Novel microbiome technology boosts Clostridioides difficile cure rate to >90 percent

A novel microbiome technology developed by researchers at the Chinese University of Hong Kong (CUHK) enhances faecal microbiota transplantation (FMT) success rate to >90 percent in patients with recurrent Clostridioides difficile infection (CDI). FMT with the novel technology will become available in public hospitals in Hong Kong.

CDI is a common hospital-acquired infection worldwide, with a reported mortality rate of 40 percent. Over the last decade, the incidence of CDI in Hong Kong had increased by more than 3-fold from 15 cases/100,000 adults in 2006 to 54 cases/100,000 adults in 2019. The elderly, patients with chronic disease or inflammatory bowel disease, and frequent antibiotic users are at high risk of CDI. “With the ageing population and increasing use of antibiotics in Hong Kong, we anticipate that the burden of CDI will be substantial,” pointed out Dr Rashid Lui of the Department of Medicine and Therapeutics at the Prince of Wales Hospital (PWH).

“Antibiotics are the standard treatment for CDI, but not all patients respond, and the recurrence rate is high at 34 percent,” said Professor Margaret Ip of the Department of Microbiology, CUHK. “Without timely and effective management, patients with recurrent CDI are not only at high mortality risk, but also pose a potential risk for larger-scale infection.”

While FMT has emerged as a promising treatment for CDI, its clinical use is still limited, with only 1,800 procedures performed in 31 centres across Europe in 2019. Success rates of FMT vary widely, ranging from 40 percent to 80 percent.

Since 2013, the CUHK team has been conducting research on FMT in recurrent CDI and other diseases at PWH, with >800 FMT procedures performed. In 2020, researchers at CUHK’s Microbiota I-Center (MagIC) developed a novel microbiome technology known as MOZAIC (multikingdom optimization for microbiota consortia) to improve clinical outcomes of FMT, using funding from the InnoHK initiative.

The microbiome technology is driven by machine learning analysis, utilizing >800 FMT datasets and >2,000 metagenomic sequenced samples to analyze the complex network of microbiota as well as their genes and functions. The novel technology improves FMT’s outcomes and long-term safety by facilitating personalized donor selection and donor-recipient matching.

“FMT success rate with the new technology is >90 percent in recurrent CDI. Our 8-year registry data showed doubled median overall survival [from 2.1 years to 4.7 years], reduced length of hospital stay, and lower medical cost with FMT vs antibiotics,” highlighted Professor Siew Ng, Director of MagIC, CUHK.

In partnership with CUHK, the Hospital Authority will introduce FMT with the novel microbiome technology for treatment of refractory or recurrent CDI at Hong Kong’s public hospitals. “The collaboration will not only help the public healthcare system cope with the growing number of CDI cases, but also has huge potential to reduce the frequency and duration of hospitalizations in these patients, thus allowing for more efficient resource utilization,” commented Lui.

“We have the expertise and capability to establish Hong Kong as a leading microbiome innovation and technology hub in the Asia Pacific region,” said Professor Francis Chan, Co-Director of MagIC, CUHK. “Our team will continue to work closely with industry partners to extend the application of this technology to the Greater Bay Area, to benefit >80 million residents in the region.”