Fecal transplants have shown promise in improving the balance and diversity of bacteria in the gut microbiome (the complex community of microorganisms that live in the digestive tract). Jessica Allegretti, MD, MPH, director of the Fecal Transplant Program at BWH, led a study that evaluated fecal transplant in patients with PSC and IBD (most with ulcerative colitis). The study, which was published in July 2019 in the American Journal of Gastroenterology, found that fecal transplant was safe for patients with PSC, that it decreased levels of ALP (a biomarker of liver injury) in a small subset of patients, and that it improved the diversity of the gut microbiome. However, overall fecal transplant did not appear to have a significant impact on the disease.
Vancomycin for PSC
Vancomycin is an antibiotic used to treat infections caused by the bacterium Clostridium difficile. After a small study found that this antibiotic dramatically improved symptoms in pediatric patients with PSC, Dr. Korzenik and colleagues at Massachusetts General Hospital conducted a pilot study of vancomycin for adults with the disease. The study showed that vancomycin was safe in adult patients with PSC, but had limited benefits. While disappointing, this is an example of how pilot studies can provide data that enable the team to focus their energy on finding more viable treatments.