Fecal Microbiota Transplantation for Treatment of Acute Graft-versus-Host Disease

Abstract

The growing understanding of the bidirectional relationship between the gastrointestinal (GI) microbiome and the immune system has opened up new avenues for treatment of graft-versus-host disease (GVHD). Fecal microbiota transplantation (FMT) is the transfer of stool from a donor to a recipient who harbors a perturbed GI microbiome resulting in disease. We review the rationale for performing FMT for the treatment of acute GVHD, and summarize data on the safety and efficacy of the procedure among allogeneic hematopoietic stem cell transplantation (HSCT) recipients. Overall, FMT is a promising strategy in treating and preventing HSCT-related complications. However, caution should be exerted as HSCT recipients are highly immunosuppressed and unanticipated infectious adverse events may appear with the increasing application of FMT.

Long-term impact of fecal transplantation in healthy volunteers

“…We have used the FMT protocol including dosage and timing of the procedure, as well as observation terms which, in general, correspond to the protocol from the clinical trial NCT03214289. The workflow of the study was used in other clinical trials applied for the treatment of different gastrointestinal disorders [25]. The FMT procedure was performed in three healthy volunteers (38.6 ±7.4 years old, two male and one female).…”

The Butyrogenic and Lactic Bacteria of the Gut Microbiota Determine the Outcome of Allogenic Hematopoietic Cell Transplant

“…However, it is now necessary to enter more deeply into the characterization of the bacterial species that distinguish homeostasis from dysbiosis in non-GVHD versus GVHD patients and to study their enzymatic equipment which can vary both at the level of the bacterial strain and at the clone level. There is currently evidence that the adverse outcomes of irradiation and antibiotics/chemotherapy treatments (oxidative stress) on gut microbiota could be avoided by using probiotics and/or fecal microbiota transplant, opening new perspective for the prevention of GVHD in allo-HCT patients ( Delia et al, 2002 ; Kaito et al, 2018 ; Severyn et al, 2019 ; Shouval et al, 2019 ). The next challenge is to offer transplant patients a beneficial combination of easy-to-consume probiotics, which should prevent the occurrence of GVHD.…”

Treatment and unmet needs in steroid-refractory acute graft-versus-host disease

“…FMT is a therapy that reestablishes the microbiota system through infusing a fecal suspension from a healthy donor into a patient's gastrointestinal tract [87,88]; three case reports of its use in patients with SR-aGVHD have been published (Table 2) [23][24][25]27]. A pilot study of four patients (three with gastrointestinal SR-aGVHD; one with steroiddependent gastrointestinal aGVHD) evaluated the safety and efficacy of FMT [24].…”