Responses to faecal microbiota transplantation in female and male patients with irritable bowel syndrome

Abstract

BACKGROUND Faecal microbiota transplantation (FMT) seems to be a promising treatment for irritable bowel syndrome (IBS) patients. In Western countries (United States and Europe), there is a female predominance in IBS. A sex difference in the response to FMT has been reported recently in IBS patients. AIM To investigate whether there was a sex difference in the response to FMT in the IBS patients who were included in our previous randomized controlled trial of the efficacy of FMT. METHODS The study included 164 IBS patients who participated in our previous randomized controlled trial. These patients had moderate-to-severe IBS symptoms belonging to the IBS-D (diarrhoea-predominant), IBS-C (constipation-predominant) and IBS-M (mixed) subtypes, and had not responded to the National Institute for Health and Care Excellence (NICE)-modified diet. The y belonged in three groups: placebo (own faeces), and active treated group (30-g or 60-g superdonor faeces). The patients completed the IBS severity scoring system (IBS-SSS), Fatigue Assessment Scale (FAS) and the IBS quality of life scale (IBS-QoL) questionnaires at the baseline and 2 wk, 1 mo and 3 mo after FMT. They also provided faecal samples at the baseline and 1 mo after FMT. The faecal bacteria profile and dysbiosis were determined using the 16S rRNA gene polymerase chain reaction DNA amplification covering V3-V9; probe labelling by single nucleotide extension and signal detection. The levels of short-chain fatty acids (SCFAs) were determined by gas chromatography and flame ionization. RESULTS There was no sex difference in the response to FMT either in the placebo group or active treated group. There was no difference between females and males in either the placebo group or actively treated groups in the total score on the IBS-SSS, FAS or IBS-QoL, in dysbiosis, or in the faecal bacteria or SCFA level. However, the response rate was significantly higher in females with diarrhoea-predominant (IBS-D) than that of males at 1 mo, and 3 mo after FMT. Moreover, IBS-SSS total score was significantly lower in female patients with IBS-D than that of male patients both 1 mo and 3 mo after FMT. CONCLUSION There was no sex difference in the response to FMT among IBS patients with moderate-to-severe symptoms who had previously not responded to NICE-modified diet. However, female patients with IBS-D respond better and have higher reduction of symptoms than males after FMT.

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

“…In the subgroup of IBS-D and IBS-M patients with refractory IBS and severe bloating who had not responded to at least three conventional therapies for IBS, the response to FMT was better for females than for males[ 27 ]. On the other hand, the response to FMT did not differ between female and male IBS patients with moderate-to-severe symptoms belonging to the IBS-D, IBS-C, and IBS-M subtypes who had previously not responded to the NICE-modified diet[ 56 ].…”

“…In the patients that received FMT, the fecal levels of butyric acid increased at 1 mo after FMT and remained elevated at 1 year after transplantation(unpublished data)[ 56 ]. Butyrate provides colonic epithelial cells with energy[ 105 ], modulates the immune response and oxidative stress, and decreases intestinal motility and the permeability of intestinal cells[ 87 ].…”

Species- and strain-level assessment usingrrnlong-amplicons suggests donor’s influence on gut microbial transference via fecal transplants in metabolic syndrome subjects

“…We have previously unveiled differential responses of women and men gut microbiota to a particular dietary intervention, suggesting that such disparate sex-associated microbial configurations and related traits could plausibly explain the success of FMT 30 . Nonetheless, previous FMT interventions in the context of IBS show no differential response between women and men 31 . Finally, an individual-specific response to FMTs cannot be disregarded as in our trial the material from Donor1 exerted the most positive impact on the metabolic health of their three different recipients.…”

Species- and strain-level assessment using rrn long-amplicons suggests donor’s influence on gut microbial transference via fecal transplants in metabolic syndrome subjects

“… 30 Nonetheless, previous FMT interventions in the context of IBS show no differential response between women and men. 31 Finally, an individual-specific response to FMTs cannot be disregarded as in our trial the material from Donor1 exerted the most positive impact on the metabolic health of their three different recipients. Consequently, the role of the personal features of the donor, particularly those influencing the gut microbiota composition and metabolic potential (e.g.…”