Fecal Microbiota Transplantation in Patients With Primary Sclerosing Cholangitis: A Pilot Clinical Trial

Allegretti, Jessica R.; Kassam, Zain; Carrellas, Madeline; Mullish, Benjamin H.; Marchesi, Julian R.; Smith, Mark; Gerardin, Ylaine; Timberlake, Sonia; Pratt, Daniel S.; Korzenik, Joshua R.

doi:10.14309/ajg.0000000000000115

Cited by 178 publications

(116 citation statements)

References 35 publications

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“…The open-label experience of IMT in PSC with controlled IBD demonstrated that it was safe and 3 of the 10 patients demonstrated a 50% reduction in alkaline phosphatase. 157 However, larger randomised trials are needed. Similarly, an even smaller experience in HBeAg-positive…”

Section: Human Experience Of Imt In Chronic Liver Diseasementioning

confidence: 99%

Microbiota changes and intestinal microbiota transplantation in liver diseases and cirrhosis

Bajaj

Khoruts

2020

Journal of Hepatology

132

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Patients with chronic liver disease and cirrhosis demonstrate a global mucosal immune impairment, which is associated with altered gut microbiota composition and functionality. These changes progress along with the advancing degree of cirrhosis and can be linked with hepatic encephalopathy, infections and even prognostication independent of clinical biomarkers. Along with compositional changes, functional alterations to the microbiota, related to short-chain fatty acids, bioenergetics and bile acid metabolism, are also associated with cirrhosis progression and outcomes. Altering the functional and structural profile of the microbiota is partly achieved by medications used in patients with cirrhosis such as rifaximin, lactulose, proton pump inhibitors and other antibiotics. However, the role of faecal or intestinal microbiota transplantation is increasingly being recognised. Herein, we review the challenges, opportunities and road ahead for the appropriate and safe use of intestinal microbiota transplantation in liver disease.

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Section: Human Experience Of Imt In Chronic Liver Diseasementioning

confidence: 99%

Microbiota changes and intestinal microbiota transplantation in liver diseases and cirrhosis

Bajaj

Khoruts

2020

Journal of Hepatology

132

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“…In this early study of 10 patients who received a single FMT, 30% achieved a reduction in ALP, which was correlated with the extent of donor engraftment. The procedure was safe and well tolerated and opens the door to further investigation in this area …”

Section: Clinical Trials: Translating Precision Medicine Into Practicementioning

confidence: 99%

“…There is reduced bacterial diversity in PSC, and a recent Mdr2 −/− mouse model elegantly demonstrated the overexpression of inflammasome proteins, a phenomenon that could be transferred by fecal microbiota transplantation (FMT) and provides a link between dysbiosis and immune dysregulation in PSC . Very early studies have explored a role for FMT in PSC, but more work is required to develop firm conclusions about any potential role in managing the condition through manipulating the microbiome …”

Section: Etiology and Pathogenesismentioning

confidence: 99%

Precision medicine in primary sclerosing cholangitis

Maurice

Thorburn

2019

J of Digest Diseases

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Primary sclerosing cholangitis is a rare, complex autoimmune disease in relatively young patients. There is currently no treatment for the disease, resulting in high rates of advanced liver disease leading to death or liver transplantation. However, advances have been made in our understanding of the pathophysiological mechanisms of the disease, particularly from breakthroughs in the underlying genetics. Moreover, large international collaborations have generated important clinical data that have given greater detail on the different disease phenotypes and natural history, generating new risk prediction models. As a result, drug development may be designed to target specific disease mechanisms at known points of the disease natural history. Therefore, more drugs are entering phase II and III development, giving hope that soon patient‐specific treatments may be available to treat this difficult disease.

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“…Cumulative experience from case series and controlled trials shows that FMT is effective when used to treat relapsing CDI [5,6]. The high therapeutic efficacy of FMT for recurrent CDI is an important proof of concept that substantial modification of the gut microbiota can be an effective modality for treatment of other diseases in humans such as primary sclerosing cholangitis, inflammatory bowel disease, and serious antibiotic-associated diarrhea [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Fecal Microbiota Transplantation for Clostridioides Difficile Infection in Patients with Chronic Liver Disease

Meighani

Alimirah

Ramesh

et al. 2020

International Journal of Hepatology

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Background. Fecal microbiota transplantation (FMT) is a well-established therapeutic option for patients with antibiotic resistant Clostridioides difficile infection (CDI). However, the efficacy of FMT in patients with chronic liver disease remains elusive. Aims. We studied the effect of FMT on chronic liver disease (CLD) patients with CDI at our tertiary medical center. Methods. A cohort of all patients who received FMT from December 2012 to May 2014 for refractory or recurrent CDI was identified. Patients were monitored for a year after FMT. Descriptive analysis was conducted to compare the effect of FMT in patients with and without CLD. Results. A total of 201 patients with CDI received FMT, 14 of which had a history of CLD. Nine of these patients exhibited cirrhosis of the liver with a mean Child-Turcotte-Pugh score of 8. CDI development in these patients was associated with recent exposure to antibiotics and was observed to be significantly different between both groups (17% of CLD patients vs. 58% in the general cohort, p=0.01). Four patients with CLD received >1 FMT, of which 2 did not respond to treatment. There was no significant difference between patients with liver disease and the rest of the cohort with regard to FMT response (12/14 (87%) vs. 164/187 (88%), p=0.68). Conclusion. FMT is a safe and effective therapy against CDI for patients with CLD and cirrhosis.

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Fecal Microbiota Transplantation in Patients With Primary Sclerosing Cholangitis: A Pilot Clinical Trial

Cited by 178 publications

References 35 publications

Microbiota changes and intestinal microbiota transplantation in liver diseases and cirrhosis

Microbiota changes and intestinal microbiota transplantation in liver diseases and cirrhosis

Precision medicine in primary sclerosing cholangitis

Fecal Microbiota Transplantation for Clostridioides Difficile Infection in Patients with Chronic Liver Disease

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