Clinical results and microbiota changes after faecal microbiota transplantation for chronic pouchitis: a pilot study

Kousgaard, Sabrina Just; Michaelsen, Thomas Yssing; Nielsen, Hans Linde; Kirk, Karina Frahm; Brandt, Jakob; Albertsen, Mads; Thorlacius-Ussing, Ole

doi:10.1080/00365521.2020.1748221

Cited by 23 publications

(75 citation statements)

References 40 publications

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“…One patient achieved clinical remission, and the donor’s microbiota seemed to colonize only in this patient. In a recent pilot study, Kousgaard et al 23 observed a higher rate of the donor’s microbiota engraftment in 6 out of 9 patients. In their study, patients were treated by FMT enemas for 14 continuous days and followed up for 6 months.…”

Section: Discussionmentioning

confidence: 94%

Fecal Microbiota Transplantation in Chronic Pouchitis: A Randomized, Parallel, Double-Blinded Clinical Trial

Karjalainen

Renkonen–Sinisalo

Satokari

et al. 2021

Inflammatory Bowel Diseases

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Background In ulcerative colitis, a pouchitis is the most common long-term adverse effect after proctocolectomy and ileal pouch-anal anastomosis. Approximately 5% of patients develop chronic antibiotic-dependent or antibiotic-refractory pouchitis without any effective treatment. The aim of this trial was to investigate the efficacy and safety of fecal microbiota transplantation in the treatment of chronic pouchitis. Methods This was a single-center, double-blinded, parallel group trial comparing donor fecal microbiota transplantation with placebo (autologous transplant) in chronic pouchitis. Twenty-six patients were recruited at the Helsinki University Hospital between December 2017 and August 2018 and were randomly allocated a 1:1 ratio to either donor fecal microbiota transplantation or placebo. The protocol included 2 transplantations into the pouch on weeks 0 and 4, and patients were followed up for 52 weeks. Results Nine patients in the intervention group and 8 patients in the placebo group relapsed during the 52-week follow-up, and the relapse-free survival did not differ between the groups (P = 0.183, log-rank; hazard ratio, 1.90 [95% confidence interval, 0.73-4.98; P = 0.190]). In the subgroup analysis of patients using continuous antibiotics before the study, the relapse-free survival was shorter in the intervention group (P = 0.004, log-rank; hazard ratio, 13.08 [95% confidence interval, 1.47-116.60; P = 0.021]). No major adverse effects were reported. Conclusions The fecal microbiota transplantation treatment regime used in our study was not effective in the treatment of chronic pouchitis. The safety profile of fecal microbiota transplantation was good. ClinicalTrials.gov identifier NCT03378921.

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Section: Discussionmentioning

confidence: 94%

Fecal Microbiota Transplantation in Chronic Pouchitis: A Randomized, Parallel, Double-Blinded Clinical Trial

Karjalainen

Renkonen–Sinisalo

Satokari

et al. 2021

Inflammatory Bowel Diseases

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“…Chronic pouchitis was defined as ≥3 episodes of pouchitis diagnosed according to clinical symptoms, endoscopic signs of inflammation and histologic inflammation of pouch biopsies with a Pouchitis Disease Activity Index (PDAI) score ≥7 within the last year [ 14 ]. Patients with chronic pouchitis were also included in a pilot study using faecal microbiota transplantation in the treatment of pouchitis, as described by Kousgaard et al [ 15 ]. Faecal samples were collected before study intervention in the pilot study.…”

Section: Methodsmentioning

confidence: 99%

The Microbiota Profile in Inflamed and Non-Inflamed Ileal Pouch–Anal Anastomosis

et al. 2020

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The objective was to determine the bacterial composition in inflamed and non-inflamed pouches for comparison to the microbiota of healthy individuals. Pouch patients and healthy individuals were included between November 2017 and June 2019 at the Department of Gastrointestinal Surgery, Aalborg University Hospital, Denmark. A faecal sample was collected from all participants for microbiota analysis using 16S rRNA amplicon sequencing. Overall, 38 participants were included in the study. Eleven patients with a normally functioning pouch, 9 patients with chronic pouchitis, 6 patients with familial adenomatous polyposis, and 12 healthy individuals. Patients with chronic pouchitis had overall lower microbial diversity and richness compared to patients with a normal pouch function (p < 0.001 and p = 0.009) and healthy individuals (p < 0.001 and p < 0.001). No significant difference was found between patients with familial adenomatous polyposis and chronic pouchitis (microbial diversity p = 0.39 and richness p = 0.78). Several taxa from the family Enterobacteriaceae, especially genus Escherichia, were associated primarily with patients with chronic pouchitis, while taxa from the genus Bacteroides primarily were associated with healthy individuals and patients with a normally functioning pouch. Finally, a microbial composition gradient could be established from healthy individuals through patients with normal pouch function and familial adenomatous polyposis to patients with chronic pouchitis.

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“…The exact pathogenesis of pouchitis remains unclear, but dysbiosis seems to be a key factor. This hypothesis is supported by differences in the microbiota composition between patients with pouchitis and those with a noninflamed pouch, and the role of antibiotics in the treatment of pouchitis and probiotics in the prevention of relapses [ 94 , 95 ]. A recent systematic review evaluating the role of FMT in the treatment of chronic pouchitis included only nine studies eligible for the review, so reliable data in this indication are limited [ 93 ].…”

Section: Fecal Microbiota Transplantation (Fmt) In the Treatment Of Inflammatory Bowel Diseasementioning

confidence: 99%

The Role of Fecal Microbiota Transplantation in the Treatment of Inflammatory Bowel Disease

Stojek

Jabłońska

Adrych

2021

JCM

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The exact pathogenesis of inflammatory bowel disease (IBD) is still not completely understood. It is hypothesized that a genetic predisposition leads to an exaggerated immune response to an environmental trigger, leading to uncontrolled inflammation. As there is no known causative treatment, current management strategies for inflammatory bowel disease focus on correcting the excessive immune response to environmental (including microbial) triggers. In recent years, there has been growing interest in new avenues of treatment, including targeting the microbial environment itself. Fecal microbiota transplantation (FMT) is a novel treatment modality showing promising results in early studies. The article discusses the rationale for the use of FMT in inflammatory bowel disease and the yet-unresolved questions surrounding its optimal use in practice.

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Clinical results and microbiota changes after faecal microbiota transplantation for chronic pouchitis: a pilot study

Cited by 23 publications

References 40 publications

Fecal Microbiota Transplantation in Chronic Pouchitis: A Randomized, Parallel, Double-Blinded Clinical Trial

Fecal Microbiota Transplantation in Chronic Pouchitis: A Randomized, Parallel, Double-Blinded Clinical Trial

The Microbiota Profile in Inflamed and Non-Inflamed Ileal Pouch–Anal Anastomosis

The Role of Fecal Microbiota Transplantation in the Treatment of Inflammatory Bowel Disease

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