Durable Alteration of the Colonic Microbiota by the Administration of Donor Fecal Flora

Grehan, Martin; Borody, Thomas J.; Leis, Sharyn; Campbell, John; Mitchell, Hazel M.; Wettstein, Antony

doi:10.1097/mcg.0b013e3181e5d06b

Cited by 216 publications

(164 citation statements)

References 33 publications

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“…The microbiota of CDI patients is characterized by an absence or reduction of Bacteroidetes spp., as observed both by cultivation (Tvede and Rask-Madsen, 1989) as well as with 16S rRNA gene-targeted molecular approaches (Grehan et al, 2010;Khoruts et al, 2010). This was confirmed in our study, where patients at day 0 showed significant reduction in the relative abundance of several groups belonging to the Bacteroidetes, as well as displaying complete absence of the central co-occurrence networks involving these bacteria.…”

Section: Discussionsupporting

confidence: 76%

Reset of a critically disturbed microbial ecosystem: faecal transplant in recurrent Clostridium difficile infection

et al. 2014

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Recurrent Clostridium difficile infection (CDI) can be effectively treated by infusion of a healthy donor faeces suspension. However, it is unclear what factors determine treatment efficacy. By using a phylogenetic microarray platform, we assessed composition, diversity and dynamics of faecal microbiota before, after and during follow-up of the transplantation from a healthy donor to different patients, to elucidate the mechanism of action of faecal infusion. Global composition and network analysis of the microbiota was performed in faecal samples from nine patients with recurrent CDI. Analyses were performed before and after duodenal donor faeces infusion, and during a follow-up of 10 weeks. The microbiota data were compared with that of the healthy donors. All patients successfully recovered. Their intestinal microbiota changed from a low-diversity diseased state, dominated by Proteobacteria and Bacilli, to a more diverse ecosystem resembling that of healthy donors, dominated by Bacteroidetes and Clostridium groups, including butyrate-producing bacteria. We identified specific multi-species networks and signature microbial groups that were either depleted or restored as a result of the treatment. The changes persisted over time.Comprehensive and deep analyses of the microbiota of patients before and after treatment exposed a therapeutic reset from a diseased state towards a healthy profile. The identification of microbial groups that constitute a niche for C. difficile overgrowth, as well as those driving the reinstallation of a healthy intestinal microbiota, could contribute to the development of biomarkers predicting recurrence and treatment outcome, identifying an optimal microbiota composition that could lead to targeted treatment strategies.

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Section: Discussionsupporting

confidence: 76%

Reset of a critically disturbed microbial ecosystem: faecal transplant in recurrent Clostridium difficile infection

et al. 2014

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“…Whether this approach of enhancing innate immune defects will be selectively eff ective in those patients with genetic defects in bacterial killing (NOD2, ATG16L1, IRGM1, NCF2, and so on) remains to be determined. Analogous to successful use of fecal transplants to correct antibiotic-induced dysbiosis in recurrent C. diffi cile toxin-associated colitis, Grehan et al ( 74 ) have reported uncontrolled benefi t of fecal transplantation in IBD patients. Th is novel and potentially nontoxic approach needs controlled validation.…”

Section: Microbial Complications Of Ibdmentioning

confidence: 99%

Intestinal Microbes in Inflammatory Bowel Diseases

Sartor¹,

Mazmanian²

2012

Am J Gastroenterol Suppl

186

152

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“…they note that the solution of the disease occurs in about 92%, with adverse effects being uncommon and deaths are not usually due to the process, but parallel problems. The favorable changes that appear in the microbiota after transplantation have been documented [23][24][25], imt is one of the most commonly used procedures as emergency treatment for C. difficile infection, being imposed on other systems such as the use of monoclonal antibodies directed against toxin a and b, C. difficile vaccination [26]. imt is increasingly adopted by groups that treat patients with C. difficile infection, since the cure is more than 90%, as reported in multiple centers.…”

Section: Discussionmentioning

confidence: 99%

Pseudomembranous enterocolitis cured with three intestinal microbiota transplantations

Zamudio-Tiburcio¹,

Bermúdez-Ruiz²,

Reyes-López³

et al. 2018

Gastroenterol Hepatol Endosc

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SummaryWe present a unique case of a 82 years old women, with this newly described condition called "pseudomembranous enterocolitis cured with three transplants of intestinal microbi0ta (imt)." We evaluated the case of gaw, who had a perforates sigmoid diverticulum 10m days ago and had surgery with sigmoid resection, colostomy and hartmann's pouch. Her progress was good. However, she was given metronidazole and vancomycin, antibiotics that caused severe diarrhea and toxic state, a week postoperatively. Histopathological study of surgical specimen showed colonic mucosa extensively ulcerated and granulation tissue, fibrin and abundant neutrophils. Submucosal edema and acute periserositis. The muscular and mucosal layer had not alterations. A diagnosis of pseudomembranous enterocolitis (pm) was made. The patient had a toxic state, semi-conscious, diaphoretic and extensive erythema in the right forearm, with minor erythema at the left forearm and face, as well as perineal erythema, third degree edema in lower limbs, dehydrated and chest x-ray showed interstitial pneumonitis. She had a typical case of pm, and proceeded to perform an intestinal microbiota transplantation (imt) from healthy donors at clinical and laboratory studies. After that imt we performed colonoscopy, which showed at the course of transverse and right colon multiple plaques of whitish, cotton-like appearance, which protuded on the mucosal surface. This appearance were also seen at the left colon. We applied 400 ml. Of imt in the right colon and 100 ml at the hartmann's pouch of rectum. At the colonoscopy we placed a foley's catheter with an inflated balloon 20 ml. Also, solid petroleum jelly was left to prevent imt elimination. We removed all antibiotic treatment and replaced with probiotics, through the nasogastric tube.Three day later the patient had a better general condition, was conscious, with erythema limited to forearms, face and perineum, the lowers limb had no edema and she was better hydrated.The second imt was performed with another 400 ml. Of microbiota in right colon and 100 ml. At the hartmann's pouch. To prevent imt a 20 ml. Inflated balloon colostomy (foley's catheter) sealed with solid petroleum jelly.Three days later, a new imt was required under the same conditions as the former two imt. On this occasion the patient was fully aware, speaking and responded correctly to our questions. She had no erythema in her body, no edema at her legs and her chest x-ray had no pneumonitis, and showed only a small leak at the base of right lung.Further treatment without antibiotics, was with symbiotic by mouth and was under another treating team.We reviewed the literature, and we hope to encourage colleagues to use this procedure, which had similar results in the world. Presentation of the caseGaw, female, 82 years old with a history of sigmoid diverticulum perforation, peritonitis treated with sigmoid resection, colostomy and hartmann's pouch were given the following antibiotics: metronidazole, vancomycin which caused pseudomembranous enteroc...

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Durable Alteration of the Colonic Microbiota by the Administration of Donor Fecal Flora

Cited by 216 publications

References 33 publications

Reset of a critically disturbed microbial ecosystem: faecal transplant in recurrent Clostridium difficile infection

Reset of a critically disturbed microbial ecosystem: faecal transplant in recurrent Clostridium difficile infection

Intestinal Microbes in Inflammatory Bowel Diseases

Pseudomembranous enterocolitis cured with three intestinal microbiota transplantations

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