Oxalobacter formigenes: a potential tool for the treatment of primary hyperoxaluria type 1

• DOI: 10.1038/sj.ki.5001707
• Publication Date: 2006-07-19T07:57:21Z
• Authors: B. Hoppe; B. Beck; N. Gatter; G. von Unruh; A. Tischer; A. Hesse; N. Laube; P. Kaul; H. Sidhu
• Keywords: Adult; Male; Chromatography, Gas; Adolescent; Administration, Oral; Capsules; Kidney; Kidney Function Tests; Feces; 03 medical and health sciences; 0302 clinical medicine; Humans; Child; Flame Ionization; treatment; oxalobacter formigenes; Kidney Transplantation; 3. Good health; Nephrology; Child, Preschool; Creatinine; Hyperoxaluria, Primary; Kidney Failure, Chronic; Female; Kidney Diseases; primary hyperoxaluria; Follow-Up Studies

Primary hyperoxaluria is characterized by severe urolithiasis, nephrocalcinosis, and early renal failure. As treatment options are scarce, we aimed for a new therapeutic tool using colonic degradation of endogenous oxalate by Oxalobactor formigenes. Oxalobacter was orally administered for 4 weeks as frozen paste (IxOC-2) or as enteric-coated capsules (IxOC-3). Nine patients (five with normal renal function, one after liver-kidney transplantation, and three with renal failure) completed the IxOC-2 study. Seven patients (six with normal renal function and one after liver-kidney transplantation) completed the IxOC-3 study. Urinary oxalate or plasma oxalate in renal failure was determined at baseline, weekly during treatment and for a 2-week follow-up. The patients who showed >20% reduction both at the end of weeks 3 and 4 were considered as responders. Under IxOC-2, three out of five patients with normal renal function showed a 22-48% reduction of urinary oxalate. In addition, two renal failure patients experienced a significant reduction in plasma oxalate and amelioration of clinical symptoms. Under IxOC-3 treatment, four out of six patients with normal renal function responded with a reduction of urinary oxalate ranging from 38.5 to 92%. Although all subjects under IxOC-2 and 4 patients under IxOC-3 showed detectable levels of O. formigenes in stool during treatment, fecal recovery dropped directly at follow up, indicating only transient gastrointestinal-tract colonization. The preliminary data indicate that O. formigenes is safe, leads to a significant reduction of either urinary or plasma oxalate, and is a potential new treatment option for primary hyperoxaluria.