title: Bovine immunoglobulin concentrate-clostridium difficile retains C difficile toxin neutralising activity after passage through the human stomach and small intestine.
abstract: BACKGROUND
  Bovine immunoglobulin concentrate (BIC)-Clostridium difficile is prepared from the colostrum of cows immunised against C difficile toxins and contains high concentrations of neutralising IgG antitoxin.
  
  
  OBJECTIVE
  To determine the proportion of BIC-C difficile which survives passage through the human stomach and small intestine.
  
  
  METHODS
  Six volunteers with an end ileostomy took 5 g of BIC-C difficile containing 2.1 g of bovine IgG on four occasions: alone, with an antacid, during treatment with omeprazole, and within enteric coated capsules.
  
  
  RESULTS
  When BIC-C difficile was taken alone, a mean (SEM) of 1033 (232) mg of bovine IgG was recovered in the ileal fluid representing 49% of the total ingested dose. Bovine IgG recovery was not significantly increased by antacid (636 (129) mg) or omeprazole (1052 (268) mg). The enteric capsules frequently remained intact or only partially opened in the ileal effluent and free bovine IgG levels were low in this treatment group (89 (101) mg). Bovine IgG recovery was higher in volunteers with shorter (less than two hours) mouth to ileum transit times (68% versus 36%, p<0. 05). Specific bovine IgG against C difficile toxin A was detected in ileal fluid following oral BIC. Toxin neutralising activity was also present and correlated closely with bovine IgG levels (r=0.95, p<0. 001).
  
  
  CONCLUSIONS
  BIC-C difficile resists digestion in the human upper gastrointestinal tract and specific anti-C difficile toxin A binding and neutralising activity was retained. Passive oral immunotherapy with anti-C difficile BIC may be a useful non-antibiotic approach to the prevention and treatment of C difficile antibiotic associated diarrhoea and colitis.
authors.affiliation: Gastroenterology Division, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, Massachusetts 02215, USA.
authors.forename: M
authors.initials: M
authors.lastname: Warny
authors.forename: A
authors.initials: A
authors.lastname: Fatimi
authors.forename: E F
authors.initials: EF
authors.lastname: Bostwick
authors.forename: D C
authors.initials: DC
authors.lastname: Laine
authors.forename: F
authors.initials: F
authors.lastname: Lebel
authors.forename: J T
authors.initials: JT
authors.lastname: LaMont
authors.forename: C
authors.initials: C
authors.lastname: Pothoulakis
authors.forename: C P
authors.initials: CP
authors.lastname: Kelly
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000818:Animals; D000907:Antibodies, Bacterial / Q000378:metabolism*; D000992:Antitoxins / Q000378:metabolism*; D001427:Bacterial Toxins / Q000276:immunology / Q000378:metabolism; D002417:Cattle; D016360:Clostridioides difficile / Q000276:immunology*; D003126:Colostrum / Q000276:immunology; D004064:Digestive System / Q000378:metabolism*; D004768:Enterotoxins / Q000276:immunology / Q000378:metabolism; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism; D005772:Gastrointestinal Transit; D006801:Humans; D007082:Ileum / Q000378:metabolism; D007074:Immunoglobulin G / Q000378:metabolism*; D008297:Male; D008875:Middle Aged
chemical_list: D000907:Antibodies, Bacterial; D000992:Antitoxins; D001427:Bacterial Toxins; D004768:Enterotoxins; D007074:Immunoglobulin G; C041348:tcdA protein, Clostridium difficile