Fecal microbiota transplantation ameliorates active ulcerative colitis

Abstract

Ulcerative colitis (UC) is a complex chronic pathological condition of the gut in which microbiota targeted treatment, such as fecal microbiota transplantation (FMT), has shown an encouraging effect. The aim of the present study was to investigate the efficacy and safety of FMT in patients with mild or moderate UC. A single-center, open-label study was designed, including 47 patients with mild or moderate active UC who received three treatments of fresh FMT via colonic transendoscopic enteral tubing within 1 week. The inflammatory bowel disease questionnaire, partial Mayo scores, colonoscopy, erythrocyte sedimentation rate, C-reactive protein level and procalcitoin values were used to assess the efficacy of FMT and alteration in gut microbiota was detected by 16S ribosomal RNA-sequencing. Before FMT, microbiota Faecalibacterium prausnitzii (F. prausnitzii) levels were significantly decreased in patients with UC compared with healthy donors (P<0.01). At 4 weeks post-FMT, F. prausnitzii levels were significantly increased (P<0.05), and the Mayo score was significantly decreased (1.91±1.07 at baseline vs. 4.02±1.47 at week 4; P<0.001) in patients with UC compared with healthy donors. Steroid-free clinical responses were reported in 37 patients (84.1%), and steroid-free clinical remission was achieved in 31 patients (70.5%) at week 4 post-FMT, however, steroid-free remission was not achieved in any patient. No adverse events were reported in 41 (93.2%) patients after FMT or during the 12-week follow-up. Shannon's diversity index and Chao1 estimator were also improved in patients with UC receiving FMT. In conclusion, the results of the present study suggested that FMT resulted in clinical remission in patients with mild to moderate UC, and that the remission may be associated with significant alterations to the intestinal microbiota of patients with UC. Furthermore, F. prausnitzii may serve as a diagnostic and therapeutic biomarker for the use of FMT in UC.

Gut Microbiome Changes in Patients with Active Left-Sided Ulcerative Colitis after Fecal Microbiome Transplantation and Topical 5-aminosalicylic Acid Therapy

“…The increased microbiota diversity reported by several authors in UC patients after FMT from multi-donor blended stool (2–7 donors) [ 11 , 12 , 13 , 14 , 15 ] was not found in our study using one donor for all patients. The finding reported in this work of no significant differences in Shannon diversity in FMT responders and non-responders between the baseline and any other sampling point after therapy initiation is in agreement with the studies of Damman et al [ 17 ] and Kump et.…”

“…F. prausnitzii has even been suggested to constitute a marker of a healthy gut [ 57 , 58 ]. The increased levels of F. prausnitzii after FMT found in this study have been also reported by Chen [ 14 ] and Fuentes [ 6 ], indicating a positive influence of FMT. However, we did not find any data about the effect of FMT on Blautia in UC patients in the corresponding literature.…”

“…Several studies have already demonstrated a positive influence of FMT and its potential therapeutic value for the treatment of UC. Significantly increased bacterial diversity was described in the majority of studies [ 11 , 12 , 13 , 14 , 15 ], however, it is not the only prerequisite for successful FMT, as Kump et al [ 16 ] and Damman et al [ 17 ] did not find alpha diversity differences but still observed temporary disease remission in some patients. A significantly increased similarity of the patient to the donor was described by several authors [ 10 , 15 , 16 , 18 ], indicating a high rate of microbiota transfer and shift of the bacterial community to a new, healthier composition.…”

Fecal Microbiota Transplant in Two Ulcerative Colitis Pediatric Cases: Gut Microbiota and Clinical Course Correlations

“…The role of FMT in the treatment of pediatric UC is still debated, although the safety and tolerability of this clinical practice have already been assessed [ 16 , 17 , 28 ]. Recent reviews examined the current state of knowledge on FMT in IBD, and concluded that translational research on FMT is important in order to transfer its potential to real clinical management [ 15 , 37 ].…”

“…The success of FMT for the treatment of Clostridium difficile infection has been proven [ 8 , 9 ]. However, several articles have already reported on FMT’s potential therapeutic use in GI and GI-related diseases, including IBD [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”