Lyophilized compositions comprising fecal microbe-based therapeutic agents and methods for making and using same
This application provides compositions, e.g., formulations, used for gastric, gastrointestinal and/or colonic treatments, and methods for making, storing and using them, including formulations that effectively preserve microbial cell viability during freeze-thaw or freeze-drying. Compositions provided herein are useful for treating various diseases or conditions such as autism spectrum disorder, Crohn's Disease, ulcerative colitis, irritable bowel syndrome, and recurrent or primary C. difficile infection.
1. A pharmaceutical composition comprising a lyophilized fecal microbe preparation comprising microbial cells derived from a healthy human donor and a lyophilization formulation, wherein, prior to lyophilization, said lyophilization formulation comprises between about 12.5% and about 60% trehalose and between about 0.005% and about 0.08% cysteine.
2. The pharmaceutical composition of claim 1 , wherein said cysteine is D-cysteine.
3. The pharmaceutical composition of claim 1 , wherein said lyophilization formulation comprises about 0.025% cysteine.
4. The pharmaceutical composition of claim 1 , wherein said fecal microbe preparation comprises a non-selected fecal microbiota preparation from a single donor.
5. The pharmaceutical composition of claim 4 , wherein the preparation of said fecal microbe preparation involves a separation step selected from the group consisting of filtering, sieving, density gradients, filtration, chromatography, sedimentation, centrifugation, and a combination thereof.
6. The pharmaceutical composition of claim 4 , wherein said lyophilized formulation further comprises one or more cryoprotectants selected from the group consisting of dimethyl sulfoxide (DMSO), glycerol, polyethylene glycol (PEG), alanine, glycine, proline, mannitol, sucrose, glucose, lactose, ribose, hydroxypropyl-β-cyclodextrin (HPβCD), and any combination thereof.
7. The pharmaceutical composition of claim 4 , wherein said pharmaceutical composition is in an oral formulation.
8. The pharmaceutical composition of claim 4 , wherein said pharmaceutical composition is formulated as a geltab, pill, microcapsule, capsule, or tablet.
9. The pharmaceutical composition of claim 4 , wherein every 200 mg of said pharmaceutical composition comprises a pharmacologically active dose of microbes or spores from 10 3 to 10 15 cfu or total cell count.
10. The pharmaceutical composition of claim 4 , wherein said fecal microbe preparation has at least about 50% microbes in a spore form.
11. The pharmaceutical composition of claim 1 , wherein said lyophilization formulation comprises about 15% trehalose.
12. The pharmaceutical composition of claim 1 , wherein said lyophilization formulation comprises about 20% trehalose.
13. The pharmaceutical composition of claim 1 , wherein cysteine is L-cysteine.
14. The pharmaceutical composition of claim 1 , wherein, prior to lyophilization, said lyophilization formulation is in the form of a liquid.
15. The pharmaceutical composition of claim 14 , wherein said liquid comprises a buffering agent.
16. The pharmaceutical composition of claim 15 , wherein said buffering agent comprises phosphate-buffered saline.
17. The pharmaceutical composition of claim 1 , wherein said lyophilized fecal microbe preparation further comprises an inert powdered diluent.