S2259 Microbiome Diversity in a Patient Treated With Serum-Derived Bovine Immunoglobulin/Protein Isolate

INTRODUCTION: Crohn's disease (CD) is a chronic relapsing inflammatory disease that can affect any part of the GI tract. Recent evidence suggests that changes in the composition of gut microbiota are a common feature in CD. This is paving the way for novel therapeutics that target the microbiome. Recently, serum-derived bovine Ig/protein isolate (SBI) has emerged as a novel therapeutic for different GI pathologies. SBI is uniquely designed to increase gut Ig levels, over 50% of which is IgG. SBI works by neutralizing microbial components, maintaining gut microbiota, managing gut barrier function, and sustaining GI immune balance. We present a patient with CD who sought to avoid immune-suppression. We introduced SBI to modify the composition of the gut microbiome, restore intestinal diversity and thus achieve clinical remission. CASE DESCRIPTION/METHODS: An 18 y/o male presented to our office after being hospitalized for newly diagnosed CD where he was treated with prednisone, mesalamine and infliximab yet his fecal calprotectin was >2,000 and CDAI 424 . The family and patient were against starting infliximab and inquired about alternative treatments. He had ongoing hematochezia and diarrhea after he refused the 3rd dose of infliximab due to persistent itching. Genetic sequencing was done on patient’s stool and revealed an overabundance of Bacteroides compared to his mother’s stool (Figure 1). The patient and family agreed to start SBI. During the 2-week follow-up, a significant reduction of hematochezia and diarrhea occurred. 1 month later, the patient reported being symptom-free. On his 8-month follow-up, he continued to be asymptomatic. His fecal calprotectin decreased to 26.2 and CDAI decreased to 10. Stool genetic sequencing showed improvement in the diversity of microbiome with a Shannon index increased from 2.9 to 4.6 (Figure 2). DISCUSSION: To our knowledge, this is the first report of CD treated with SBI to achieve clinical remission. These results indicate that a specially formulated bovine immunoglobulin preparation, that modifies the composition of the gut microbiome ecosystem, can restore intestinal diversity and achieve clinical remission. Further clinical trials are needed to assess the efficacy and safety of SBI as an alternative treatment for CD.Figure 1Figure 2

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