An alternative, modern method for obtaining biomaterial from the small intestine.
A special capsule (uncontrolled or controlled) is used to collect biomaterial from the lumen of the small intestine. The capsule is coated with an enteric coating. It is swallowed, then naturally moves through the gastrointestinal tract and exits naturally.
After the capsule enters the duodenum, the outer coating dissolves, and at a certain point, the capsule collects liquid chyme (biomaterial containing the bacterial microbiome). The capsule is then hermetically sealed to prevent microbiome contamination of the underlying parts of the small and large intestines.
The timing of biomaterial collection is either random (uncontrolled capsule) or specific (the capsule’s position is monitored externally, controlled capsule). If the capsule is controlled, the entire procedure is performed on an outpatient or inpatient basis. For unguided capsules, the start of biomaterial collection can be delayed due to the thickness of the enteric coating.
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There are numerous theoretical and laboratory models of such capsules. I have been tracking this process for over 10 years. In recent years, real progress has been observed. A good overview of the situation as of early 2024 is available in this good review:
Smart capsules for sensing and sampling the gut: status, challenges, and prospects.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10715516/
Since the publication of this review (and almost simultaneously), several articles on capsules have appeared that are not mentioned in this review.
The most interesting:
- SIMBA. Canada. Unguided capsule (pictured).
Spatially and temporally precise microbiome profiling in the small intestine using the SIMBA capsule with X-ray tracking.
https://www.frontiersin.org/journals/microbiomes/articles/10.3389/frmbi.2024.1321624/full
https://www.nimblesci.com/simbagiplatform - Capscan. USA. Unguided. The collection site is determined by the thickness (type) of the outer shell.
Profiling the human intestinal environment under physiological conditions.
https://www.nature.com/articles/s41586-023-05989-7
https://envivo.bio/ - Unguided capsule. China. The collection site is determined by the thickness (type) of the outer shell.
Dual-Functional Ingestible Passive Capsules for High-Throughput Intestinal Sampling with Sealed Containment and Targeted Drug Delivery.
https://advanced.onlinelibrary.wiley.com/doi/full/10.1002/adrr.202500100 - Review for early 2025 and guided capsule
Magnetically guided gastric capsule endoscopy: a review and new developments.
https://www.e-ce.org/journal/view.php?number=8049
I believe that in the near future, small intestinal SIBO testing will be performed exclusively using unguided capsules.
The patient will swallow several (4 to 8) of these capsules with enteric coatings of varying types (or thicknesses). After the capsules arrive in the laboratory, these biomaterials will be analyzed separately and/or together.
Culture, 16S rRNA, and whole-genome sequencing will be used. There are currently no commercial offerings, but they may appear soon. The closest to this is the SIMBA capsule manufacturer. More than 1,000 patients have already used it in various clinical trials.
https://www.simba-gi.com/
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The capsule SIBO test is significantly more informative than the classic test (performed during gastroduodenoscopy), as it allows for information about the small intestinal microbiome throughout the entire small intestine, not just in the area of the ligament of Treitz.
And, of course, the capsule SIBO test is much simpler and less expensive.
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Read about the role of the small intestinal microbiome in the development and maintenance of psoriatic disease here.
