Overcoming donor variability and risks associated with fecal microbiota transplants through bacteriophage-mediated treatments

From BugSigDB
Needs review
study design
Citation
PMID PubMed identifier for scientific articles.
DOI Digital object identifier for electronic documents.
URI
Authors
Rasmussen TS, Mao X, Forster S, Larsen SB, Von Münchow A, Tranæs KD, Brunse A, Larsen F, Mejia JLC, Adamberg S, Hansen AK, Adamberg K, Hansen CHF, Nielsen DS
Journal
Microbiome
Year
2024
BACKGROUND: Fecal microbiota transplantation (FMT) and fecal virome transplantation (FVT, sterile filtrated donor feces) have been effective in treating recurrent Clostridioides difficile infections, possibly through bacteriophage-mediated modulation of the gut microbiome. However, challenges like donor variability, costly screening, coupled with concerns over pathogen transfer (incl. eukaryotic viruses) with FMT or FVT hinder their wider clinical application in treating less acute diseases. METHODS: To overcome these challenges, we developed methods to broaden FVT's clinical application while maintaining efficacy and increasing safety. Specifically, we employed the following approaches: (1) chemostat-fermentation to reproduce the bacteriophage FVT donor component and remove eukaryotic viruses (FVT-ChP), (2) solvent-detergent treatment to inactivate enveloped viruses (FVT-SDT), and (3) pyronin-Y treatment to inhibit RNA virus replication (FVT-PyT). We assessed the efficacy of these processed FVTs in a C. difficile infection mouse model and compared them with untreated FVT (FVT-UnT), FMT, and saline. RESULTS: FVT-SDT, FVT-UnT, and FVT-ChP reduced the incidence of mice reaching the humane endpoint (0/8, 2/7, and 3/8, respectively) compared to FMT, FVT-PyT, and saline (5/8, 7/8, and 5/7, respectively) and significantly reduced the load of colonizing C. difficile cells and associated toxin A/B levels. There was a potential elimination of C. difficile colonization, with seven out of eight mice treated with FVT-SDT testing negative with qPCR. In contrast, all other treatments exhibited the continued presence of C. difficile. Moreover, the results were supported by changes in the gut microbiome profiles, cecal cytokine levels, and histopathological findings. Assessment of viral engraftment following FMT/FVT treatment and host-phage correlations analysis suggested that transfer of phages likely were an important contributing factor associated with treatment efficacy. CONCLUSIONS: This proof-of-concept study shows that specific modifications of FVT hold promise in addressing challenges related to donor variability and infection risks. Two strategies lead to treatments significantly limiting C. difficile colonization in mice, with solvent/detergent treatment and chemostat propagation of donor phages emerging as promising approaches. Video Abstract.

Experiment 1


Needs review

Curated date: 2024/11/14

Curator: Tosin

Revision editor(s): Tosin, Aleru Divine

Subjects

Location of subjects
Denmark
Host species Species from which microbiome was sampled. Contact us to have more species added.
Mus musculus
Body site Anatomical site where microbial samples were extracted from according to the Uber Anatomy Ontology
Feces Cow dung,Cow pat,Droppings,Dung,Excrement,Excreta,Faeces,Fecal material,Fecal matter,Fewmet,Frass,Guano,Matières fécales@fr,Merde@fr,Ordure,Partie de la merde@fr,Piece of shit,Porción de mierda@es,Portion of dung,Portion of excrement,Portion of faeces,Portion of fecal material,Portion of fecal matter,Portion of feces,Portion of guano,Portion of scat,Portionem cacas,Scat,Spoor,Spraint,Stool,Teil der fäkalien@de,Feces,feces
Condition The experimental condition / phenotype studied according to the Experimental Factor Ontology
Clostridium difficile infection clostridium difficile disease,Clostridium difficile infection,clostridium difficile infection
Group 0 name Corresponds to the control (unexposed) group for case-control studies
Mice Before Clostridioides difficile infection (CDI)
Group 1 name Corresponds to the case (exposed) group for case-control studies
Survived mice
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Mice that survived a Clostridioides difficile infection (CDI) followed by one of 4 FVT (fecal virome transplantation), FMT (fecal microbiota transplantaiton) or saline treatments until study termination.
Group 0 sample size Number of subjects in the control (unexposed) group
48
Group 1 sample size Number of subjects in the case (exposed) group
24

Lab analysis

Sequencing type
16S
16S variable region One or more hypervariable region(s) of the bacterial 16S gene
V3
Sequencing platform Manufacturer and experimental platform used for quantifying microbial abundance
Illumina

Statistical Analysis

Data transformation Data transformation applied to microbial abundance measurements prior to differential abundance testing (if any).
raw counts
Statistical test
DESeq2
Significance threshold p-value or FDR threshold used for differential abundance testing (if any)
0.05
MHT correction Have statistical tests be corrected for multiple hypothesis testing (MHT)?
Yes

Alpha Diversity

Shannon Estimator of species richness and species evenness: more weight on species richness
increased

Signature 1

Needs review

Curated date: 2024/11/16

Curator: Tosin

Revision editor(s): Tosin

Source: Figure 7A

Description: Differential abundance of significantly different bacterial taxa between Before CDI (Clostridioides difficile Infection) and Survived mice.

Abundance in Group 1: increased abundance in Survived mice

NCBI Quality ControlLinks
Akkermansia muciniphila
Bacillota
Clostridioides difficile
Clostridium
Turicibacter sanguinis

Revision editor(s): Tosin

Signature 2

Needs review

Curated date: 2024/11/16

Curator: Tosin

Revision editor(s): Tosin

Source: Figure 7A

Description: Differential abundance of significantly different bacterial taxa Between Before CDI (Clostridioides difficile infection) and Survived mice.

Abundance in Group 1: decreased abundance in Survived mice

NCBI Quality ControlLinks
Bacteroides thetaiotaomicron
Enterococcus
Enterococcus canintestini
Escherichia fergusonii
Lactobacillus taiwanensis
Limosilactobacillus vaginalis
Parabacteroides goldsteinii
Parasutterella excrementihominis

Revision editor(s): Tosin

Experiment 2


Needs review

Curated date: 2024/11/14

Curator: Tosin

Revision editor(s): Tosin, Aleru Divine

Differences from previous experiment shown

Subjects

Group 1 name Corresponds to the case (exposed) group for case-control studies
Euthanized mice
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Mice that reached a humane endpoint and were euthanized before the intended study termination date.
Group 1 sample size Number of subjects in the case (exposed) group
23

Lab analysis

Statistical Analysis

Alpha Diversity

Shannon Estimator of species richness and species evenness: more weight on species richness
increased

Signature 1

Needs review

Curated date: 2024/11/16

Curator: Tosin

Revision editor(s): Tosin

Source: Figure 7B

Description: Differential abundance of significantly different bacterial taxa between Before CDI (Clostridioides difficile Infection) and euthanized mice.

Abundance in Group 1: increased abundance in Euthanized mice

NCBI Quality ControlLinks
Akkermansia muciniphila
Bacteroides
Clostridioides difficile

Revision editor(s): Tosin

Signature 2

Needs review

Curated date: 2024/11/16

Curator: Tosin

Revision editor(s): Tosin

Source: Figure 7B

Description: Differential abundance of significantly different bacterial taxa between Before CDI (Clostridioides difficile Infection) and euthanized mice.

Abundance in Group 1: decreased abundance in Euthanized mice

NCBI Quality ControlLinks
Bacillota
Lactobacillus taiwanensis
Ligilactobacillus animalis
Limosilactobacillus vaginalis
Parasutterella excrementihominis
Turicibacter sanguinis

Revision editor(s): Tosin

Experiment 3


Needs review

Curated date: 2024/11/14

Curator: Tosin

Revision editor(s): Tosin, Aleru Divine

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Euthanized mice
Group 1 name Corresponds to the case (exposed) group for case-control studies
Survived mice
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Mice that survived a Clostridioides difficile infection (CDI) followed by one of 4 FVT (fecal virome transplantation), FMT (fecal microbiota transplantaiton) or saline treatments until study termination.
Group 0 sample size Number of subjects in the control (unexposed) group
23
Group 1 sample size Number of subjects in the case (exposed) group
24

Lab analysis

Statistical Analysis

Alpha Diversity

Shannon Estimator of species richness and species evenness: more weight on species richness
increased

Signature 1

Needs review

Curated date: 2024/11/17

Curator: Tosin

Revision editor(s): Tosin

Source: Figure 7C

Description: Differential abundance of significantly different bacterial taxa between euthanized and survived mice.

Abundance in Group 1: increased abundance in Survived mice

NCBI Quality ControlLinks
Bacillota
Clostridium
Lactobacillus taiwanensis
Ligilactobacillus animalis
Limosilactobacillus vaginalis
Turicibacter sanguinis

Revision editor(s): Tosin

Signature 2

Needs review

Curated date: 2024/11/17

Curator: Tosin

Revision editor(s): Tosin

Source: Figure 7C

Description: Differential abundance of significantly different bacterial taxa between euthanized and survived mice.

Abundance in Group 1: decreased abundance in Survived mice

NCBI Quality ControlLinks
Parasutterella excrementihominis
Parabacteroides goldsteinii
Enterococcus
Escherichia fergusonii
Enterococcus canintestini
Clostridioides difficile
Bacteroides thetaiotaomicron
Akkermansia muciniphila

Revision editor(s): Tosin

Experiment 4


Needs review

Curated date: 2024/11/17

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Mice before Clostridioides difficile infection (CDI)
Group 0 sample size Number of subjects in the control (unexposed) group
48
Group 1 sample size Number of subjects in the case (exposed) group
21

Lab analysis

Sequencing type
WMS
16S variable region One or more hypervariable region(s) of the bacterial 16S gene
Not specified

Statistical Analysis

Alpha Diversity

Shannon Estimator of species richness and species evenness: more weight on species richness
increased

Signature 1

Needs review

Curated date: 2024/11/17

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Source: Figure 7D

Description: Differential abundance of significantly different viral taxa between Before CDI (Clostridioides difficile Infection) and Survived mice.

Abundance in Group 1: increased abundance in Survived mice

NCBI Quality ControlLinks
VOC5VOC5
Tubulavirales
Crassvirales

Revision editor(s): Aleru Divine

Signature 2

Needs review

Curated date: 2024/11/17

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Source: Figure 7D

Description: Differential abundance of significantly different viral taxa between Before CDI (Clostridioides difficile Infection) and Survived mice.

Abundance in Group 1: decreased abundance in Survived mice

NCBI Quality ControlLinks
VOC1VOC1
unidentified virus
unclassified viruses
Norzivirales
Durnavirales

Revision editor(s): Aleru Divine

Experiment 5


Needs review

Curated date: 2024/11/17

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Differences from previous experiment shown

Subjects

Group 1 name Corresponds to the case (exposed) group for case-control studies
Euthanized mice
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Mice that reached a humane endpoint and were euthanized before the intended study termination date.
Group 1 sample size Number of subjects in the case (exposed) group
24

Lab analysis

Statistical Analysis

Alpha Diversity

Shannon Estimator of species richness and species evenness: more weight on species richness
unchanged

Signature 1

Needs review

Curated date: 2024/11/17

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Source: Figure 7E

Description: Differential abundance of significantly different viral taxa between Before CDI (Clostridioides difficile Infection) and Euthanized mice.

Abundance in Group 1: increased abundance in Euthanized mice

NCBI Quality ControlLinks
Tubulavirales
Petitvirales

Revision editor(s): Aleru Divine

Signature 2

Needs review

Curated date: 2024/11/18

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Source: Figure 7E

Description: Differential abundance of significantly different viral taxa between Before CDI (Clostridioides difficile Infection) and Euthanized mice.

Abundance in Group 1: decreased abundance in Euthanized mice

NCBI Quality ControlLinks
unidentified virus
Norzivirales
Durnavirales

Revision editor(s): Aleru Divine

Experiment 6


Needs review

Curated date: 2024/11/17

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
Euthanized mice
Group 1 name Corresponds to the case (exposed) group for case-control studies
Survived mice
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Mice that survived a Clostridioides difficile infection (CDI) followed by one of 4 FVT (fecal virome transplantation), FMT (fecal microbiota transplantaiton) or saline treatments until study termination.
Group 0 sample size Number of subjects in the control (unexposed) group
24
Group 1 sample size Number of subjects in the case (exposed) group
21

Lab analysis

Statistical Analysis

Alpha Diversity

Shannon Estimator of species richness and species evenness: more weight on species richness
increased

Signature 1

Needs review

Curated date: 2024/11/18

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Source: Figure 7F

Description: Differential abundance of significantly different viral taxa between Euthanized and Survived mice.

Abundance in Group 1: increased abundance in Survived mice

NCBI Quality ControlLinks
VOC5VOC5

Revision editor(s): Aleru Divine

Signature 2

Needs review

Curated date: 2024/11/18

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Source: Figure 7F

Description: Differential abundance of significantly different viral taxa between Euthanized and Survived mice.

Abundance in Group 1: decreased abundance in Survived mice

NCBI Quality ControlLinks
Petitvirales
Durnavirales

Revision editor(s): Aleru Divine

Experiment 7


Needs review

Curated date: 2024/12/20

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Differences from previous experiment shown

Subjects

Condition The experimental condition / phenotype studied according to the Experimental Factor Ontology
Clostridium difficile [Clostridium] difficile,Bacillus difficilis,Clostridium difficile,clostridium difficile
Group 0 name Corresponds to the control (unexposed) group for case-control studies
Saline
Group 1 name Corresponds to the case (exposed) group for case-control studies
FVT-UnT (Untreated Fecal Virome Transplantation)
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Mice that received untreated donor fecal virome material (Before second treatment).
Group 0 sample size Number of subjects in the control (unexposed) group
8
Group 1 sample size Number of subjects in the case (exposed) group
7

Lab analysis

Sequencing type
PCR
Sequencing platform Manufacturer and experimental platform used for quantifying microbial abundance
RT-qPCR

Statistical Analysis

Data transformation Data transformation applied to microbial abundance measurements prior to differential abundance testing (if any).
relative abundances
Statistical test
Linear Regression


Signature 1

Needs review

Curated date: 2024/12/20

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Source: Figure 4B

Description: Evaluation of C. difficile abundance by qPCR.

Abundance in Group 1: decreased abundance in FVT-UnT (Untreated Fecal Virome Transplantation)

NCBI Quality ControlLinks
Clostridioides difficile

Revision editor(s): Aleru Divine

Experiment 8


Needs review

Curated date: 2024/12/20

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Differences from previous experiment shown

Subjects

Group 1 name Corresponds to the case (exposed) group for case-control studies
FVT-ChP (Chemostat-Processed Fecal Virome Transplantation)
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Mice that received fecal virome material reproduced through chemostat fermentation (Before second treatment).
Group 1 sample size Number of subjects in the case (exposed) group
8

Lab analysis

Statistical Analysis

Signature 1

Needs review

Curated date: 2024/12/20

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Source: Figure 4B

Description: Evaluation of C. difficile abundance by qPCR.

Abundance in Group 1: decreased abundance in FVT-ChP (Chemostat-Processed Fecal Virome Transplantation)

NCBI Quality ControlLinks
Clostridioides difficile

Revision editor(s): Aleru Divine

Experiment 9


Needs review

Curated date: 2024/12/20

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Differences from previous experiment shown

Subjects

Group 1 name Corresponds to the case (exposed) group for case-control studies
FVT-SDT (Solvent-Detergent Treated Fecal Virome Transplantation)
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Mice that received fecal virome material subjected to solvent-detergent treatment to inactivate enveloped viruses (Before second treatment).

Lab analysis

Statistical Analysis

Signature 1

Needs review

Curated date: 2024/12/20

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Source: Figure 4B

Description: Evaluation of C. difficile abundance by qPCR.

Abundance in Group 1: decreased abundance in FVT-SDT (Solvent-Detergent Treated Fecal Virome Transplantation)

NCBI Quality ControlLinks
Clostridioides difficile

Revision editor(s): Aleru Divine

Experiment 10


Needs review

Curated date: 2024/12/20

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Differences from previous experiment shown

Subjects

Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Mice that received fecal virome material subjected to solvent-detergent treatment to inactivate enveloped viruses (At termination).

Lab analysis

Statistical Analysis

Signature 1

Needs review

Curated date: 2024/12/20

Curator: Aleru Divine

Revision editor(s): Aleru Divine

Source: Figure 4B

Description: Evaluation of C. difficile abundance by qPCR.

Abundance in Group 1: decreased abundance in FVT-SDT (Solvent-Detergent Treated Fecal Virome Transplantation)

NCBI Quality ControlLinks
Clostridioides difficile

Revision editor(s): Aleru Divine