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Ursodeoxycholic Acid Inhibits Clostridium difficile Spore Germination and Vegetative Growth, and Prevents the Recurrence of Ileal Pouchitis Associated With the Infection

Weingarden, Alexa R. ; Chen, Chi ; Zhang, Ningning ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2016

In: Journal of Clinical Gastroenterology Vol. 50, No. 8 ( 2016-09), p. 624-630

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In: Journal of Clinical Gastroenterology, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. 8 ( 2016-09), p. 624-630

Abstract: To test whether ursodeoxycholic acid (UDCA) is inhibitory to Clostridium difficile and can be used in the treatment of C. difficile -associated ileal pouchitis. Background: The restoration of secondary bile metabolism may be the key mechanism for fecal microbiota transplantation (FMT) in treating recurrent C. difficile infections (RCDI). Therefore, it is possible that exogenous administration of inhibitory bile acids may be used directly as nonantibiotic therapeutics for this indication. The need for such a treatment alternative is especially significant in patients with refractory C. difficile -associated pouchitis, where the efficacy of FMT may be limited. Study: We measured the ability of UDCA to suppress the germination and the vegetative growth of 11 clinical isolate strains of C. difficile from patients treated with FMT for RCDI. In addition, we used oral UDCA to treat a patient with RCDI pouchitis that proved refractory to multiple antibiotic treatments and FMT. Results: UDCA was found to be inhibitory to the germination and the vegetative growth of all C. difficile strains tested. Fecal concentrations of UDCA from the patient with RCDI pouchitis exceeded levels necessary to inhibit the germination and the growth of C. difficile in vitro. The patient has remained infection free for over 10 months after the initiation of UDCA. Conclusions: UDCA can be considered as a therapeutic option in patients with C. difficile -associated pouchitis. Further studies need to be conducted to define the optimal dose and duration of such a treatment. In addition, bile acid derivatives inhibitory to C. difficile that are able to achieve high intracolonic concentrations may be developed as therapeutics for RCDI colitis.

Type of Medium: Online Resource

ISSN: 0192-0790

URL: Article

DOI: 10.1097/MCG.0000000000000427

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2016

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