WO 2013/171515 Al 21 November 2013 (21.11.2013) P O P C T
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(12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2013/171515 Al 21 November 2013 (21.11.2013) P O P C T (51) International Patent Classification: AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, C12Q 1/04 (2006.01) A61K 38/14 (2006.01) BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (21) International Application Number: HN, HR, HU, ID, IL, IN, IS, JP, KE, KG, KM, KN, KP, PCT/GB20 13/05 1298 KR, KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, (22) International Filing Date: ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, 20 May 20 13 (20.05.2013) NO, NZ, OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, (25) Filing Language: English TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, (26) Publication Language: English ZM, ZW. (30) Priority Data: (84) Designated States (unless otherwise indicated, for every 1208845.6 18 May 2012 (18.05.2012) kind of regional protection available): ARIPO (BW, GH, 121 1961 .6 5 July 2012 (05.07.2012) GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, SZ, TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, TJ, (71) Applicant: GENOME RESEARCH LIMITED TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, [GB/GB]; Gibbs Building, 215 Euston Road, London, EE, ES, FI, FR, GB, GR, HR, HU, IE, IS, IT, LT, LU, LV, Greater London NW1 2BE (GB). MC, MK, MT, NL, NO, PL, PT, RO, RS, SE, SI, SK, SM, TR), OAPI (BF, BJ, CF, CG, CI, CM, GA, GN, GQ, GW, (72) Inventors: LAWLEY, Trevor D.; c/o Genome Research ML, MR, NE, SN, TD, TG). Limited, Gibbs Building, 215 Euston Road, London Great er London NW1 2BE (GB). CLARE, Simon; c/o Genome Published: Research Limited, Gibbs Building, 215 Euston Road, Lon — with international search report (Art. 21(3)) don Greater London NW1 2BE (GB). DOUGAN, Gordon; c/o Genome Research Limited, Gibbs Building, 215 Euston — before the expiration of the time limit for amending the Road, London Greater London NW1 2BE (GB). claims and to be republished in the event of receipt of amendments (Rule 48.2(h)) (74) Agents: STEPHEN, Robert et al; 90 High Holborn, Lon don, Greater London WC1V 6XX (GB). — with sequence listing part of description (Rule 5.2(a)) (81) Designated States (unless otherwise indicated, for every kind of national protection available): AE, AG, AL, AM, < l o- (54) Title: METHODS AND GROUPS (57) Abstract: A method, for the identification of bacterial isolates suitable for use in bacteriotherapy, the method comprising: (i)preparing a suspension of material collected from a host harbouring microbiota; (ii)addition of an activator of bacterial spores suf- ¾ ficient to allow growth of bacteria from spores present in the suspension; (iii)culturing the suspension; and (iv)identification of at least one bacterial species within the culture. Methods and Groups Technical Field The invention relates to methods and groups of bacterial isolates relevant to bacteriotherapy. In particular, the invention relates t o methods for identifying bacterial isolates suitable for bacteriotherapy, t o bacterial isolates identified by such methods and t o the use of such bacterial isolates in bacteriotherapy. Background Clostridium difficile, an anaerobic, Gram-positive bacterium, is a major cause of antibiotic-associated diarrhea and challenges healthcare infection control measures by producing highly infectious and resistant spores . Antibiotic treatment, advanced age and hospitalization are the major risk factors for C. difficile colonization, leading t o a spectrum of outcomes ranging from asymptomatic carriage, severe diarrhea, pseudomembranous colitis or even death. Current first line treatments for C. difficile disease are vancomycin or metronidazole, although in 20-35% of these cases recurrent disease (relapse or re infection) follows the cessation of antibiotic therapy. Recurrent C. difficile disease is associated with a pathological imbalance within the resident intestinal microbial community, or "dysbiosis", so therapies that restore a healthy microbiota are viewed as promising alternatives. Recurrent Clostridium difficile disease in humans is associated with a pathological imbalance within the resident intestinal microbiota, referred to as dysbiosis. Fecal bacteriotherapy, the administration of homogenized feces from a healthy donor, has been investigated as an alternative therapy for recurrent C. difficile disease in humans. However, the mechanism of bacteriotherapy using fecal flora and specific probiotic mix in the feces which are of use in bacteriotherapy has so far been unclear. Summary In a first aspect, the invention provides a method, for the identification of bacterial isolates suitable for use in bacteriotherapy, the method comprising: (i) preparing a suspension of material collected from a host harbouring microbiota; (ii) addition of an activator of bacterial spores sufficient t o allow growth of bacteria from spores present in the suspension; (iii) culturing the suspension; and (iv) identification of at least one bacterial isolate within the culture In a second aspect, the invention provides method for preparing fecal material suitable for bacteriotherapy or a method for identification of bacterial isolates suitable for use in bacteriotherapy the method comprising preparing a suspension of fecal material followed by incubation of the suspension in a standing culture under anaerobic or aerobic conditions. In one aspect, the invention provides a method for preparing material suitable for use in bacteriotherapy, the method comprising: (i) preparing a suspension of fecal material; (ii) addition of an activator of bacterial spores sufficient to allow growth of bacteria from spores present in the suspension; and (iii) culturing the suspension. In one aspect, the invention provides a group of bacterial isolates suitable for bacteriotherapy obtainable or identifiable according to any of the methods described above and in the rest of this application. In another aspect, the invention provides a group of bacterial isolates obtainable or identifiable according to the method of any previous aspect of the invention for use in bacteriotherapy. In another aspect, the invention provides the use of a group of bacterial isolates obtainable or identifiable according to the method of any previous aspect of the invention in the manufacture of a medicament for providing bacteriotherapy. In another aspect, the invention provides cultured fecal material for use in bacteriotherapy, and/or for identification of bacterial strains suitable for use in bacteriotherapy, wherein the bacteriotherapy is to facilitate repopulation of the gut and/or prevention or treatment of diseases associated with infections or the microbiota, or diseases related thereto, and/or prevention of transmission of infection.. In one embodiment the infection is a bacterial infection. In one embodiment the infection is a viral infection. In one embodiment the infection is C. difficile infection. In another aspect, the invention provides a subset of bacteria obtainable or identifiable from fecal material for use in facilitating repopulation of the gut and/or in prevention or treatment of bacterial or viral infections, dysfunction associated with the microbiota or diseases related thereto and/or in prevention of transmission of bacterial or viral infection, wherein the subset comprises 3 to 9, optionally no more than 6, isolates of bacteria. In another aspect, the invention provides use of 3 to 9, optionally no more 6, bacterial isolates in the preparation of a medicament to facilitate repopulation of the gut and/or in prevention or treatment of bacterial or viral infections, dysfunction associated with the microbiota or diseases related thereto and/or in prevention of transmission of bacterial or viral infection. In another aspect, the invention provides a composition comprising or consisting essentially of a group of bacterial isolates according t o any of the previous aspects. The composition is suitable for providing bacteriotherapy. In another aspect, the invention provides a method of providing bacteriotherapy, the method comprising delivering t o a human or non-human animal a group of bacterial isolates according t o any of the previous aspects. The preferred features may be combined as appropriate, as would be apparent t o a skilled person, and may be combined with any of the aspects of the invention. Brief Description of the Drawings Embodiments of the invention will be described, by way of example, with reference to the following drawings, in which: Figure 1. Epidemic C. difficile 027/BI induces a persisting supershedder state with enhanced transmissibility compared t o other virulent variants Figure 2. Fecal bacteriotherapy resolves relapsing C. difficile 027/BI-7 disease and host contagiousness Figure 3. Effective bacteriotherapy re-establishes a healthy, diverse microbiota profile in epidemic C. difficile 027/BI supershedder mice. Figure 4. Whole genome (Maximum likelihood) phylogeny of intestinal bacteria demonstrating the phylogenetic placement of protective bacteriotherapy bacteria (MixB) and the dominant members of the supershedder microbiota. Figure 5. Toxin A production by C. difficile 027/BI-7, 012/630 and 017/M68. Figure 6. C. difficile supershedders are highly contagious Figure 7. Epidemic C. difficile 027/BI-7 induces intestinal dysbiosis in mice Figure 8. Impact of various oral treatments on epidemic C. difficile 027/BI supershedder state in mice. Figure 9. Distinct intestinal microbiota community structures from healthy/naive mice (n=17), clindamycin supershedders (C. difficile 027/BI-7 infected mice on clindamycin; n=10) and persisting supershedders (C. difficile 027/BI-7 infected mice not on clindamycin; n=17) Figure 10. Opportunistic pathogens routinely cultured from the feces of epidemic C. difficile 027/BI supershedder mice. Figure 11. Fecal bacteriotherapy suppresses C. difficile intestinal colonization and diversifies the intestinal bacterial community of supershedder mice.