Faecal microbiota transplantation effective for treating inflammatory bowel disease
A recent study from China showed that faecal microbiota transplantation (FMT) is effective as a therapeutic option for patients with inflammatory bowel disease (IBD).
“In a self-control study, we demonstrated positive results 4–6 months after FMT treatment of patients with ulcerative colitis [UC]. The clinical response rate was 88.2 percent, clinical remission rate was 64.7 percent, and endoscopic remission rate was 76.5 percent,” reported primary investigator Professor Yunshen Yang of the People’s Liberation Army General Hospital in Beijing, China, who spoke at the Asian Pacific Digestive Week (APDW) 2017 held in Hong Kong. [Yang Y, et al, unpublished data]
Significant decreases in Mayo Scores and endoscopic Mayo Scores were also found as early as 2–3 months after FMT (p<0.0001).
“A substantial proportion of patients [76.5 percent] who received FMT also experienced an average weight increase of 4 kg. Erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], white blood cell [WBC] count and inflammatory bowel disease questionnaire [IBDQ] also improved among FMT-treated patients,” said Yang.
A recent meta-analysis of 14 cohort studies and four randomized controlled trials also showed higher clinical response rate (49 vs 28 percent; p= 0.02) and clinical remission rate (28 vs 9 percent; p< 0.01) in IBD patients treated with FMT vs placebo. [Aliment Pharmacol Ther 2017;46:213-224]
Possible mechanisms of FMT include re-establishment of microbiota diversity, with increase in Roseburia spp, Oscillibacter spp, Lachtnospiraceae spp and Ruminococcaceae spp. [Transplant Proc 2016;48:402e407]
Viruses also play a role in the mechanism by being detectable as viral contigs transferred from the donors, with none of these viruses replicating on human cells but scoring as bacteriophages with Siphoviridae temperate phages transferring more efficiently as compared with other groups. [mBio 2016;7:e00322]
Studies have previously shown that chronic intestinal inflammation develops in germ-free mouse models after colonization with commensal gut bacteria. IBD patients were found to have fewer anti-inflammatory bacteria and more proinflammatory bacteria in the gut as compared with controls. Metabolites of intestinal microbiota are also disturbed in IBD. Metagenomic studies have suggested compositional changes of the gut microbiota in patients with IBD. [World J Gastroenterol 2014;20:14805-14820; Microorganisms 2016;4:20; Ital J Pediatr 2014;40:32]
Significant changes in fungal composition are also observed in IBD. For instance, a study revealed that Basidiomycota spp was significantly increased whereas Ascomycota spp was significantly reduced. [Gut 2017;66:1039-1048]
Significant expansion of bacteriophages of the viruses of the Caudovirales order were noted in IBD patients vs healthy controls. [Cell 2015;160:447-460]
Recently, probiotics containing Escherichia coli Nissle 1917 (EcN) was recommended by guidelines of the European Crohn’s and Colitis Organisation (ECCO) as an effective treatment alternative to mesalazine in maintenance remission among UC patients. [World J Gastroenterol 2016;22:5505-5511]
“Currently, international and local recommendations on FMT are weak and use of the treatment is limited to clinical research… A lot still need to be addressed, such as the mechanism of FMT, its safety, indications, preparation of donors, follow-up of patients and ethical implications associated with the procedure,” Yang commented.