Efficacy and safety of fecal microbiota transplantation for the treatment of diseases other than <i>Clostridium difficile</i> infection: a systematic review and meta-analysis

Green, Jessica Emily; Davis, Jessica A; Berk, Michael; Hair, Christopher; Loughman, Amy; Castle, David; Athan, Eugene; Nierenberg, Andrew A.; Cryan, John F.; Jacka, Felice N.; Marx, Wolfgang

doi:10.1080/19490976.2020.1854640

Cited by 102 publications

(97 citation statements)

References 64 publications

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“…The outcomes of FMT in inflammatory bowel disease (IBD) have varied considerably between studies[ 20 ], which has been attributed to differences in the donor used[ 10 , 30 ]. A donor that produces a large response to FMT in IBD patients is called a superdonor[ 10 ].…”

Section: Factors That Affect the Outcome Of Fmtmentioning

confidence: 99%

Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21^st century

Patcharatrakul¹,

Gonlachanvit²

2021

WJG

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Irritable bowel syndrome (IBS) affects about 12% of the global population. Although IBS does not develop into a serious disease or increase mortality, it results in a considerable reduction in the quality of life. The etiology of IBS is not known, but the intestinal microbiota appears to play a pivotal role in its pathophysiology. There is no effective treatment for IBS, and so the applied treatments clinically focus on symptom relief. Fecal microbiota transplantation (FMT), an old Chinese treatment, has been applied to IBS patients in seven randomized controlled trials (RCTs). Positive effects on IBS symptoms in various degrees were obtained in four of these RCTs, while there was no effect in the remaining three. Across the seven RCTs there were marked differences in the selection processes for the donor and treated patients, the transplant dose, the route of administration, and the methods used to measure how the patients responded to FMT. The present frontier discusses these differences and proposes: (1) criteria for selecting an effective donor (superdonor); (2) selection criteria for patients that are suitable for FMT; (3) the optimal FMT dose; and (4) the route of transplant administration. FMT appears to be safe, with only mild, self-limiting side effects of abdominal pain, cramping, tenderness, diarrhea, and constipation. Although it is early to speculate about the mechanisms underlying the effects of FMT, the available data suggest that changes in the intestinal bacteria accompanied by changes in fermentation patterns and fermentation products (specifically short-chain fatty acids) play an important role in improving the IBS symptoms seen after FMT. FMT appears to be a promising treatment for IBS, but further studies are needed before it can be applied in everyday clinical practice.

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Section: Factors That Affect the Outcome Of Fmtmentioning

confidence: 99%

Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21^st century

Patcharatrakul¹,

Gonlachanvit²

2021

WJG

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“…It is also recognised for its ability to deliver a diverse and metabolically active microbial community to the host with greater durability compared with commercial probiotics, making it of great interest in supportive cancer care. Its efficacy is well documented in the case of recurrent Clostridium difficile infection [12], with experimental efficacy also shown for inflammatory bowel disease [13], highlighting its luminal and mucosal benefits. Within oncology, its use has been met with caution because of the perceived risks of translocation [14]; however, recent reports detail profound benefits in steroid-refractory GvHD [15,16].…”

Section: Introductionmentioning

confidence: 99%

Antibiotic-induced disruption of the microbiome exacerbates chemotherapy-induced diarrhoea and can be mitigated with autologous faecal microbiota transplantation

Wardill

Ferreira

et al. 2021

European Journal of Cancer

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Background: Chemotherapy is well documented to disrupt the gut microbiome, leading to poor treatment outcomes and a heightened risk of adverse toxicity. Although strong associations exist between its composition and gastrointestinal toxicity, its causal contribution remains unclear. Our inability to move beyond association has limited the development and implementation of microbial-based therapeutics in chemotherapy adjuncts with no clear rationale of how and when to deliver them. Methods/Results: Here, we investigate the impact of augmenting the gut microbiome on gastrointestinal toxicity caused by the chemotherapeutic agent, methotrexate (MTX). Faecal microbiome transplantation (FMT) delivered after MTX had no appreciable impact on gastrointestinal toxicity. In contrast, disruption of the microbiome with antibiotics administered before chemotherapy exacerbated gastrointestinal toxicity, impairing mucosal recovery

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“…The therapeutic approach for UC is currently based on inflammation control. Fecal microbiota transplantation (FMT) has emerged as a therapeutic option for UC, aiming to modulate the gut microbiota composition and thus the chronic inflammatory status (8,9), although its clinical effectiveness is not as high as reported for Clostridioides difficile infection (CDI) (10,11). Significant efforts has been made in recent years to determine the reasons behind this suboptimal performance, and a number of authors have suggested the importance of the donor's microbial composition as a determinant for FMT success in UC (12,13), particularly in relation to ecosystem diversity (14) or the so-called super-donor phenomenon (15).…”

Section: Introductionmentioning

confidence: 99%

An Immunologic Compatibility Testing Was Not Useful for Donor Selection in Fecal Microbiota Transplantation for Ulcerative Colitis

et al. 2021

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Fecal microbiota transplantation (FMT) is an effective procedure against Clostridioides difficile infection (CDI), with promising but still suboptimal performance in other diseases, such as ulcerative colitis (UC). The recipient’s mucosal immune response against the donor’s microbiota could be relevant factor in the effectiveness of FMT. Our aim was to design and validate an individualized immune-based test to optimize the fecal donor selection for FMT. First, we performed an in vitro validation of the test by co-culturing lymphocytes obtained from the small intestine mucosa of organ donor cadavers (n=7) and microbe-associated molecular patterns (MAMPs) obtained from the feces of 19 healthy donors. The inflammatory response was determined by interleukin supernatant quantification using the Cytometric Bead Array kit (B&D). We then conducted a clinical pilot study with 4 patients with UC using immunocompetent cells extracted from rectal biopsies and MAMPs from 3 donor candidates. We employed the test results to guide donor selection for FMT, which was performed by colonoscopy followed by 4 booster instillations by enema in the following month. The microbiome engraftment was assessed by 16S rDNA massive sequencing in feces, and the patients were clinically followed-up for 16 weeks. The results demonstrated that IL-6, IL-8, and IL-1ß were the most variable markers, although we observed a general tolerance to the microbial insults. Clinical and colonoscopy remission of the patients with UC was not achieved after 16 weeks, although FMT provoked enrichment of the Bacteroidota phylum and Prevotella genus, with a decrease in the Actinobacteriota phylum and Agathobacter genus. The most relevant result was the lack of Akkermansia engraftment in UC. In summary, the clinical success of FMT in patients with UC appears not to be influenced by donor selection based on the explored recipient’s local immunological response to FMT, suggesting that this approach would not be valid for FMT fecal donor optimization in such patients.

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Efficacy and safety of fecal microbiota transplantation for the treatment of diseases other than Clostridium difficile infection: a systematic review and meta-analysis

Cited by 102 publications

References 64 publications

Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21^st century

Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21^st century

Antibiotic-induced disruption of the microbiome exacerbates chemotherapy-induced diarrhoea and can be mitigated with autologous faecal microbiota transplantation

An Immunologic Compatibility Testing Was Not Useful for Donor Selection in Fecal Microbiota Transplantation for Ulcerative Colitis

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Efficacy and safety of fecal microbiota transplantation for the treatment of diseases other than Clostridium difficile infection: a systematic review and meta-analysis

Cited by 102 publications

References 64 publications

Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21st century

Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21st century

Antibiotic-induced disruption of the microbiome exacerbates chemotherapy-induced diarrhoea and can be mitigated with autologous faecal microbiota transplantation

An Immunologic Compatibility Testing Was Not Useful for Donor Selection in Fecal Microbiota Transplantation for Ulcerative Colitis

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Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21^st century

Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21^st century