Fecal Microbiota Transplantation Influences Procarcinogenic Escherichia coli in Recipient Recurrent Clostridioides difficile Patients

Nooij, Sam; Ducarmon, Quinten R; Laros, Jeroen F. J.; Zwittink, Romy D.; Norman, Jason; Smits, Wiep Klaas; Verspaget, Hein W.; Keller, Josbert J.; Terveer, Elisabeth M.; Kuijper, Ed J.

doi:10.1053/j.gastro.2021.06.009

Cited by 25 publications

(18 citation statements)

References 32 publications

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“… 45 Another retrospective study conducted among 49 rCDI patient treated with FMT screened patients via fecal metagenomics for procarcinogenic E. coli demonstrated that patients with rCDI due to dysbiosis have higher levels of procarcinogenic E. coli ; among these patients, FMT promoted the persistence of procarcinogenic bacteria in a recipient if donor is positive but eradication if donor is negative. 46 However, this study found no clear evidence of donor to patient transmission of procarcinogenic bacteria. 46 Both of these studies further highlight the importance for the need of additional studies regarding appropriate screening process and long-term effects of FMT.…”

Section: What Is the Data On Long-term Follow-up After Fmt?contrasting

confidence: 63%

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Fecal microbiota transplantation for recurrent Clostridioides difficile, safety, and pitfalls

Sandhu

Chopra

2021

Therap Adv Gastroenterol

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Clostridioides difficile infection (CDI) is one of the leading causes of hospital-acquired infection attributing to substantial morbidity, mortality, and healthcare cost. Recurrent CDI (rCDI) is common and occurs after effective treatment of first episode. Treatment of rCDI is based on accurate diagnoses, due to difficulty in distinguishing between colonization of C. difficile spores or CDI; coronavirus disease 2019 (COVID-19) added to the complexity of diagnoses as both entities can co-occur. It is difficult to eradicate rCDI, and there remains a critical gap regarding treatment of rCDI. The treatment goal of rCDI is to reestablish normal microbiota. Fecal microbiota transplantation (FMT) is suggested as a treatment for second episode of rCDI. Based on the collective evidence of all randomized controlled trials, FMT was reported more efficacious compared with vancomycin or fidaxomicin; however, these trials had limited number of patients and all patients were pre-treated with vancomycin prior to FMT. Furthermore, when comparing various routes of instillation and types of preparation of fecal microbiota, no difference was observed in cure rate. Despite the success rate of FMT, there remains a concern for transmission of infectious agents, such as Gram negative bacteremia or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), adverse events (diarrhea and abdominal pain), and reports of new diagnoses (inflammatory bowel disease, weight gain and irritable bowel syndrome). To lessen the risk of transmissible infections, donor screening should be performed, which includes screening for medical comorbidities and infectious pathogens in blood and feces. Scheduling complexities and reimbursement places an additional roadblock for using FMT. Microbiome-based therapies are being developed to eliminate the logistical challenges related to FMT. Large prospective and placebo-controlled studies are needed to evaluate the efficacy and long-term safety of FMT, so its use can be justified in clinical practice.

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Section: What Is the Data On Long-term Follow-up After Fmt?contrasting

confidence: 63%

“… 46 However, this study found no clear evidence of donor to patient transmission of procarcinogenic bacteria. 46 Both of these studies further highlight the importance for the need of additional studies regarding appropriate screening process and long-term effects of FMT.…”

Section: What Is the Data On Long-term Follow-up After Fmt?contrasting

confidence: 63%

Fecal microbiota transplantation for recurrent Clostridioides difficile, safety, and pitfalls

Sandhu

Chopra

2021

Therap Adv Gastroenterol

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“…Also, data on transmission of uncovered harmful species (i.e. potentially procarcinogenic or pathogenic) can only be derived retrospectively from performed conventional FMT studies [ 55 ]. Using synthetic microbial products in FMT trials would rule out the possibilities for these ancillary findings.…”

Section: Discussionmentioning

confidence: 99%

Challenges and costs of donor screening for fecal microbiota transplantations

Bénard

Bruijn²,

Fenneman³

et al. 2022

PLoS ONE

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Background The increasing interest to perform and investigate the efficacy of fecal microbiota transplantation (FMT) has generated an urge for feasible donor screening. We report our experience with stool donor recruitment, screening, follow-up, and associated costs in the context of clinical FMT trials. Methods Potential stool donors, aged between 18−65 years, underwent a stepwise screening process starting with an extensive questionnaire followed by feces and blood investigations. When eligible, donors were rescreened for MDROs and SARS-CoV-2 every 60-days, and full rescreening every 4−6 months. The costs to find and retain a stool donor were calculated. Results From January 2018 to August 2021, 393 potential donors underwent prescreening, of which 202 (51.4%) did not proceed primarily due to loss to follow-up, medication use, or logistic reasons (e.g. COVID-19 measures). 191 potential donors filled in the questionnaire, of which 43 (22.5%) were excluded. The remaining 148 candidates underwent parasitology screening: 91 (61.5%) were excluded, mostly due to Dientamoeba fragilis and/or high amounts of Blastocystis spp. After additional feces investigations 18/57 (31.6%) potential donors were excluded (mainly for presence of Helicobacter Pylori and ESBL-producing organisms). One donor failed serum testing. Overall, 38 out of 393 (10%) potential donors were enrolled. The median participation time of active stool donors was 13 months. To recruit 38 stool donors, €64.112 was spent. Conclusion Recruitment of stool donors for FMT is challenging. In our Dutch cohort, failed eligibility of potential donors was often caused by the presence of the protozoa Dientamoeba fragilis and Blastocystis spp.. The exclusion of potential donors that carry these protozoa, especially Blastocystis spp., is questionable and deserves reconsideration. High-quality donor screening is associated with substantial costs.

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“…Antibiotic-induced depletion of this bacteria enhanced the gemcitabine-mediated chemotherapy response in a CRC mouse model ( 121 ). Alternatively, fecal microbiota transplantation (FMT) may also be employed to prevent CRC in patients with dysbiosis ( 122 ). A FMT procedure could help eradicate procarcinogenic E. coli ( 114 ).…”

Section: Therapeutic Implications By Targeting Tmementioning

confidence: 99%

Tumor Microenvironment Shapes Colorectal Cancer Progression, Metastasis, and Treatment Responses

Chen

2022

Front. Med.

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Colorectal cancer (CRC) is one of the most devastating diseases that accounts for numerous deaths worldwide. Tumor cell-autonomous pathways, such as the oncogenic signaling activation, significantly contribute to CRC progression and metastasis. Recent accumulating evidence suggests that the CRC microenvironment also profoundly promotes or represses this process. As the roles of the tumor microenvironment (TME) in CRC progression and metastasis is gradually uncovered, the importance of these non-cell-autonomous signaling pathways is appreciated. However, we are still at the beginning of this TME function exploring process. In this review, we summarize the current understanding of the TME in CRC progression and metastasis by focusing on the gut microbiota and host cellular and non-cellular components. We also briefly discuss TME-remodeling therapies in CRC.

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Fecal Microbiota Transplantation Influences Procarcinogenic Escherichia coli in Recipient Recurrent Clostridioides difficile Patients

Cited by 25 publications

References 32 publications

Fecal microbiota transplantation for recurrent Clostridioides difficile, safety, and pitfalls

Fecal microbiota transplantation for recurrent Clostridioides difficile, safety, and pitfalls

Challenges and costs of donor screening for fecal microbiota transplantations

Tumor Microenvironment Shapes Colorectal Cancer Progression, Metastasis, and Treatment Responses

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