Short-Term Surveillance of Cytokines and C-Reactive Protein Cannot Predict Efficacy of Fecal Microbiota Transplantation for Ulcerative Colitis

Abstract

ObjectiveThere were no reports on predicting long-term efficacy of fecal microbiota transplantation (FMT) for ulcerative colitis (UC). This study aimed to detect short-term changes of cytokines and C-reactive protein (CRP) in patients with UC undergoing FMT, and to evaluate the predictive value of CRP and cytokines for the long-term efficacy of FMT.MethodsNineteen patients with moderate to severe UC (Mayo score ≥ 6) were treated with single fresh FMT through mid-gut. Serum samples were collected before and three days post-FMT. Clinical responses were evaluated by a minimum follow-up of three months. Patients with clinical improvement and remission at the assessment point of three-month were included as response group, while patients without clinical improvement or remission were included as non-response group. Serum concentrations of cytokines (IL-1β, IL-2, IL-4, IL-6, IL-10, IL-11, IL-17A, IFN-γ, TNF, TNFR-1, TNFR-2, MCP-1, G-CSF, GM-CSF) and CRP were assayed to predict the clinical response of FMT.ResultsIn total, 10.5% (2/19) of patients achieved clinical remission and 47.4% (9/19) achieved clinical improvement (Response group, including clinical remission and clinical improvement), 42.1% (8/19) failed to benefit from FMT (Non-response group). In both Response group and Non-response group, the level of CRP at three days after FMT didn’t show significant decrease compared with that before FMT (p>0.05). However, in Response group, CRP level at three months after FMT decreased significantly than that before FMT (p<0.05). Compared with healthy controls (n = 9), patients with UC showed a higher baseline level of serum IL-6, TNFR-2 and G-CSF, and a lower level of IL-2 and IL-4 (p<0.05). In both Response group and Non-response group, none of the eleven detectable cytokines showed a significant difference between the value at three days after FMT and that before FMT (p>0.05).ConclusionsPatients with moderate to severe UC presented a complex disorder of cytokines. However, the efficacy of FMT for UC might not be predicted by the short-term surveillance of cytokines and CRP.

Role of fecal microbiota transplantation in inflammatory bowel disease

“…with magnesium citrate being administered in a single study. In order to inhibit gastric acid secretion before the FMT procedure administered via gastroscopy or a nasojejunal tube, proton pump inhibitors were used in seven studies . Metoclopramide was used in three studies to prevent adverse events, such as vomiting, during the endoscopic administration of FMT .…”

“…The number of FMT procedures performed per patient also varied. In 58% of studies only one procedure was performed, whereas in the remaining studies the number of procedures per patient ranged from two to six infusions (excluding the 41 infusions given in the study by Paramsothy et al …”

“…The studies demonstrated high heterogeneity in the age (from 7 to 71 years) of patients with IBD receiving FMT and in the severity of their baseline diseases. Overall, 51% of patients had mild-to-moderate disease, [21][22][23][24][25][26][27][28][29] and 23% had moderate-to-severe disease [30][31][32][33][34] . It is important to bear in mind the limited proportion of patients with severe disease when interpreting the currently available efficacy and safety data.…”

“…All but one study reported data on the preparation of the patients before FMT. [21][22][23][24][25][26][27][28][29][30][32][33][34][35][36][37][38][39] In nine studies the patients received antibiotics before FMT (vancomycin, metronidazole or rifaximin). [22][23][24]26,27,29,30,35,36 Polyethylene glycol was used for bowel cleansing in more than half the studies.…”

“…In order to inhibit gastric acid secretion before the FMT procedure administered via gastroscopy or a nasojejunal tube, proton pump inhibitors were used in seven studies. [23][24][25]30,[32][33][34] Metoclopramide was used in three studies to prevent adverse events, such as vomiting, during the endoscopic administration of FMT. [32][33][34] Most patients received more than one type of preparation.…”