbò
- Digestive Disease Center, Fondazione Policlinico Universitario "A Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Mohammed N Quraishi
- University of Birmingham Microbiome Treatment Centre, University of Birmingham, Birmingham, UK; Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Harry Sokol
- Service de Gastroenterologie, Hôpital Saint Antoine, Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, Paris, France; French Group of Fecal Microbiota Transplantation, Paris, France; INRA, UMR1319 Micalis, AgroParisTech, Jouy-en-Josas, France
| | - Faming Zhang
- Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Josbert Keller
- Netherlands Donor Feces Bank, Leiden University Medical Centre, Leiden, Netherlands; Department of Gastroenterology, Leiden University Medical Centre, Leiden, Netherlands; Department of Gastroenterology, Haaglanden Medical Center, The Hague, Netherlands
| | - Luca Masucci
- Microbiology Unit, Fondazione Policlinico Universitario "A Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianluca Quaranta
- Microbiology Unit, Fondazione Policlinico Universitario "A Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Zain Kassam
- Finch Therapeutics Group, Somerville, MA, USA
| | - Maurizio Sanguinetti
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Innsbruck Medical University, Innsbruck, Austria; Microbiology Unit, Fondazione Policlinico Universitario "A Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Innsbruck Medical University, Innsbruck, Austria; Microbiology Unit, Fondazione Policlinico Universitario "A Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Gasbarrini
- Digestive Disease Center, Fondazione Policlinico Universitario "A Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Cammarota
- Digestive Disease Center, Fondazione Policlinico Universitario "A Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Allegretti JR, Mehta SR, Kassam Z, Kelly CR, Kao D, Xu H, Fischer M. Risk Factors that Predict the Failure of Multiple Fecal Microbiota Transplantations for Clostridioides difficile Infection. Dig Dis Sci 2021; 66:213-217. [PMID: 32170474 DOI: 10.1007/s10620-020-06198-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 03/05/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent Clostridioides difficile infection (CDI); however, a small percentage of patients fail to achieve cure even after two FMTs. This high-risk cohort remains poorly understood. METHODS We performed a multicenter, multinational retrospective review of patients that underwent at least one FMT for a CDI indication at four academic FMT referrals. Patients' data including CDI, FMT, and FMT variables were assessed. The primary outcome was FMT failure after a second FMT defined as persistent diarrhea and positive laboratory test for C. difficile (PCR or toxin) despite a second FMT within 8 weeks of the first FMT. A multivariable logistic regression model was performed to determine predictors of second FMT failure. RESULTS A total of 540 patients received at least one FMT during the study period, of which 432 patients had success following the first FMT, 108 had documented failure (25%). Among those who failed the first FMT, 63 patients received a second FMT, of which 36 achieved cure, and 24 had documented failure after the second FMT. Patients that failed the first FMT but did not receive a second FMT and those lost to follow-up were excluded leaving 492 patients included in the analysis. The second FMT failure rate was 4.8% (24/492). Risk factors for second FMT failure identified by multivariable logistic regression included: inpatient status (OR 7.01, 95% CI: 2.37-20.78), the presence of pseudomembranes (OR 3.53, 95% CI: 1.1-11.33), and immunocompromised state (OR 3.56, 95% CI: 1.45-8.72) at the time of first FMT. CONCLUSION This study identifies clinically relevant risk factors predictive of failing a second FMT. Clinicians can use these variables to help identify high-risk patients and provide a better-informed consent regarding the possibility of needing multiple FMTs.
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Affiliation(s)
- Jessica R Allegretti
- Division of Gastroenterology, Brigham and Women's Hospital, 850 Boylston Street, Suite 201, Chestnut Hill, MA, 02467, USA.
| | - Shama R Mehta
- Department of Medicine, Indiana University, Indianapolis, IN, USA
| | | | - Colleen R Kelly
- Division of Gastroenterology, Lifespan Women's Medicine Collaborative, Alpert Medical School of Brown University, Providence, RI, USA
| | - Dina Kao
- Department of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, Edmonton, AB, Canada
| | - Huiping Xu
- Department of Biostatistics, The Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Monika Fischer
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN, USA
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21
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Gerardin Y, Timberlake S, Allegretti JR, Smith MB, Kassam Z. Beyond Fecal Microbiota Transplantation: Developing Drugs from the Microbiome. J Infect Dis 2020; 223:S276-S282. [PMID: 33330910 DOI: 10.1093/infdis/jiaa700] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The transfer of live gut microbes may transform patient care across a range of autoimmune, metabolic, hepatic, and infectious diseases. One early approach, fecal microbiota transplantation, has shown promise in Clostridiodes difficile infection and the potential for improving clinical and public health outcomes for other antibiotic-resistant bacteria. These clinical successes have motivated the development of microbiome drugs, which will need to address challenges in safety, uniformity, and delivery while seeking to preserve the benefits of using whole microbiome communities as novel therapeutics and an innovative platform for drug discovery.
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Affiliation(s)
| | | | - Jessica R Allegretti
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Mark B Smith
- Finch Therapeutics, Somerville, Massachusetts, USA
| | - Zain Kassam
- Finch Therapeutics, Somerville, Massachusetts, USA
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22
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Allegretti JR, Kelly CR, Grinspan A, Mullish BH, Kassam Z, Fischer M. Outcomes of Fecal Microbiota Transplantation in Patients With Inflammatory Bowel Diseases and Recurrent Clostridioides difficile Infection. Gastroenterology 2020; 159:1982-1984. [PMID: 32738249 DOI: 10.1053/j.gastro.2020.07.045] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Jessica R Allegretti
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Colleen R Kelly
- Division of Gastroenterology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ari Grinspan
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Benjamin H Mullish
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Zain Kassam
- Finch Therapeutics, Somerville, Massachusetts
| | - Monika Fischer
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana
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23
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Allegretti JR, Elliott RJ, Ladha A, Njenga M, Warren K, O’Brien K, Budree S, Osman M, Fischer M, Kelly CR, Kassam Z. Stool processing speed and storage duration do not impact the clinical effectiveness of fecal microbiota transplantation. Gut Microbes 2020; 11:1806-1808. [PMID: 32552337 PMCID: PMC7524162 DOI: 10.1080/19490976.2020.1768777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Jessica R. Allegretti
- Division of Gastroenterology, Brigham and Women’s Hospital, Boston, MA, USA,CONTACT Jessica R. Allegretti Division of Gastroenterology, Brigham and Women’s Hospital, Boston, MA02115
| | | | - Alim Ladha
- OpenBiome, Cambridge, MA, USA,Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | | | | | - Shrish Budree
- OpenBiome, Cambridge, MA, USA,Finch Therapeutics, Somerville, MA, USA
| | | | - Monika Fischer
- Division of Gastroenterology, Indiana University, Indianapolis, IN, USA
| | - Colleen R. Kelly
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
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24
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Cheng YW, Phelps E, Nemes S, Rogers N, Sagi S, Bohm M, El-Halabi M, Allegretti JR, Kassam Z, Xu H, Fischer M. Fecal Microbiota Transplant Decreases Mortality in Patients with Refractory Severe or Fulminant Clostridioides difficile Infection. Clin Gastroenterol Hepatol 2020; 18:2234-2243.e1. [PMID: 31923639 DOI: 10.1016/j.cgh.2019.12.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/23/2019] [Accepted: 12/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Fecal microbiota transplantation (FMT) is recommended for recurrent Clostridioides difficile infection (CDI). FMT cures nearly 80% of patients with severe or fulminant CDI (SFCDI) when utilized in a sequential manner. We compared outcomes of hospitalized patients before and after implementation of an FMT program for SFCDI and investigated whether the changes could be directly attributed to the FMT program. METHODS We performed a retrospective analysis of characteristics and outcomes of patients hospitalized for SFCDI (430 hospitalizations) at a single center, from January 2009 through December 2016. We performed subgroup analyses of 199 patients with fulminant CDI and 110 patients with refractory SFCDI (no improvement after 5 or more days of maximal anti-CDI antibiotic therapy). We compared CDI-related mortality within 30 days of hospitalization, CDI-related colectomy, length of hospital stay, and readmission to the hospital within 30 days before (2009-2012) vs after (2013-2016) implementation of the inpatient FMT program. RESULTS CDI-related mortality and colectomy were lower after implementation of the FMT program. Overall, CDI-related mortality was 10.2% before the FMT program was implemented vs 4.4% after (P = .02). For patients with fulminant CDI, CDI-related mortality was 21.3% before the FMT program was implemented vs 9.1% after (P = .015). For patients with refractory SFCDI, CDI-related mortality was 43.2% before the FMT program vs 12.1% after (P < .001). The FMT program significantly reduced CDI-related colectomy in patients with SFCDI (6.8% before vs 2.7% after; P = .041), in patients with fulminant CDI (15.7% before vs 5.5% after; P = .017), and patients with refractory SFCDI (31.8% vs 7.6%; P = .001). The effect of FMT program implementation on CDI-related mortality remained significant for patients with refractory SFCDI after we accounted for the underlying secular trend (odds ratio, 0.09 for level change; P = .023). CONCLUSIONS An FMT program significantly decreased CDI-related mortality among patients hospitalized with refractory SFCDI.
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Affiliation(s)
- Yao-Wen Cheng
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Emmalee Phelps
- Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sara Nemes
- Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Nicholas Rogers
- Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sashidhar Sagi
- Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Matthew Bohm
- Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mustapha El-Halabi
- Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jessica R Allegretti
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Zain Kassam
- Finch Therapeutics Group, Somerville, Massachusetts
| | - Huiping Xu
- Department of Biostatistics, Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, Indiana
| | - Monika Fischer
- Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
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Ianiro G, Mullish BH, Kelly CR, Kassam Z, Kuijper EJ, Ng SC, Iqbal TH, Allegretti JR, Bibbò S, Sokol H, Zhang F, Fischer M, Costello SP, Keller JJ, Masucci L, van Prehn J, Quaranta G, Quraishi MN, Segal J, Kao D, Satokari R, Sanguinetti M, Tilg H, Gasbarrini A, Cammarota G. Reorganisation of faecal microbiota transplant services during the COVID-19 pandemic. Gut 2020; 69:1555-1563. [PMID: 32620549 PMCID: PMC7456726 DOI: 10.1136/gutjnl-2020-321829] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic has led to an exponential increase in SARS-CoV-2 infections and associated deaths, and represents a significant challenge to healthcare professionals and facilities. Individual countries have taken several prevention and containment actions to control the spread of infection, including measures to guarantee safety of both healthcare professionals and patients who are at increased risk of infection from COVID-19. Faecal microbiota transplantation (FMT) has a well-established role in the treatment of Clostridioides difficile infection. In the time of the pandemic, FMT centres and stool banks are required to adopt a workflow that continues to ensure reliable patient access to FMT while maintaining safety and quality of procedures. In this position paper, based on the best available evidence, worldwide FMT experts provide guidance on issues relating to the impact of COVID-19 on FMT, including patient selection, donor recruitment and selection, stool manufacturing, FMT procedures, patient follow-up and research activities.
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Affiliation(s)
- Gianluca Ianiro
- Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Benjamin H Mullish
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Colleen R Kelly
- Division of Gastroenterology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Zain Kassam
- Finch Therapeutics Group, Somerville, Massachusetts, USA
| | - Ed J Kuijper
- Center for Microbiota Analysis and Therapy, Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands,Netherlands Donor Feces Bank, Leiden University Medical Center, Leiden, The Netherlands
| | - Siew C Ng
- Center for Gut Microbiota Research, Institute of Digestive Disease, Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tariq H Iqbal
- Microbiome Treatment Centre, University of Birmingham, Birmingham, UK,Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jessica R Allegretti
- Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stefano Bibbò
- Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Harry Sokol
- Service de Gastroenterologie; French Group of Fecal Microbiota Transplantation, Hôpital Saint Antoine, Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, Paris, France,INRA, UMR1319 Micalis, AgroParisTech, Jouy-en-Josas, France
| | - Faming Zhang
- Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Monika Fischer
- Department of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Samuel Paul Costello
- Department of Gastroenterology, The Queen Elizabeth Hospital, University of Adelaide, Woodville, South Australia, Australia
| | - Josbert J Keller
- Netherlands Donor Feces Bank, Leiden University Medical Center, Leiden, The Netherlands,Department of Gastroenterology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Luca Masucci
- Institute of Microbiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Joffrey van Prehn
- Netherlands Donor Feces Bank, Leiden University Medical Center, Leiden, The Netherlands
| | - Gianluca Quaranta
- Institute of Microbiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Mohammed Nabil Quraishi
- Microbiome Treatment Centre, University of Birmingham, Birmingham, UK,Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan Segal
- Department of Gastroenterology, St Mark's Hospital, Harrow, UK
| | - Dina Kao
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Reetta Satokari
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Maurizio Sanguinetti
- Institute of Microbiology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Innsbruck Medical University, Innsbruck, Austria
| | - Antonio Gasbarrini
- Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Cammarota
- Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Chin J, Hatiboglu G, Nair S, Relle J, Hafron J, Roethke M, Mueller-Wolf M, Bonekamp D, Kassam Z, Staruch R, Burtnyk M, Schlemmer H, Pahernik S. Five-year outcomes from a prospective phase I study of MRI-guided transurethral ultrasound ablation in men with localized prostate cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33482-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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27
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Allegretti JR, Kassam Z, Mullish BH, Chiang A, Carrellas M, Hurtado J, Marchesi JR, McDonald JAK, Pechlivanis A, Barker GF, Miguéns Blanco J, Garcia-Perez I, Wong WF, Gerardin Y, Silverstein M, Kennedy K, Thompson C. Effects of Fecal Microbiota Transplantation With Oral Capsules in Obese Patients. Clin Gastroenterol Hepatol 2020; 18:855-863.e2. [PMID: 31301451 DOI: 10.1016/j.cgh.2019.07.006] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/27/2019] [Accepted: 07/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Studies in mice have shown that the intestinal microbiota can contribute to obesity via the anorexigenic gut hormone glucagon-like peptide 1 (GLP1) and bile acids, which affect lipid metabolism. We performed a randomized, placebo-controlled, pilot study of the effects of fecal microbiota transplantation (FMT) in obese, metabolically uncompromised patients. METHODS We performed a double-blind study of 22 obese patients (body mass index [BMI] ≥5 kg/m2) without a diagnosis of diabetes, nonalcoholic steatohepatitis, or metabolic syndrome. Participants were assigned randomly (1:1) to groups that received FMT by capsules (induction dose of 30 capsules at week 4 and maintenance dose of 12 capsules at week 8) or placebo capsules. FMT capsules were derived from a single lean donor (BMI, 17.5 kg/m2). Patients were followed up through week 26; the primary outcome was safety. Stool and serum samples were collected from patients at baseline and at weeks 1, 4, 6, 8, and 12 after administration of the first dose of FMT or placebo and analyzed by 16S RNA gene sequencing. Stool and serum samples were analyzed for metabolomics by liquid chromatography-mass spectrometry. Additional outcomes were the change in area under the curve for GLP1 at week 12. RESULTS We observed no significant differences in adverse events between patients who received FMT vs placebo. There was no increase in the area under the curve of GLP1 in either group. Patients who received FMT had sustained shifts in microbiomes associated with obesity toward those of the donor (P < .001). Patients who received FMT had a sustained decrease in stool levels of taurocholic acid (P < .05) compared with baseline; bile acid profiles began to resemble those of the donor more closely. We did not observe significant changes in mean BMI at week 12 in either group. CONCLUSIONS In a placebo-controlled pilot study, we found that FMT capsules (derived from a lean donor) were safe but did not reduce BMI in obese metabolically uncompromised patients. The FMT capsules were well tolerated and led to sustained changes in the intestinal microbiome and bile acid profiles that were similar to those of the lean donor. ClinicalTrials.gov number: NCT02741518.
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Affiliation(s)
- Jessica R Allegretti
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Zain Kassam
- Finch Therapeutics Group, Somerville, Massachusetts
| | - Benjamin H Mullish
- Division of Integrative Systems Medicine and Digestive Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Austin Chiang
- Division of Gastroenterology, Jefferson University, Philadelphia, Pennsylvania
| | - Madeline Carrellas
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Hurtado
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julian R Marchesi
- Division of Integrative Systems Medicine and Digestive Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Julie A K McDonald
- Division of Integrative Systems Medicine and Digestive Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Alexandros Pechlivanis
- Division of Integrative Systems Medicine and Digestive Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Grace F Barker
- Division of Integrative Systems Medicine and Digestive Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Jesús Miguéns Blanco
- Division of Integrative Systems Medicine and Digestive Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Isabel Garcia-Perez
- Division of Integrative Systems Medicine and Digestive Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | | | | | - Kevin Kennedy
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Christopher Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Selvig D, Piceno Y, Terdiman J, Zydek M, Umetsu SE, Balitzer D, Fadrosh D, Lynch K, Lamere B, Leith T, Kassam Z, Beck K, Lewin S, Ma A, Somsouk M, Lynch SV, El-Nachef N. Fecal Microbiota Transplantation in Pouchitis: Clinical, Endoscopic, Histologic, and Microbiota Results from a Pilot Study. Dig Dis Sci 2020; 65:1099-1106. [PMID: 31302808 DOI: 10.1007/s10620-019-05715-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 07/02/2019] [Indexed: 12/26/2022]
Abstract
AIMS This pilot study assessed the efficacy, safety, and microbiome dynamics of fecal microbiota transplantation (FMT) for patients with chronic pouchitis. METHODS A prospective open-label pilot study was performed at an academic center among pouchitis patients undergoing FMT. Patients received a minimum of a single FMT by pouchoscopy from healthy, screened donors. The primary outcome was clinical improvement in pouchitis assessed by patient survey at week 4. Secondary outcomes included decrease in total Pouchitis Disease Activity Index (PDAI) Score ≥ 3 at week 4, bowel movement frequency, ESR, CRP, fecal calprotectin, abdominal pain, and PDAI subscores including endoscopic and histologic changes. Stool samples were collected at baseline and 4 weeks post-FMT to assess bacterial microbiota using V4 16S rRNA sequencing. RESULTS Nineteen patients were enrolled; however, 1 patient was lost to follow-up. No patients had a major adverse event or escalation of therapy related to FMT. Total PDAI scores, endoscopic scores, and histologic scores did not decrease significantly post-FMT. However, there was a statistically significant improvement in bowel movement (BM) frequency (9.25-7.25 BM/day, p = 0.03) and trend for improvement in abdominal pain to improve post-FMT (p = 0.05). Bacterial microbiota profiling revealed no distinct community-level changes post-FMT, though a small number of specific bacterial taxa significantly differed in relative abundance. CONCLUSIONS A single FMT has a tolerable short-term safety profile and may be associated with a decrease in bowel movements in patients with chronic pouchitis; however, no robust endoscopic or histologic changes were observed.
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Affiliation(s)
- Daniel Selvig
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Yvette Piceno
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jonathan Terdiman
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Martin Zydek
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah E Umetsu
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Dana Balitzer
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
| | - Doug Fadrosh
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kole Lynch
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Brandon Lamere
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Zain Kassam
- OpenBiome, Somerville, MA, USA
- Finch Therapeutics Group, Somerville, MA, USA
| | - Kendall Beck
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sara Lewin
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Averil Ma
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Ma Somsouk
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Susan V Lynch
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Najwa El-Nachef
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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Ianiro G, Mullish BH, Kelly CR, Sokol H, Kassam Z, Ng SC, Fischer M, Allegretti JR, Masucci L, Zhang F, Keller J, Sanguinetti M, Costello SP, Tilg H, Gasbarrini A, Cammarota G. Screening of faecal microbiota transplant donors during the COVID-19 outbreak: suggestions for urgent updates from an international expert panel. Lancet Gastroenterol Hepatol 2020; 5:430-432. [PMID: 32192627 PMCID: PMC7104244 DOI: 10.1016/s2468-1253(20)30082-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Gianluca Ianiro
- Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
| | - Benjamin H Mullish
- Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Colleen R Kelly
- Division of Gastroenterology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Harry Sokol
- Service de Gastroenterologie, Hôpital Saint Antoine, Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, Paris, France; French Group of Fecal Microbiota Transplantation, Paris, France; INRA, UMR1319 Micalis, AgroParisTech, Jouy-en-Josas, France
| | - Zain Kassam
- Finch Therapeutics Group, Somerville, MA, USA
| | - Siew C Ng
- Institute of Digestive Disease and Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, CUHK Shenzhen Research Institute, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
| | - Monika Fischer
- Department of Medicine, Indiana University, Indianapolis, IN, USA
| | - Jessica R Allegretti
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Luca Masucci
- Microbiology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Faming Zhang
- Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Josbert Keller
- Department of Gastroenterology, Haaglanden Medical Center, The Hague, Netherlands; Netherlands Donor Feces Bank, Leiden University Medical Center, Leiden, Netherlands
| | - Maurizio Sanguinetti
- Microbiology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Samuel P Costello
- Department of Gastroenterology, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, and Metabolism, Innsbruck Medical University, Innsbruck, Austria
| | - Antonio Gasbarrini
- Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanni Cammarota
- Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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30
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Alderwish E, Schultz E, Kassam Z, Poon M, Coplan N. Evaluation of acute chest pain: Evolving paradigm of coronary risk scores and imaging. Rev Cardiovasc Med 2019; 20:231-244. [PMID: 31912714 DOI: 10.31083/j.rcm.2019.04.589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/23/2019] [Indexed: 11/06/2022] Open
Abstract
There is a broad differential diagnosis for patients presenting with acute chest pain. History, physical examination, electrocardiogram, and serial troponin assays are pivotal in assessing patients with suspected acute coronary syndrome. However, if the initial workup is equivocal, physicians are faced with a challenge to find the optimal strategy for further triage. Risk stratification scores have been validated for patients with known acute coronary syndrome, such as the TIMI and GRACE scores, but there may be limitations in undifferentiated chest pain patients. Advancements in imaging modalities such as coronary computed tomography angiography and the addition CT derived fractional flow reserve, have demonstrated utility in evaluating patients presenting with acute chest pain. With this article, we aim to provide a comprehensive review of the non-invasive modalities that are available to evaluate acute chest pain patients suspected of cardiac etiology in the emergency room. We also added a focus on new imaging modalities that have shown to have prognostic implications in stable ischemic heart disease.
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Affiliation(s)
- Edris Alderwish
- Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY, 10075, USA
| | - Emily Schultz
- Department of Medicine, Lenox Hill Hospital, Northwell Health, New York, NY, 10075, USA
| | - Zain Kassam
- Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY, 10075, USA
| | - Michael Poon
- Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY, 10075, USA
| | - Neil Coplan
- Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY, 10075, USA
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31
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Cammarota G, Ianiro G, Kelly CR, Mullish BH, Allegretti JR, Kassam Z, Putignani L, Fischer M, Keller JJ, Costello SP, Sokol H, Kump P, Satokari R, Kahn SA, Kao D, Arkkila P, Kuijper EJ, Vehreschild MJG, Pintus C, Lopetuso L, Masucci L, Scaldaferri F, Terveer EM, Nieuwdorp M, López-Sanromán A, Kupcinskas J, Hart A, Tilg H, Gasbarrini A. International consensus conference on stool banking for faecal microbiota transplantation in clinical practice. Gut 2019; 68:2111-2121. [PMID: 31563878 PMCID: PMC6872442 DOI: 10.1136/gutjnl-2019-319548] [Citation(s) in RCA: 245] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/10/2019] [Accepted: 09/22/2019] [Indexed: 12/13/2022]
Abstract
Although faecal microbiota transplantation (FMT) has a well-established role in the treatment of recurrent Clostridioides difficile infection (CDI), its widespread dissemination is limited by several obstacles, including lack of dedicated centres, difficulties with donor recruitment and complexities related to regulation and safety monitoring. Given the considerable burden of CDI on global healthcare systems, FMT should be widely available to most centres.Stool banks may guarantee reliable, timely and equitable access to FMT for patients and a traceable workflow that ensures safety and quality of procedures. In this consensus project, FMT experts from Europe, North America and Australia gathered and released statements on the following issues related to the stool banking: general principles, objectives and organisation of the stool bank; selection and screening of donors; collection, preparation and storage of faeces; services and clients; registries, monitoring of outcomes and ethical issues; and the evolving role of FMT in clinical practice,Consensus on each statement was achieved through a Delphi process and then in a plenary face-to-face meeting. For each key issue, the best available evidence was assessed, with the aim of providing guidance for the development of stool banks in order to promote accessibility to FMT in clinical practice.
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Affiliation(s)
- Giovanni Cammarota
- Internal Medicine and Gastroenterology, Day Hospital of Gastroenterology and Intestinal Microbiota Transplantation, Fondazione Policlinico A Gemelli IRCCS, Catholic University of Medicine, Roma, Italy
| | - Gianluca Ianiro
- Internal Medicine and Gastroenterology, Day Hospital of Gastroenterology and Intestinal Microbiota Transplantation, Fondazione Policlinico A Gemelli IRCCS, Roma, Italy
| | - Colleen R Kelly
- Division of Gastroenterology, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Benjamin H Mullish
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Jessica R Allegretti
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Zain Kassam
- Microbiome Informatics, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- OpenBiome, Somerville, Massachusetts, United States of America
| | - Lorenza Putignani
- Parasitology Unit and Human Microbiome Unit, Bambino Gesù Pediatric Hospital, Roma, Italy
| | - Monika Fischer
- Department of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Josbert J Keller
- Department of Gastroenterologyand Hepatology, Haaglanden Medical Center, 2597 AX, The Hague, Netherlands
- National Donor Feces Bank, LUMC, Leiden, the Netherlands
| | - Samuel Paul Costello
- Department of Gastroenterology, The Queen Elizabeth Hospital, University of Adelaide, Woodville, South Australia, Australia
| | - Harry Sokol
- Service de Gastroenterologie, Hôpital Saint Antoine, Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, Paris, France
- French Group of Fecal Microbiota Transplantation, Paris, France
- INRA, UMR1319 Micalis, AgroParisTech, Jouy-en-Josas, France
| | - Patrizia Kump
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Reetta Satokari
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Stacy A Kahn
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, Uunited States of America
| | - Dina Kao
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Perttu Arkkila
- Department of Clinic of Gastroenterology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ed J Kuijper
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Maria J Gt Vehreschild
- Department I of Internal Medicine; German Centre for Infection Research, Partner site Bonn-Cologne, University Hospital of Cologne, Cologne, Germany
| | - Cristina Pintus
- Tissues and Cells Area, Italian National Transplant Center, Rome, Italy
| | - Loris Lopetuso
- Internal Medicine and Gastroenterology, Fondazione Policlinico A Gemelli IRCCS, Roma, Italy
| | - Luca Masucci
- Microbiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Medicine, Roma, Italy
| | - Franco Scaldaferri
- Internal Medicine and Gastroenterology, Fondazione Policlinico A Gemelli IRCCS, Roma, Italy
| | - E M Terveer
- National Donor Feces Bank, LUMC, Leiden, the Netherlands
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Max Nieuwdorp
- Department of Internal Medicine, Amsterdam University Medical Centers, location AMC and VuMC, Amsterdam, Netherlands
| | - Antonio López-Sanromán
- Gastroenterology and Hepatology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Juozas Kupcinskas
- Department of Gastroenterology, Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ailsa Hart
- Department of Gastroenterology, St Mark's Hospital, London, United Kingdom
| | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Endocrinology & Metabolism, Innsbruck Medical University, Innsbruck, Austria
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology, Fondazione Policlinico A Gemelli IRCCS, Catholic University of Medicine, Roma, Italy
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32
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Kassam Z, Dubois N, Ramakrishna B, Ling K, Qazi T, Smith M, Kelly CR, Fischer M, Allegretti JR, Budree S, Panchal P, Kelly CP, Osman M. Donor Screening for Fecal Microbiota Transplantation. N Engl J Med 2019; 381:2070-2072. [PMID: 31665572 DOI: 10.1056/nejmc1913670] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | | | | | | | - Colleen R Kelly
- Warren Alpert Medical School of Brown University, Providence, RI
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33
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Allegretti JR, Kao D, Sitko J, Fischer M, Kassam Z. Early Antibiotic Use After Fecal Microbiota Transplantation Increases Risk of Treatment Failure. Clin Infect Dis 2019; 66:134-135. [PMID: 29020157 DOI: 10.1093/cid/cix684] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 07/28/2017] [Indexed: 12/30/2022] Open
Abstract
Antibiotic use within the first 8 weeks after fecal microbiota transplantation (FMT) may disrupt microbial engraftment and limit FMT effectiveness. We aimed to assess the burden of antibiotic use within 8 weeks of FMT and its impact on FMT efficacy.
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Affiliation(s)
- Jessica R Allegretti
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Dina Kao
- Division of Gastroenterology, University of Alberta Zeidler Ledcor Centre, Edmonton, Canada
| | - Jessica Sitko
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Monika Fischer
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis
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34
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Liu W, Fakir H, Randhawa G, Kassam Z, Chung H, Chung P, Ward A, Zukotynski K, Emmett L, Bauman G. DRIVE: Defining Radiorecurrent Intraprostatic Target Volumes. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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35
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Gutin L, Piceno Y, Fadrosh D, Lynch K, Zydek M, Kassam Z, LaMere B, Terdiman J, Ma A, Somsouk M, Lynch S, El-Nachef N. Fecal microbiota transplant for Crohn disease: A study evaluating safety, efficacy, and microbiome profile. United European Gastroenterol J 2019; 7:807-814. [PMID: 31316785 PMCID: PMC6620877 DOI: 10.1177/2050640619845986] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/29/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Emerging trials suggest fecal microbiota transplantation (FMT) is a promising treatment for ulcerative colitis; however, there is a paucity of data in Crohn disease (CD). OBJECTIVE The objectives of this article are to determine whether single-dose FMT improves clinical and endoscopic outcomes in CD patients and to identify meaningful changes in the microbiome in response to FMT. METHODS We performed a prospective, open-label, single-center study. Ten CD patients underwent FMT and were evaluated for clinical response (defined as decrease in Harvey-Bradshaw Index score ≥3 at one month post-FMT) and microbiome profile (16S ribosomal RNA sequencing) at one month post-FMT. RESULTS Three of 10 patients responded to FMT. Two of 10 patients had significant adverse events requiring escalation of therapy. On microbiome analysis, bacterial communities of responders had increased relative abundance of bacteria commonly found in donor gut microbiota. CONCLUSIONS Single-dose FMT in this cohort of CD patients showed modest effect and potential for harm. Responders tended to have lower baseline alpha diversity, suggesting baseline perturbation of microbiota may be an indicator of potential responders to FMT in this patient population. Controlled trials are needed to further assess the efficacy and safety of FMT in CD and determine whether FMT is a viable option in this patient population.Clinicaltrials.gov number: NCT02460705.
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Affiliation(s)
- Liat Gutin
- Department of Medicine, University of
California San Francisco, San Francisco, CA, USA
| | - Yvette Piceno
- Division of Gastroenterology, University
of California San Francisco, San Francisco, CA, USA
| | - Douglas Fadrosh
- Division of Gastroenterology, University
of California San Francisco, San Francisco, CA, USA
| | - Kole Lynch
- Division of Gastroenterology, University
of California San Francisco, San Francisco, CA, USA
| | - Martin Zydek
- Division of Gastroenterology, University
of California San Francisco, San Francisco, CA, USA
| | | | - Brandon LaMere
- Division of Gastroenterology, University
of California San Francisco, San Francisco, CA, USA
| | - Jonathan Terdiman
- Division of Gastroenterology, University
of California San Francisco, San Francisco, CA, USA
| | - Averil Ma
- Division of Gastroenterology, University
of California San Francisco, San Francisco, CA, USA
| | - Ma Somsouk
- Division of Gastroenterology, Zuckerberg
San Francisco General Hospital, San Francisco, CA, USA
| | - Susan Lynch
- Division of Gastroenterology, University
of California San Francisco, San Francisco, CA, USA
| | - Najwa El-Nachef
- Division of Gastroenterology, University
of California San Francisco, San Francisco, CA, USA,Najwa El-Nachef, University of California
San Francisco, Division of Gastroenterology, 505 Parnassus Ave, Box 0119, M1479,
San Francisco, CA 94143-0119.
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36
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Allegretti JR, Fischer M, Sagi SV, Bohm ME, Fadda HM, Ranmal SR, Budree S, Basit AW, Glettig DL, de la Serna EL, Gentile A, Gerardin Y, Timberlake S, Sadovsky R, Smith M, Kassam Z. Fecal Microbiota Transplantation Capsules with Targeted Colonic Versus Gastric Delivery in Recurrent Clostridium difficile Infection: A Comparative Cohort Analysis of High and Lose Dose. Dig Dis Sci 2019; 64:1672-1678. [PMID: 30519847 DOI: 10.1007/s10620-018-5396-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 11/24/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Fecal microbiota transplantation (FMT) is an effective therapy for recurrent Clostridium. difficile infection (rCDI). FMT capsules have emerged, and it is unknown if delivery location and dose impact efficacy. METHODS We compared two cohorts of patients receiving two capsule formulations: gastric release (FMTgr) and targeted colonic release (FMTcr) at two different sites. Cohort A received FMTgr at (1) high dose: 60 capsules and low dose: 30 capsules. Patients in Cohort B received FMTcr at (1) high dose: 30 capsules (2) low dose: 10 capsules. Clinical cure rates and adverse events were monitored through week 8. Paired t-tests were used to compare diversity pre- and post-FMT. RESULTS 51 rCDI patients were enrolled. Cohort A contained n = 20 and Cohort B contained n = 31. Overall cure at week 8 for FMTgr was 75% (15/20) compared to 80.6% for FMTcr, (25/31), p = 0.63. Both formulations were safe with no serious adverse events. FMTcr was superior at increasing gut microbial diversity. DISCUSSION To our knowledge, this is the first study to compare targeted delivery of FMT capsules. While both capsules were safe and efficacious, microbial engraftment patterns were superior in FMTcr.
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Affiliation(s)
- Jessica R Allegretti
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Monika Fischer
- Division of Gastroenterology, Indiana University, Indianapolis, IN, USA
| | - Sashidhar V Sagi
- Division of Gastroenterology, Indiana University, Indianapolis, IN, USA
| | - Matthew E Bohm
- Division of Gastroenterology, Indiana University, Indianapolis, IN, USA
| | - Hala M Fadda
- College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN, USA
| | | | - Shrish Budree
- OpenBiome, Somerville, MA, USA.,University of Cape Town, Cape Town, South Africa
| | - Abdul W Basit
- Intract Pharma, London, UK.,School of Pharmacy, University College London, London, UK
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37
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Allegretti JR, Kao D, Phelps E, Roach B, Smith J, Ganapini VC, Kassam Z, Xu H, Fischer M. Risk of Clostridium difficile Infection with Systemic Antimicrobial Therapy Following Successful Fecal Microbiota Transplant: Should We Recommend Anti-Clostridium difficile Antibiotic Prophylaxis? Dig Dis Sci 2019; 64:1668-1671. [PMID: 30632052 DOI: 10.1007/s10620-018-5450-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 12/29/2018] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The risk of a new Clostridium difficile infection (CDI) after FMT is unknown if non-CDI antibiotics are required. It is uncertain if anti-CDI prophylaxis or probiotics would reduce risk. We therefore aimed to compare the risk of CDI with and without antibiotic exposure and the benefit of concomitant anti-CDI antibiotic or probiotic prophylaxis. METHODS This is a multicenter retrospective study carried out at three large FMT referral centers of patients who underwent FMT for recurrent CDI. Patients were assessed for antibiotic use, as well as concomitant use of prophylactic anti-CDI antibiotics or probiotics. Time to CDI recurrence after FMT was evaluated using the Kaplan-Meier method. RESULTS A total of 404 patients were included: 63% were females, with a mean age of 61.3 ± 18.8 years. Mean length of post-FMT follow-up was 18.1 ± 11.9 months (range 2.2-45.2). Among the entire cohort 8.1% (n = 33) experienced a CDI recurrence. Overall, 111 patients (27.4%) used a non-CDI antibiotic, of which 16.2% (n = 18) experienced a CDI recurrence. Patients who used non-CDI antibiotics were more likely to develop CDI (HR 8.44, 95% CI 4.21-16.93, p < 0.001). The risk of CDI recurrence was not different between patients who received anti-CDI antibiotic prophylaxis to those who did not (HR = 1.88, 95% CI 0.72-4.86, p = 0.2); however, probiotic prophylaxis was associated with a greater risk of CDI recurrence (HR = 2.65, 95% CI 1.02-6.86, p = 0.045). CONCLUSION Non-CDI antibiotic use was not uncommon after successful FMT and significantly increased the risk of a new episode of CDI. In this study, we found that the prophylactic use of anti-CDI antibiotics or probiotics was not protective.
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Affiliation(s)
- Jessica R Allegretti
- Division of Gastroenterology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Dina Kao
- Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, Edmonton, AB, Canada
| | - Emmalee Phelps
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN, USA
| | - Brandi Roach
- Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, Edmonton, AB, Canada
| | - Justin Smith
- Division of Gastroenterology, Zeidler Ledcor Centre, University of Alberta, Edmonton, AB, Canada
| | - Vincent C Ganapini
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN, USA
| | | | - Huiping Xu
- Department of Biostatistics, The Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Monika Fischer
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN, USA
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Bajaj JS, Fagan A, Gavis EA, Kassam Z, Sikaroodi M, Gillevet PM. Long-term Outcomes of Fecal Microbiota Transplantation in Patients With Cirrhosis. Gastroenterology 2019; 156:1921-1923.e3. [PMID: 30664879 PMCID: PMC6475479 DOI: 10.1053/j.gastro.2019.01.033] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, Virginia.
| | - Andrew Fagan
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA
| | - Edith A Gavis
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA
| | - Zain Kassam
- Finch Therapeutics Group, Somerville, Massachusetts, USA
| | - Masoumeh Sikaroodi
- Microbiome Analysis Center, George Mason University, Manassas, Virginia, USA
| | - Patrick M Gillevet
- Microbiome Analysis Center, George Mason University, Manassas, Virginia, USA
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Herfarth H, Barnes EL, Long MD, Isaacs KL, Leith T, Silverstein M, Gerardin Y, Kassam Z. Combined Endoscopic and Oral Fecal Microbiota Transplantation in Patients with Antibiotic-Dependent Pouchitis: Low Clinical Efficacy due to Low Donor Microbial Engraftment. Inflamm Intest Dis 2019; 4:1-6. [PMID: 31172007 DOI: 10.1159/000497042] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/15/2019] [Indexed: 12/14/2022] Open
Abstract
Background and Objective A significant number of pouch patients develop antibiotic-dependent pouchitis (ADP). Microbial dysbiosis is thought to be a major driver of clinical symptoms in ADP. The objective of this proof of concept study was to evaluate safety, efficacy, and donor microbial engraftment of an intensified fecal microbiota transplant (FMT) consisting of a single endoscopic FMT followed by daily oral FMT for 2 weeks in patients with ADP. Methods We performed a prospective placebo-controlled double-blind FMT trial in patents with established ADP and planned to enroll 20 patients in this proof of concept study. In case of non-response, patients were offered an optional open label active FMT treatment. The endpoints were safety, clinical remission without need for antibiotics during 16 weeks of follow-up, quantitative changes of fecal calprotectin (FCP), and engraftment of donor FMT as determined by metagenomic sequencing of the V4 region of the 16S rRNA gene. Results Due to a lower than expected clinical remission rate and low FMT engraftment, enrollment in the study was stopped prematurely after 6 patients were included. All 6 patients enrolled in the placebo-controlled portion failed to respond and needed antibiotic rescue therapy shortly after FMT. FCP increased in the majority of patients in the setting of relapse after FMT. In the active open label FMT extension study 1 out of 5 patients achieved antibiotic-free clinical remission. FMT engraftment after active FMT was observed only in this single patient, whereas engraftment of donor FMT occurred in none of the other patients receiving active FMT, paralleling the lack of clinical response. Conclusions Low donor FMT engraftment resulted in low clinical efficacy of FMT in patients with ADP. Before embarking on larger clinical trials with FMT in patients with ADP or other forms of pouchitis, it is mandatory to explore approaches for superior FMT engraftment.
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Affiliation(s)
- Hans Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.,University of North Carolina Multidisciplinary Center for Inflammatory Bowel Diseases, Chapel Hill, North Carolina, USA
| | - Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.,University of North Carolina Multidisciplinary Center for Inflammatory Bowel Diseases, Chapel Hill, North Carolina, USA
| | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.,University of North Carolina Multidisciplinary Center for Inflammatory Bowel Diseases, Chapel Hill, North Carolina, USA
| | - Kim L Isaacs
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA.,University of North Carolina Multidisciplinary Center for Inflammatory Bowel Diseases, Chapel Hill, North Carolina, USA
| | - Tom Leith
- OpenBiome, Somerville, Massachusetts, USA
| | | | | | - Zain Kassam
- OpenBiome, Somerville, Massachusetts, USA.,Finch Therapeutics Group, Somerville, Massachusetts, USA
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40
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Rai RS, Tirona R, Kassam Z, Beaton MD. A196 A COMPARISON OF LIVER FIBROSIS AND SIMPLE STEATOSIS ASSESSMENT USING GADOXETIC-ACID ENHANCED MRI WITH MR ELASTOGRAPHY AND MRI FAT FRACTION. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R S Rai
- Gastroenterology, Western University, London, ON, Canada
| | - R Tirona
- Gastroenterology, Western University, London, ON, Canada
| | - Z Kassam
- Gastroenterology, Western University, London, ON, Canada
| | - M D Beaton
- Gastroenterology & Hepatology, London Health Sciences Centre, London, ON, Canada
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Cheng YW, Phelps E, Ganapini V, Khan N, Ouyang F, Xu H, Khanna S, Tariq R, Friedman-Moraco RJ, Woodworth MH, Dhere T, Kraft CS, Kao D, Smith J, Le L, El-Nachef N, Kaur N, Kowsika S, Ehrlich A, Smith M, Safdar N, Misch EA, Allegretti JR, Flynn A, Kassam Z, Sharfuddin A, Vuppalanchi R, Fischer M. Fecal microbiota transplantation for the treatment of recurrent and severe Clostridium difficile infection in solid organ transplant recipients: A multicenter experience. Am J Transplant 2019; 19:501-511. [PMID: 30085388 PMCID: PMC6349556 DOI: 10.1111/ajt.15058] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023]
Abstract
Fecal microbiota transplant (FMT) is recommended for Clostridium difficile infection (CDI) treatment; however, use in solid organ transplantation (SOT) patients has theoretical safety concerns. This multicenter, retrospective study evaluated FMT safety, effectiveness, and risk factors for failure in SOT patients. Primary cure and overall cure were defined as resolution of diarrhea or negative C difficile stool test after a single FMT or after subsequent FMT(s) ± anti-CDI antibiotics, respectively. Ninety-four SOT patients underwent FMT, 78% for recurrent CDI and 22% for severe or fulminant CDI. FMT-related adverse events (AE) occurred in 22.3% of cases, mainly comprising self-limiting conditions including nausea, abdominal pain, and FMT-related diarrhea. Severe AEs occurred in 3.2% of cases, with no FMT-related bacteremia. After FMT, 25% of patients with underlying inflammatory bowel disease had worsening disease activity, while 14% of cytomegalovirus-seropositive patients had reactivation. At 3 months, primary cure was 58.7%, while overall cure was 91.3%. Predictors of failing a single FMT included inpatient status, severe and fulminant CDI, presence of pseudomembranous colitis, and use of non-CDI antibiotics at the time of FMT. These data suggest FMT is safe in SOT patients. However, repeated FMT(s) or additional antibiotics may be needed to optimize rates of cure with FMT.
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Affiliation(s)
- Yao-Wen Cheng
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emmalee Phelps
- Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Vincent Ganapini
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Noor Khan
- Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fangqian Ouyang
- Department of Biostatistics, The Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Huiping Xu
- Department of Biostatistics, The Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Sahil Khanna
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Raseen Tariq
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Michael H. Woodworth
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Tanvi Dhere
- Division of Digestive Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Colleen S. Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA,Department of Pathology, Emory University, Atlanta, Georgia, USA
| | - Dina Kao
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Justin Smith
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lien Le
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Najwa El-Nachef
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nirmal Kaur
- Division of Gastroenterology, Department of Medicine, Henry Ford Medical Center, Detroit, MI, USA
| | - Sree Kowsika
- Division of Gastroenterology, Department of Medicine, Henry Ford Medical Center, Detroit, MI, USA
| | - Adam Ehrlich
- Division of Gastroenterology, Department of Medicine, Temple University, Philadelphia, PA, USA
| | - Michael Smith
- Division of Gastroenterology, Department of Medicine, Temple University, Philadelphia, PA, USA
| | - Nasia Safdar
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA,William S. Middleton Memorial Veterans Hospital, Madison WI, USA
| | - Elizabeth Ann Misch
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jessica R. Allegretti
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Ann Flynn
- Division of Gastroenterology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Asif Sharfuddin
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Raj Vuppalanchi
- Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Monika Fischer
- Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Santiago M, Eysenbach L, Allegretti J, Aroniadis O, Brandt LJ, Fischer M, Grinspan A, Kelly C, Morrow C, Rodriguez M, Osman M, Kassam Z, Smith MB, Timberlake S. Microbiome predictors of dysbiosis and VRE decolonization in patients with recurrent C. difficile infections in a multi-center retrospective study. AIMS Microbiol 2019; 5:1-18. [PMID: 31384699 PMCID: PMC6646931 DOI: 10.3934/microbiol.2019.1.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/23/2018] [Indexed: 12/27/2022] Open
Abstract
The gastrointestinal microbiome is intrinsically linked to the spread of antibiotic resistance. Antibiotic treatment puts patients at risk for colonization by opportunistic pathogens like vancomycin resistant Enterococcus and Clostridioides difficile by destroying the colonization resistance provided by the commensal microbiota. Once colonized, the host is at a much higher risk for infection by that pathogen. Furthermore, we know that microbiome community differences are associated with disease states, but we do not have a good understanding of how we can use these changes to classify different patient populations. To that end, we have performed a multicenter retrospective analysis on patients who received fecal microbiota transplants to treat recurrent Clostridioides difficile infection. We performed 16S rRNA gene sequencing on fecal samples collected as part of this study and used these data to develop a microbiome disruption index. Our microbiome disruption index is a simple index that is predictive across cohorts, indications, and batch effects. We are able to classify pre-fecal transplant vs post-fecal transplant samples in patients with recurrent C. difficile infection, and we are able to predict, using previously-published data from a cohort of patients receiving hematopoietic stem cell transplants, which patients would go on to develop bloodstream infections. Finally, we also identified patients in this cohort that were initially colonized with vancomycin resistant Enterococcus and that 92% (11/12) were decolonized after the transplant, but the microbiome disruption index was unable to predict such decolonization. We, however, were able to compare the relative abundance of different taxa between the two groups, and we found that increased abundance of Enterobacteriaceae predicts whether patients were colonized with vancomycin resistant Enterococcus. This work is an early step towards a better understanding of how microbiome predictors can be used to help improve patient care and patient outcomes.
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Affiliation(s)
- Marina Santiago
- Finch Therapeutics, 200 Inner Belt Rd, Somerville, MA 02143, USA
| | | | - Jessica Allegretti
- Division of Gastroenterology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Olga Aroniadis
- Department of Medicine (Gastroenterology), Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, USA
| | - Lawrence J Brandt
- Department of Medicine (Gastroenterology), Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, USA
| | - Monika Fischer
- Division of Gastroenterology, Indiana University School of Medicine, 340 W. 10th St, Indianapolis, IN 46202, USA
| | - Ari Grinspan
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
| | - Colleen Kelly
- Women's Medicine Collaborative, Brown Alpert Medial School, 222 Richmond St, Providence, RI 02903, USA
| | - Casey Morrow
- Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL 35294, USA
| | - Martin Rodriguez
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, 1670 University Blvd, Birmingham, AL 35233, USA
| | - Majdi Osman
- OpenBiome, 2067 Massachusetts Ave, Cambridge, MA 02140, USA
| | - Zain Kassam
- Finch Therapeutics, 200 Inner Belt Rd, Somerville, MA 02143, USA
| | - Mark B Smith
- Finch Therapeutics, 200 Inner Belt Rd, Somerville, MA 02143, USA
| | - Sonia Timberlake
- Finch Therapeutics, 200 Inner Belt Rd, Somerville, MA 02143, USA
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43
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Hundal R, Kassam Z, Johnstone J, Lee C, Marshall JK. Fecal transplantation for recurrent or refractory Clostridium difficile diarrhea. Cochrane Database of Systematic Reviews 2018. [DOI: 10.1002/14651858.cd009295.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rajveer Hundal
- McMaster University; PGY-1 Internal Medicine; Hamilton ON Canada
| | - Zain Kassam
- McMaster University; PGY-2 Internal Medicine; Hamilton ON Canada
| | - Jennie Johnstone
- McMaster University; 3200 MDCL; 1200 Main Street West Hamilton ON Canada L8N 3Z5
| | - Christine Lee
- McMaster University; St. Joseph's Healthcare; 424 Luke Wing 50 Charlton Ave. East Hamilton ON Canada L8N 4A6
| | - John K Marshall
- McMaster University; Department of Medicine, Division of Gastroenterology; 1280 Main Street West 2F59 Hamilton, Ontario Canada L8S 4K1
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Kassam Z, Brinster D, Poon M, Conroy JM, Kronzon I. Mechanical prosthetic valve malfunction diagnosed by gated non-contrast computed tomography. Eur Heart J Cardiovasc Imaging 2018; 19:1428. [PMID: 30203069 DOI: 10.1093/ehjci/jey124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zain Kassam
- Department of Cardiovascular Medicine, Lenox Hill Hospital, Northwell Health, 100 E 77th street, 2nd Floor, New York, NY, USA
| | - Derek Brinster
- Department of Cardiovascular Medicine, Lenox Hill Hospital, Northwell Health, 100 E 77th street, 2nd Floor, New York, NY, USA
| | - Michael Poon
- Department of Cardiovascular Medicine, Lenox Hill Hospital, Northwell Health, 100 E 77th street, 2nd Floor, New York, NY, USA
| | - Jennifer M Conroy
- Department of Cardiovascular Medicine, Lenox Hill Hospital, Northwell Health, 100 E 77th street, 2nd Floor, New York, NY, USA
| | - Itzhak Kronzon
- Department of Cardiovascular Medicine, Lenox Hill Hospital, Northwell Health, 100 E 77th street, 2nd Floor, New York, NY, USA
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45
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Budree S, Osman M, Panchal P, Shu E, Carrellas M, Kassam Z, Allegretti J. 618. Do Clinical Factors Affect Microbial Engraftment After Fecal Microbiota Transplantation in Recurrent Clostridium difficile Infection? Open Forum Infect Dis 2018. [PMCID: PMC6254229 DOI: 10.1093/ofid/ofy210.625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Fecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection (rCDI). Few studies have evaluated clinical factors associated with microbial engraftment. We describe microbial changes post-FMT and clinical factors impacting engraftment. Methods Patients undergoing FMT for rCDI via colonoscopy were enrolled. Clinical data and stool were collected pre- and 8 weeks post-FMT. Microbial profiles were assessed by 16S rRNA sequencing. Difference in microbial alpha and β-diversity between groups was determined. Significance testing was assessed using Mann–Whitney–Wilcoxon and PERMANOVA tests. The Jensen Shannon divergence (JSD) between donor and their recipient post-FMT was used as a measure of engraftment. The association of clinical factors on engraftment was evaluated by linear regression. Results A total of 12 patients received an FMT from 12 unique donors. The efficacy rate was 92%. Mean recipient age was 60 years (range: 33–87) with more females (7/12). Recipients pre-FMT alpha diversity was significantly lower compare to donors (P = 0.04, Figure 1a). This difference dissipated post-FMT (P = 0.67). On β-diversity analysis, the recipients pre-FMT samples clustered separately from their post-FMT samples (P = 0.01, Figure 1b), with the post-FMT samples shifting closer to the donor samples. Proteobacteria was dominant in patients’ pre-FMT samples and were substantially reduced post-FMT, combined with an expansion in Bacteroidetes (Figure 2). On linear regression analysis, clinical factors (age, sex, previous recurrent CDI episodes, inflammatory bowel disease, proton pump inhibitor, immunosuppression, previous anti-CDI antibiotic courses, probiotics) were not significantly associated with engraftment outcomes. Conclusion There is a significant and durable shift in recipients’ microbial profile to resemble their donor post-FMT. Recipients’ pre-FMT clinical factors did not significantly affect microbial engraftment. Future metagenomic studies may help elucidate whether clinical factors impact engraftment. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Shrish Budree
- OpenBiome, Somerville, Massachusetts
- Pediatrics, University of Cape Town, Cape Town, South Africa
| | | | | | - Edina Shu
- Gastroenterology, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Zain Kassam
- Finch Therapeutics, Somerville, Massachusetts
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46
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Panchal P, Kahn S, Zellmer C, Kassam Z, Osman M, Allegretti J, Seng M, Budree S. 533. Scaling Pediatric Access to Fecal Microbiota Transplantation in the United States: A Time-Series Geospatial Analysis. Open Forum Infect Dis 2018. [PMCID: PMC6255084 DOI: 10.1093/ofid/ofy210.542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The rising prevalence of recurrent Clostridium difficile infection (CDI) in pediatrics is a public health concern. Fecal microbiota transplantation (FMT) is an effective treatment and is recommended in US guidelines. Universal stool banks (USB) have enabled widespread FMT access among adult patients; however, the progression of FMT uptake in pediatrics is unknown. We present a geospatial timeseries analysis of growth in pediatric FMT providers within the United States between 2013 and 2018. Methods A list of healthcare facilities associated with a USB and an FMT special interest group was geocoded using Google Maps. Spatial network analysis methods were used to create drive-time polygons for each healthcare facility with simulated traffic for 12 pm on a Wednesday. US Census data were used to estimate the percentage population living within 1, 2, and 4-hour drive time to a pediatric FMT provider cumulatively from 2013 to March 2018. Results Between 2013 and 2018, there was a rapid expansion in access to FMT to include 45 pediatric healthcare facilities (Figure 1). As of March 2018, 40.51% of the US population lives within a 1-hour drive, 62.73% within a 2-hour drive, and 89.38% within a 4-hour drive of an FMT provider (Table 1). The largest percentage increases in access occurred between 2013 and 2014 (28.43% increase within a 1-hour drive time). These 45 FMT providers include 6 community hospitals, seven private practices, and 32 academic centers. Conclusion Although these results demonstrate a rise in pediatric FMT providers across the United States, there remains a significant discrepancy in access between adult and pediatric populations, despite growing evidence of safety and efficacy of FMT. Additional efforts are needed to address barriers to FMT and improve access for pediatric patients with recurrent CDI. Disclosures P. Panchal, OpenBiome: Employee, Salary.
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Affiliation(s)
- Pratik Panchal
- OpenBiome, Somerville, Massachusetts
- Global Health and Population, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts
| | - Stacy Kahn
- Boston Children’s Hospital, Boston, Massachusetts
| | | | - Zain Kassam
- OpenBiome, Somerville, Massachusetts
- Finch Therapeutics, Somerville, Massachusetts
| | | | | | | | - Shrish Budree
- OpenBiome, Somerville, Massachusetts
- Pediatrics, University of Cape Town, Cape Town, South Africa
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Allegretti JR, Allegretti AS, Phelps E, Xu H, Fischer M, Kassam Z. Classifying Fecal Microbiota Transplantation Failure: An Observational Study Examining Timing and Characteristics of Fecal Microbiota Transplantation Failures. Clin Gastroenterol Hepatol 2018; 16:1832-1833. [PMID: 29104129 DOI: 10.1016/j.cgh.2017.10.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/21/2017] [Accepted: 10/24/2017] [Indexed: 02/07/2023]
Abstract
Fecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection (rCDI), with cure rates higher than 80%.1-3 FMT failure is defined as diarrhea and a positive stool laboratory test for C difficile at any point during the 8-week follow-up period after FMT.4.
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Affiliation(s)
- Jessica R Allegretti
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Andrew S Allegretti
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Emmalee Phelps
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana
| | - Huiping Xu
- Department of Biostatistics, The Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, Indiana
| | - Monika Fischer
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana
| | - Zain Kassam
- OpenBiome, Somerville, Massachusetts; Massachusetts Institute of Technology, Cambridge, Massachusetts
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Razik R, Osman M, Lieberman A, Allegretti JR, Kassam Z. Faecal microbiota transplantation for <em>Clostridium difficile</em> infection: a multicentre study of non-responders. Med J Aust 2018; 207:159-160. [PMID: 28814217 DOI: 10.5694/mja16.01452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/01/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Alexandra Lieberman
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Gurry T, Gibbons SM, Nguyen LTT, Kearney SM, Ananthakrishnan A, Jiang X, Duvallet C, Kassam Z, Alm EJ. Predictability and persistence of prebiotic dietary supplementation in a healthy human cohort. Sci Rep 2018; 8:12699. [PMID: 30139999 PMCID: PMC6107591 DOI: 10.1038/s41598-018-30783-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/26/2018] [Indexed: 01/05/2023] Open
Abstract
Dietary interventions to manipulate the human gut microbiome for improved health have received increasing attention. However, their design has been limited by a lack of understanding of the quantitative impact of diet on a host’s microbiota. We present a highly controlled diet perturbation experiment in a healthy, human cohort in which individual micronutrients are spiked in against a standardized background. We identify strong and predictable responses of specific microbes across participants consuming prebiotic spike-ins, at the level of both strains and functional genes, suggesting fine-scale resource partitioning in the human gut. No predictable responses to non-prebiotic micronutrients were found. Surprisingly, we did not observe decreases in day-to-day variability of the microbiota compared to a complex, varying diet, and instead found evidence of diet-induced stress and an associated loss of biodiversity. Our data offer insights into the effect of a low complexity diet on the gut microbiome, and suggest that effective personalized dietary interventions will rely on functional, strain-level characterization of a patient’s microbiota.
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Affiliation(s)
- Thomas Gurry
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.,Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.,The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | | | - Sean M Gibbons
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.,Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.,The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Le Thanh Tu Nguyen
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.,Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Sean M Kearney
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.,Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Ashwin Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Xiaofang Jiang
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.,Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.,The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Claire Duvallet
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.,Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Zain Kassam
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.,OpenBiome, Somerville, MA, 02143, USA
| | - Eric J Alm
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA. .,Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA. .,The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA.
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50
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Fischer M, Kao D, Kassam Z, Smith J, Louie T, Sipe B, Torbeck M, Xu H, Ouyang F, Mozaffarian D, Allegretti JR. Stool Donor Body Mass Index Does Not Affect Recipient Weight After a Single Fecal Microbiota Transplantation for Clostridium difficile Infection. Clin Gastroenterol Hepatol 2018; 16:1351-1353. [PMID: 29246701 DOI: 10.1016/j.cgh.2017.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Monika Fischer
- Department of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Dina Kao
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | | | - Justin Smith
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Thomas Louie
- Division of Infectious Diseases, University of Calgary, Calgary, AB, Canada
| | | | - Michelle Torbeck
- Department of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Huiping Xu
- Department of Biostatistics, Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, Indiana
| | - Fangqian Ouyang
- Department of Biostatistics, Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, Indiana
| | - Dariush Mozaffarian
- Tufts Friedman School of Nutrition Science and Policy, Boston, Massachusetts
| | - Jessica R Allegretti
- Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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