AGA Clinical Practice Guideline on Fecal Microbiota–Based Therapies for Select Gastrointestinal Diseases

Peery, Anne F.; Kelly, Colleen R.; Kao, Dina; Vaughn, Byron P.; Lebwohl, Benjamin; Singh, Siddharth; Imdad, Aamer; Altayar, Osama

doi:10.1053/j.gastro.2024.01.008

Cited by 39 publications

(10 citation statements)

References 115 publications

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“…Treatment with FMT in UC is still controversial. AGA guidelines published in 2024 suggested that conventional FMT should not be used in adults with UC but could reasonably be used in the context of clinical trials or potentially outside of clinical trials when no comparable or satisfactory alternative treatment is available [32]. The following reasons were provided to deter recommendations: Significant heterogeneity in FMT administration was observed in the studies performed, as the study sizes were insufficient and most FMTs were administered in concomitant therapy; however, studies showing the effectiveness of FMT continue to be reported [16,23,24,33].…”

Section: Discussionmentioning

confidence: 99%

Complementary Therapeutic Effect of Fecal Microbiota Transplantation in Ulcerative Colitis after the Response to Anti-Tumor Necrosis Factor Alpha Agent Was Lost: A Case Report

Shin,

Baek,

Cha

et al. 2024

Biomedicines

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In patients with ulcerative colitis (UC), the development of an antidrug antibody (ADA) to anti-tumor necrosis factor (TNF)α agent is a crucial problem which aggravates the clinical course of the disease, being cited as one of the most common causes for discontinuing anti-TNFα treatment. This is due to ADA eventually causing secondary LOR, leading to discontinuation of anti-TNFα treatment. Recently, research on the microbiome and relationship between worsening UC and dysbiosis has been conducted. Further, investigations on the association between the microbiome and secondary LOR are increasing. Here, we present the therapeutic effect of fecal microbiota transplantation (FMT) on a 42-year-old man with secondary LOR and high ADA levels. FMT has recently been used for the treatment of, and for overcoming, drug resistance through microbiome modification. Stool samples were collected from the patient before and 4 weeks after FMT. Symptoms, including hematochezia and Mayo endoscopy sub-scores, improved after FMT, while ADA levels decreased by one-third to less than half the value (29 ng/mL) compared to before FMT (79 ng/mL). Additionally, the trough level of infliximab became measurable, which reflects the improvement in the area under the concentration (AUC). Butyricicoccus, Faecalibacterium, Bifidobacterium, Ligilactobacillus, Alistipes, and Odoribacter, which regulate immune responses and alleviate inflammation, also increased after FMT. We report a case in which microbiome modification by FMT increased the AUC of anti-TNFα in a patient who developed secondary LOR during anti-TNFα treatment, thereby improving symptoms and mucosal inflammation.

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Section: Discussionmentioning

confidence: 99%

Complementary Therapeutic Effect of Fecal Microbiota Transplantation in Ulcerative Colitis after the Response to Anti-Tumor Necrosis Factor Alpha Agent Was Lost: A Case Report

Shin,

Baek,

Cha

et al. 2024

Biomedicines

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“…This important concept has been highlighted by different clinical [418,419] and pre-clinical [392] studies where individual microbiota composition and functions have been reported to influence dietary fiber supplementation, with varying consequences on intestinal health. For this reason, recognizing the importance of focusing on the microbiome leads to a "before" and "after" in health research and innovation, with the perspective nowadays to develop personalized medicine for patients, taking into account individual microbiota features when indicating the most appropriate treatment [361,420]. The relationship between nutrition, production/utilization of SCFA, and variation of the microbiota is just a small example to explain this ecological perspective that is gradually evolving towards the more philosophical concept of One Health, and perhaps in the not too distant future towards the more holistic concept of "Microbiome One Health" [421].…”

Section: Discussionmentioning

confidence: 99%

“…FMT is a therapeutic approach involving the transfer of a fecal suspension from a healthy donor to the patient's gastrointestinal tract to restore average microbial composition and function [359,360]. It is recommended by guidelines and consensus from international societies for the treatment of recurrent Clostridioides difficile infection (rCDI) [361][362][363][364][365]. Encouraging results indicate that FMT might also potentially treat additional conditions linked to disruptions in gut microbiota composition, including IBD and disturbances of the gut-brain axis, like anorexia [359,361,[366][367][368][369][370][371][372].…”

Section: Fecal Microbiota Transplantationmentioning

confidence: 99%

“…It is recommended by guidelines and consensus from international societies for the treatment of recurrent Clostridioides difficile infection (rCDI) [361][362][363][364][365]. Encouraging results indicate that FMT might also potentially treat additional conditions linked to disruptions in gut microbiota composition, including IBD and disturbances of the gut-brain axis, like anorexia [359,361,[366][367][368][369][370][371][372]. The efficacy of FMT largely depends on the donor's microbiota, with "super donors" possessing favorable bacterial characteristics crucial for successful outcomes [373].…”

Section: Fecal Microbiota Transplantationmentioning

confidence: 99%

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Short-chain Fatty Acids and Human Health: from Metabolic Pathways to Current Therapeutic Implication

Facchin,

Bertin,

Bonazzi

et al. 2024

Preprint

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The gastrointestinal tract is colonized by trillions of different microorganisms, named the gut microbiota, which is key to degrade undigested food such as dietary fibers. The fermentation of these food components leads to the production of short-chain fatty acids (SCFA) acetate, propionate, and butyrate, which exploit several beneficial roles for the host’s health. Their production and absorption happen in different ways in the human intestine and depend on the type of dietary fiber reaching the gut and the microorganisms involved in the fermentation. The supplementation of SCFAs, mostly butyrate, in treating gastrointestinal, metabolic, cardiovascular, and gut-brain-related diseases has been reported in the medical literature. This review aims to give an overview of the production and absorption dynamics of acetate, propionate, and butyrate in the human gut, with a final focus on the role played by these SCFAs on gastrointestinal and metabolic health and the present therapeutic implications.

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“…Recently, the FDA has approved fecal microbiota products (e.g., Rebyota 15 and Vowst 16 ) for the prevention of rCDI in individuals 18 years of age and older, following antibiotic treatment for rCDI. Rebyota is a room temperature shelf stable suspension of healthy donor stool 17 , although its clinical effect size for the prevention of rCDI is modest (RR, 1.17; 95% CI, 0.99–1.39) 18 and its microbial composition is not predefined 19 . Although Vowst is a formulation of live fecal microbiota consisting of a highly purified collection of about 50 species of Firmicutes spores with a more robust clinical effect size (1.46; 95% CI, 1.21– 1.75) 18 , the ecological principle underlying the selection of these microbial strains is unclear.…”

Section: Introductionmentioning

confidence: 99%

Rational Design of Live Biotherapeutic Products for the Prevention ofClostridioides difficileInfection

Ke,

Villafuerte Gálvez,

Sun

et al. 2024

Preprint

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Clostridioides difficile infection (CDI) is one of the leading causes of healthcare- and antibiotic-associated diarrhea. While fecal microbiota transplantation (FMT) has emerged as a promising therapy for recurrent CDI, its exact mechanisms of action and long-term safety are not fully understood. Defined consortia of clonal bacterial isolates, known as live biotherapeutic products (LBPs), have been proposed as an alternative therapeutic option. However, the rational design of LBPs remains challenging. Here, we employ a computational pipeline and three independent metagenomic datasets to systematically identify microbial strains that have the potential to inhibit CDI. We first constructed the CDI-related microbial genome catalog, comprising 3,741 non-redundant metagenome-assembled genomes (nrMAGs) at the strain level. We then identified multiple potential protective nrMAGs that can be candidates for the design of microbial consortia targeting CDI, including strains from Dorea formicigenerans, Oscillibacter welbionis, and Faecalibacterium prausnitzii. Importantly, some of these potential protective nrMAGs were found to play an important role in the success of FMT, and the majority of the top protective nrMAGs can be validated by various previously reported findings. Our results demonstrate a computational framework for the rational selection of microbial strains targeting CDI, paving the way for the computational design of microbial consortia against other enteric infections.

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AGA Clinical Practice Guideline on Fecal Microbiota–Based Therapies for Select Gastrointestinal Diseases

Cited by 39 publications

References 115 publications

Complementary Therapeutic Effect of Fecal Microbiota Transplantation in Ulcerative Colitis after the Response to Anti-Tumor Necrosis Factor Alpha Agent Was Lost: A Case Report

Complementary Therapeutic Effect of Fecal Microbiota Transplantation in Ulcerative Colitis after the Response to Anti-Tumor Necrosis Factor Alpha Agent Was Lost: A Case Report

Short-chain Fatty Acids and Human Health: from Metabolic Pathways to Current Therapeutic Implication

Rational Design of Live Biotherapeutic Products for the Prevention ofClostridioides difficileInfection

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