Microbiota Replacement Therapies: Innovation in Gastrointestinal Care

Khanna, Sahil

doi:10.1002/cpt.923

Cited by 51 publications

(52 citation statements)

References 86 publications

(113 reference statements)

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“…Many bacterial populations in the human gut are obligate or facultative anaerobes, whose viability may depend on how FMT infusions are prepared. Comparisons conducted in rCDI subjects using aerobically and anaerobically prepared FMT infusions showed similar efficacy,77 but comparisons have not been undertaken in other indications 78. In a study of 73 active UC, treatment with 1 week of anaerobically prepared donor FMT resulted in higher steroid-free remission rates at 8 weeks compared with autologous FMT (32% vs 9%) 6.…”

Section: Formulating Fmt Preparations and Delivery Proceduresmentioning

confidence: 99%

Scientific frontiers in faecal microbiota transplantation: joint document of Asia-Pacific Association of Gastroenterology (APAGE) and Asia-Pacific Society for Digestive Endoscopy (APSDE)

Kamm

Yeoh

et al. 2019

Gut

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ObjectiveThe underlying microbial basis, predictors of therapeutic outcome and active constituent(s) of faecal microbiota transplantation (FMT) mediating benefit remain unknown. An international panel of experts presented key elements that will shape forthcoming FMT research and practice.DesignSystematic search was performed, FMT literature was critically appraised and a 1-day round-table discussion was conducted to derive expert consensus on key issues in FMT research.Results16 experts convened and discussed five questions regarding (1) the role of donor and recipient microbial (bacteria, viruses, fungi) parameters in FMT; (2) methods to assess microbiota alterations; (3) concept of keystone species and microbial predictors of FMT, (4) influence of recipient profile and antibiotics pretreatment on FMT engraftment and maintenance and (5) new developments in FMT formulations and delivery. The panel considered that variable outcomes of FMT relate to compositional and functional differences in recipient’s microbiota, and likely donor-associated and recipient-associated physiological and genetic factors. Taxonomic composition of donor intestinal microbiota may influence the efficacy of FMT in recurrent Clostridioides difficile infections and UC. FMT not only alters bacteria composition but also establishes trans-kingdom equilibrium between gut fungi, viruses and bacteria to promote the recovery of microbial homeostasis. FMT is not a one size fits all and studies are required to identify microbial components that have specific effects in patients with different diseases.ConclusionFMT requires optimisation before their therapeutic promise can be evaluated for different diseases. This summary will guide future directions and priorities in advancement of the science and practice of FMT.

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Section: Formulating Fmt Preparations and Delivery Proceduresmentioning

confidence: 99%

Scientific frontiers in faecal microbiota transplantation: joint document of Asia-Pacific Association of Gastroenterology (APAGE) and Asia-Pacific Society for Digestive Endoscopy (APSDE)

Kamm

Yeoh

et al. 2019

Gut

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“…They have been shown to exert anti-inflammatory, anti-oxidative, anti-diabetic, anti-cancer and antibacterial effects [ 20 , 21 ]. A dysbiotic gut microbiome and lower levels of SCFA contribute to various diseases such as inflammatory bowel disease [ 5 , 22 , 23 ], rheumatoid arthritis and multiple sclerosis [ 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

Supplementation of Short-Chain Fatty Acid, Sodium Propionate, in Patients on Maintenance—“Beneficial Effects on Inflammatory Parameters and Gut-Derived Uremic Toxins”—A Pilot Study (PLAN Study)

Marzocco

Fazeli

Micco

et al. 2018

JCM

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Background: In end-stage renal disease (ESRD), gut-derived uremic toxins play a crucial role in the systemic inflammation and oxidative stress promoting the excess morbidity and mortality. The biochemical derangement is in part a consequence of an insufficient generation of short-chain fatty acids (SCFA) due to the dysbiosis of the gut and an insufficient consumption of the fermentable complex carbohydrates. Aim of the study: The primary end-point was to evaluate the potential efficacy of SCFA (specifically, sodium propionate (SP)) for patients on maintenance hemodialysis (MHD) on systemic inflammation. Secondary end-points included potential attenuation of oxidative stress markers, insulin resistance and production of gut-derived uremic toxins indoxyl sulfate and p-cresol sulfate, as well as health status after SP supplementation. Study design: We performed a single-center non-randomized pilot study in 20 MHD patients. They received the food additive SP with a daily intake of 2 × 500 mg in the form of capsules for 12 weeks. Pre-dialysis blood samples were taken at the beginning, after six weeks and at the end of the administration period, as well as four weeks after withdrawal of the treatment. Results: The subjects revealed a significant decline of inflammatory parameters C-reactive protein (−46%), interleukin IL-2 (−27%) and IL-17 (−15%). The inflammatory parameters IL-6 and IFN-gamma showed a mild non-significant reduction and the anti-inflammatory cytokine IL-10 increased significantly (+71%). While the concentration of bacterial endotoxins and TNF-α remained unchanged, the gut-derived uremic toxins, indoxyl sulfate (−30%) and p-cresyl sulfate (−50%), revealed a significant decline. The SP supplementation reduced the parameters of oxidative stress malondialdehyde (−32%) and glutathione peroxidase activity (−28%). The serum insulin levels dropped by 30% and the HOMA-index by 32%. The reduction of inflammatory parameters was associated with a lowering of ferritin and a significant increase in transferrin saturation (TSAT). Four weeks after the end of the treatment phase, all improved parameters deteriorated again. Evaluation of the psycho-physical performance with the short form 36 (SF-36) questionnaire showed an enhancement in the self-reported physical functioning, general health, vitality and mental health. The SP supplementation was well tolerated and without important side effects. No patient had left the study due to intolerance to the medication. The SP supplementation in MHD patients reduced pro-inflammatory parameters and oxidative stress and improved insulin resistance and iron metabolism. Furthermore, SP effectively lowered the important gut-derived uremic toxins indoxyl and p-cresol sulfate. These improvements were associated with a better quality of life. Further controlled studies are required in a larger cohort to evaluate the clinical outcome.

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“…Possible mechanisms explaining this association include alterations in regional GI transit,21 22 bile acid malabsorption, increased intestinal permeability, or low-grade inflammation (reviewed in23). Changes in the intestinal microbiome have also been associated with functional bowel disorders, obesity and MS24 and may represent a common pathophysiological exposure. In this cross-sectional study, although MS was more prevalent in individuals reporting diarrhoea, this association was not statistically significant and was weakened after adjusting for BMI, suggesting that MS is not independently associated with diarrhoea.…”

Section: Discussionmentioning

confidence: 99%

Associations of chronic diarrhoea with non-alcoholic fatty liver disease and obesity-related disorders among US adults

Shin

Imperiale

2019

BMJ Open Gastroenterol

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Mechanisms explaining observed associations between diarrhoea and obesity or increased body mass index (BMI) are unclear.ObjectiveTo assess associations of bowel patterns with BMI, metabolic syndrome (MS), non-alcoholic fatty liver disease (NAFLD) and other obesity-related disorders.DesignWe performed a cross-sectional analysis of data from adults who completed bowel health questions for the 2005 to 2010 cycles of the National Health and Nutrition Examination Surveys. Relationships were examined using multinomial logistic regression. Confounding effects of demographics, smoking, alcohol and BMI were examined by sequential modelling.ResultsAmong 13 413 adults, weighted prevalence rates of constipation and diarrhoea were 8.9% and 6.6%, respectively. Mean BMI was associated with bowel patterns (p<0.001), and was higher with diarrhoea (30.3 kg/m2) versus normal bowel patterns (28.6 kg/m2) and with diarrhoea versus constipation (27.8 kg/m2). NAFLD was more prevalent (ORs, 95% CI) in diarrhoea versus normal bowel patterns (OR=1.34, 95% CI 1.01 to 1.78) or constipation (OR=1.45, 95% CI 1.03, 2.03) in adjusted analyses. The higher prevalence of MS in diarrhoea versus constipation (OR=1.27, 95% CI 0.97 to 1.67) was not independent of BMI.ConclusionsThese findings suggest an association between diarrhoea and NAFLD that is independent of BMI.

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Microbiota Replacement Therapies: Innovation in Gastrointestinal Care

Cited by 51 publications

References 86 publications

Scientific frontiers in faecal microbiota transplantation: joint document of Asia-Pacific Association of Gastroenterology (APAGE) and Asia-Pacific Society for Digestive Endoscopy (APSDE)

Scientific frontiers in faecal microbiota transplantation: joint document of Asia-Pacific Association of Gastroenterology (APAGE) and Asia-Pacific Society for Digestive Endoscopy (APSDE)

Supplementation of Short-Chain Fatty Acid, Sodium Propionate, in Patients on Maintenance—“Beneficial Effects on Inflammatory Parameters and Gut-Derived Uremic Toxins”—A Pilot Study (PLAN Study)

Associations of chronic diarrhoea with non-alcoholic fatty liver disease and obesity-related disorders among US adults

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