Clinical Efficacy and Microbiome Findings Following Fecal Microbiota Transplant in Children with Refractory Inflammatory Bowel Disease

Goyal, Alka; Yeh, Andrew; Siebold, Leah; Calabro, Kathleen; Firek, Brian; Bush, Brian R.; Morowitz, Michael J.

doi:10.1016/s0016-5085(17)33256-0

Cited by 7 publications

(3 citation statements)

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“…Four studies published as abstracts were duplicated with a full-length publication thereafter [44][45][46][47]. The other three were excluded from randomized controlled trials of pediatric UC [48][49][50]. The clinical standards of two experiments were different from those of other experiments [17,51].…”

Section: Search Resultsmentioning

confidence: 99%

Assessing the efficacy and safety of fecal microbiota transplantation and probiotic VSL#3 for active ulcerative colitis: A systematic review and meta-analysis

Dang

Liu

et al. 2020

PLoS ONE

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Background Fecal microbiota transplantation is an effective treatment for many gastrointestinal diseases, such as Clostridium difficile infection and inflammatory bowel disease, especially ulcerative colitis. Changes in colonic microflora may play an important role in the pathogenesis of ulcerative colitis, and improvements in the intestinal microflora may relieve the disease. Fecal bacterial transplants and oral probiotics are becoming important ways to relieve active ulcerative colitis. Purpose This systematic review with meta-analysis compared the efficacy and safety of basic treatment combined with fecal microbiota transplantation or mixed probiotics therapy in relieving mild to moderate ulcerative colitis. Methods The PubMed, Embase, and Cochrane libraries (updated September 2019) were searched to identify randomized, placebo-controlled, or head-to-head trials assessing fecal microbiota transplantation or probiotic VSL#3 as induction therapy in active ulcerative colitis. We analyze data using the R program to obtain evidence of direct comparison and to generate intermediate variables for indirect treatment comparisons. Results Seven randomized, double-blind, placebo-controlled trials were used as the sources of the induction data. All treatments were superior to placebo. In terms of clinical remission and clinical response to active ulcerative colitis, direct comparisons showed fecal microbiota transplantation (

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Section: Search Resultsmentioning

confidence: 99%

Assessing the efficacy and safety of fecal microbiota transplantation and probiotic VSL#3 for active ulcerative colitis: A systematic review and meta-analysis

Dang

Liu

et al. 2020

PLoS ONE

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“…FMT is safe and well tolerated in IBD clinical trials [57,204,[223][224][225]. Importantly, two bacteremias (one death) by ESBL E. coli were reported in immunocompromised patients who received donor stool harboring these strains [226].…”

Section: Safetymentioning

confidence: 96%

Microbial-Based and Microbial-Targeted Therapies for Inflammatory Bowel Diseases

2020

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Inflammatory bowel diseases (IBD), including Crohn's disease, ulcerative colitis, and pouchitis, are chronic, relapsing intestinal inflammatory disorders mediated by dysregulated immune responses to resident microbiota. Current standard therapies that block immune activation with oral immunosuppressives or biologic agents are generally effective, but each therapy induces a sustained remission in only a minority of patients. Furthermore, these approaches can have severe adverse events. Recent compelling evidence of a role of unbalanced microbiota (dysbiosis) driving immune dysfunction and inflammation in IBD supports the therapeutic rationale for manipulating the dysbiotic microbiota. Traditional approaches using currently available antibiotics, probiotics, prebiotics, and synbiotics have not produced optimal results, but promising outcomes with fecal microbiota transplant provide a proof of principle for targeting the resident microbiota. Rationally designed oral biotherapeutic products (LBPs) composed of mixtures of protective commensal bacterial strains demonstrate impressive preclinical results. Resident microbial-based and microbialtargeted therapies are currently being studied with increasing intensity for IBD primary therapy with favorable early results. This review presents current evidence and therapeutic mechanisms of microbiota modulation, emphasizing clinical studies, and outlines prospects for future IBD treatment using new approaches, such as LBPs, bacteriophages, bacterial function-editing substrates, and engineered bacteria. We believe that the optimal clinical use of microbial manipulation may be as adjuvants to immunosuppressive for accelerated and improved induction of deep remission and as potential safer solo approaches to sustained remission using personalized regimens based on an individual patient's microbial profile.

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“…Une étude non contrôlées ur l'effet de la TF chez des patients pédiatriques souffrant de maladie de Crohn (CD) ou de colite ulcéreuse (UC), en absence d'infection à C. difficile, était aussi rapportéea u congrès de l'AGA [4]. Comme il avait déjàé t érapporté [5], ces patients présentaient une dysbiose.…”

Section: Tf Et Dysbioseunclassified

René Lambert († 5 août 2017)

Vicari¹

2017

Hegel

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La transplantation ou greffe fécale (TF) aconnu dans les dernières années un essor considérable. Pratique ancestrale qui remonte à la médecine chinoise du début du premier millénaire, aussi pratiquéed epuis des siècles par les vétérinaires sous le nom de transfaunation, c'est son succèsi ncontestable dans le traitement des infections à Clostridium difficile qui l'a ramenéeaupremier plan durant la dernière décennie. Depuis, cette approche bénéficie de l'explosion des connaissances sur le microbiote intestinal, et de ses retombées scientifiques, médicales et médiatiques. Le rôle du microbiome étant évoqué maintenant dans de nombreuses affections intestinales -c omme la maladie de Crohn -o ue xtra-intestinalesjusqu'à récemment l'autisme -i le st tentant de proposer que la transplantation fécale pourrait aussi être bénéfique dans ces cas. Cependant, pour qu'on comprenne tous ses effets dans les infections à Clostridium comme dans d'autres maladies, la pratique clinique de la transplantation fécale doit s'effectuer dans des conditions bien définies. C'était le sujet d'une des sessions du congrès de l'American Association of Gastroenterologists (AGA) qui s'est tenu en mai dernier à Chicago (DigestiveDisease Week 2017). Le congrès de l'AGA faisait d'ailleurs la part belle au microbiome avec de nombreuses séances plénières ou spécifiques, sous l'égide de sa plus récente section institutionnelle nommée « Microbiome & Microbial Diseases in the Gastrointestinal Tract » et du « AGA Center for Gut Microbiome Research and Education ». Considérations cliniquesUne session était entièrement dédiéeaux considérations cliniques de la TF.Une des modératrices, Colleen Kelly (Brown University), présentait les aspects fondamentaux de la FT :i ndications, contre-indications, sélection des patients et sélection des donneurs, et aussi les modalitésd 'administration de la TF,e n soulignant que de manière remarquable la plupart des modalitéss ont efficaces. Monika Fischer (Indiana University) af ait une présentation ciblées ur la prise en charge de la petite fraction (environ 10 %) des patients souffrant d'infection à Clostridium difficile qui ne répondent pas à la TF,e ta ussi sur les possibles effets négatifs de la TF.E n fi n, LorenL aine( Yale University) montrait les perspectives de la TF pour d'autres indications, et introduisait le registre des TF que nous détaillons ici plus bas. Encadrementr é glementaireUn des aspects les plus discutés était l'encadrement réglementaire de la TF aux Etats-Unis qui a évolué ces derniers mois, notamment suite à la publication en mars 2016 par la Food and Drug Administration (FDA) de recommandations pour l'utilisation de TF pour traiter des infections à C. difficile réfractaires aux thérapies standard. Ces recommandations autorisaient les TF en l'absence d'autorisation IND (Investigational New Drug, IMPD en Europe) à condition que :1 )l ep raticien ait obtenu le consentement éclairé adéquat du patient ou de son représentantl é gal ;2 )l ep roduit à transplanter ne provienne pas d'une banque ;3 )l ed o...

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Clinical Efficacy and Microbiome Findings Following Fecal Microbiota Transplant in Children with Refractory Inflammatory Bowel Disease

Cited by 7 publications

References 0 publications

Assessing the efficacy and safety of fecal microbiota transplantation and probiotic VSL#3 for active ulcerative colitis: A systematic review and meta-analysis

Assessing the efficacy and safety of fecal microbiota transplantation and probiotic VSL#3 for active ulcerative colitis: A systematic review and meta-analysis

Microbial-Based and Microbial-Targeted Therapies for Inflammatory Bowel Diseases

René Lambert († 5 août 2017)

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