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Solving the complex problem of recurrent C. diff with a simple solution

Physician scientists are using fecal transplants to break the deadly cycle of a killer infection

By Bryan Goodchild and Ellie Castano

April 07, 2015

Randy Pellish, MD, co-director of the UMass Center for Microbiome Research, is utilizing a relatively simple solution for the complex problem that is recurrent clostridium difficile. C. diff infects half a million people a year, killing nearly 30,000 within a month of diagnosis. A novel therapy that Dr. Pellish is exploring with his patients who have recurrent C. diff is proving to be more than 90 percent effective.

 

What is a microbiome?
Collectively, the microorganisms and their genes inhabiting a particular environment are called a microbiome. The microorganisms that live in and on an individual are referred to as the human microbiome. The human gut contains trillions of bacteria that have profound influences on immune development, health and disease.

The UMass Center for Microbiome Research
The UMass Center for Microbiome Research was created with support from the University of Massachusetts President’s Science and Technology Initiatives Fund to accelerate the understanding of the role that the microbiome plays in individual health. The center promotes innovative and collaborative research across the five UMass campuses, translates discoveries into practice and shares information about the latest microbiome research.
   

“It is now considered almost standard of care for particular patients with recurrent C. diff to have a stool transplant,” said Pellish, associate professor of medicine at UMass Medical School and a gastroenterologist at UMass Memorial Medical Center. “Stool transplants are somewhere in the area of 90 percent effective—even more if patients have more than one transplant.” 

While C. diff. is found throughout the environment and in the guts of 5 to 10 percent of healthy adults, those most at risk for acquiring the infection are people, especially older adults, who take antibiotics and also receive care in a medical environment. While particular antibiotics can be an effective treatment for mild infections, recurrence happens in about 20 percent of patients, and in some, it recurs over and over.

Through the use of fecal transplant in a patient with recurring C. diff., Pellish introduces healthy bacteria into the severely compromised microbiome.

“With C. diff there is a really terrible disruption of the good bacteria . . . if there is such a terrible imbalance, by taking the stool from a healthy person with a healthy balance of bacteria and putting it into the colon with an unhealthy balance, it can basically restore the balance,” said Pellish.

In addition to recurring C. diff, physicians like Pellish are exploring the use of fecal transplant to treat other diseases of the gastrointestinal tract such as inflammatory bowel disease and Crohn’s disease. The role of the microbiome is also being explored in connection with some neurologic diseases as well as a possible means of controlling diabetes.

“The role of the microbiome is really exploding right now because we’re understanding . . . that it is a very, very complex system that is really is important to our health,” Pellish said.