Role of Faecal Microbiota Transplantation for Maintenance of Remission in Patients With Ulcerative Colitis: A Pilot Study

Sood, Ajit; Mahajan, Ramit; Singh, Arshdeep; Midha, Vandana; Mehta, Varun; Narang, Vikram; Singh, Tarundeep; Pannu, Anmol Singh

doi:10.1093/ecco-jcc/jjz060

Cited by 128 publications

(129 citation statements)

References 52 publications

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“…The present study demonstrated that three rounds of FMT (13,(28)(29)(30). The improved efficacy displayed in the present study may be explained by the modified FMT procedures used, including stool preparation (feces exposure to air for <30 min), microbiota resource (fresh; all FMTs for one patient were derived from the same donor), delivery route (via TET tube; remained in the right lateral position for 30 min to maintain the largest contact area between microbiota and intestines), dosage (150 ml to avoid inducing intestinal peristalsis) and intensity (three times within one week).…”

Section: Discussionsupporting

confidence: 58%

“…Ramai et al (36) reported that the clinical response in patients at 1 month and 3 months after FMT was 74.3 and 51.4%, respectively. A pilot study in India reported 87.1% clinical response, 58.1% endoscopic remission and 45.2% histological remission at week 48 post-FMT (29). The patients with UC treated with FMT in the present study displayed a steroid-free clinical response rate of 84.1 and 77.3% at week 4 and week 12, respectively.…”

Section: Discussionsupporting

confidence: 48%

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Fecal microbiota transplantation ameliorates active ulcerative colitis

Chen

Huang

et al. 2020

Exp Ther Med

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Ulcerative colitis (UC) is a complex chronic pathological condition of the gut in which microbiota targeted treatment, such as fecal microbiota transplantation (FMT), has shown an encouraging effect. The aim of the present study was to investigate the efficacy and safety of FMT in patients with mild or moderate UC. A single-center, open-label study was designed, including 47 patients with mild or moderate active UC who received three treatments of fresh FMT via colonic transendoscopic enteral tubing within 1 week. The inflammatory bowel disease questionnaire, partial Mayo scores, colonoscopy, erythrocyte sedimentation rate, C-reactive protein level and procalcitoin values were used to assess the efficacy of FMT and alteration in gut microbiota was detected by 16S ribosomal RNA-sequencing. Before FMT, microbiota Faecalibacterium prausnitzii (F. prausnitzii) levels were significantly decreased in patients with UC compared with healthy donors (P<0.01). At 4 weeks post-FMT, F. prausnitzii levels were significantly increased (P<0.05), and the Mayo score was significantly decreased (1.91±1.07 at baseline vs. 4.02±1.47 at week 4; P<0.001) in patients with UC compared with healthy donors. Steroid-free clinical responses were reported in 37 patients (84.1%), and steroid-free clinical remission was achieved in 31 patients (70.5%) at week 4 post-FMT, however, steroid-free remission was not achieved in any patient. No adverse events were reported in 41 (93.2%) patients after FMT or during the 12-week follow-up. Shannon's diversity index and Chao1 estimator were also improved in patients with UC receiving FMT. In conclusion, the results of the present study suggested that FMT resulted in clinical remission in patients with mild to moderate UC, and that the remission may be associated with significant alterations to the intestinal microbiota of patients with UC. Furthermore, F. prausnitzii may serve as a diagnostic and therapeutic biomarker for the use of FMT in UC.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionsupporting

confidence: 48%

Fecal microbiota transplantation ameliorates active ulcerative colitis

Chen

Huang

et al. 2020

Exp Ther Med

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“…The efficacy of FMT in induction of remission in moderate–severe active UC has been addressed by four high‐quality randomized controlled trials and multiple cohort studies. FMT has been shown to be effective in patients with steroid‐dependent UC, and it may also have a role in long‐term maintenance of remission . Although initial results are exciting, the available trials and cohort studies are small, and results are variable; therefore, efficacy of FMT is not clearly proven.…”

Section: Introductionmentioning

confidence: 99%

“…FMT has been shown to be effective in patients with steroiddependent UC, 5,6 and it may also have a role in long-term maintenance of remission. 7 Although initial results are exciting, the available trials and cohort studies are small, and results are variable; therefore, efficacy of FMT is not clearly proven. Moreover, apart from efficacy; acceptability, tolerability, and safety are equally vital for FMT to gain place in the therapeutic armamentarium of UC.…”

Section: Introductionmentioning

confidence: 99%

Acceptability, tolerability, and safety of fecal microbiota transplantation in patients with active ulcerative colitis (AT&S Study)

Sood

Singh

Mahajan

et al. 2019

J of Gastro and Hepatol

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Background and Aim Fecal microbiota transplantation (FMT) targets gut microbiome dysbiosis and is an emerging therapy for ulcerative colitis (UC). Although initial results with FMT in patients with active UC are encouraging, data regarding its acceptability, tolerability, and safety are scant. Methods A retrospective analysis of patients with active UC (Mayo clinic score ≥ 4), who received multisession FMT (at weeks 0, 2, 6, 10, 14, 18, and 22) via colonoscopy between June 2016 and June 2018, was performed. Patient acceptability, tolerability, and immediate and long‐term safety of the therapy were assessed. Results Of the 129 patients with active UC who were offered FMT, 101 patients consented, giving acceptability of 78.3%. Fecal slurry retention time improved with each session (3.27 ± 1.06 h for the first session vs 5.12 ± 0.5 h for the seventh session). Abdominal discomfort, flatulence, abdominal distension, borborygmi, and low‐grade fever (30.8%, 15.9%, 9.8%, 7.9%, and 7.6%, respectively) were the most common post‐procedural short‐term adverse events. Long‐term adverse events included new‐onset urticaria (n = 2, 4.3%), arthritis/arthralgia (n = 3, 6.5%), depression (n = 1, 2.2%), partial sensorineural hearing loss (n = 1, 2.2%), and allergic bronchitis (n = 1, 2.2%). Thirteen (12.9%) patients dropped out because of adverse events. Conclusion Fecal microbiota transplantation appears to be a safe and well‐tolerated procedure, with good acceptability in patients with active UC.

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“…https://doi.org/10.1101/2020.03. 16.20022293 doi: medRxiv preprint treatment presented a higher tendency to maintain a steroid-free clinical remission and significantly superior to placebo in both endoscopic and histological remission [25] . In view of the above data, multi-session FMT seems to be an effective therapy for maintaining remission in patients with UC.…”

Section: Frequency Factor Influence the Outcomes Of Fmtmentioning

confidence: 97%

Long-term efficacy and safety of single fecal microbiota transplantation for recurrent active ulcerative colitis

Hou

et al. 2020

Preprint

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Aims: To assess the long-term safety and efficacy of single fecal microbiota transplantation (FMT) for recurrent ulcerative colitis (UC). Methods: 20 UC patients were randomly divided into single FMT (n=10) and standard of care (SOC) (n=10) group. Patients in FMT group were just treated with single fresh FMT. Patients in SOC group with mild to moderate UC were treated with mesalazine, those with severe UC were given corticosteroids-induced remission, mesalazine maintenance treatment. The primary endpoint was clinical and mucosal remission at week 8. The second endpoint was the maintenance of clinical and mucosal remission, and possible adverse events during the long term follow up (12 to 24 months).Results:90% (9/10) patients in FMT group and 50% (5/10)in SOC group could achieve primary endpoint at week-8.After 12 months of follow-up, 66.7% (6/9) FMT initial responder and 80.0% (4/5) SOC initial responder could maintain remission.5 FMT initial responder recipients and 5 SOC initial responder completed 24-months follow up and mainly could maintain remission [FMT vs SOC = 80% (4/5) vs 60% (3/5)].No adverse events occurred post FMT during long-term follow-up. At Phylum level, Bacteroidetes, Firmicutes and Proteobacteria were the dominant bacteria of gut microbiota in active UC patients. Compared with donor, the relative abundance of Bacteroidetes decreased and Proteobacteria increased significantly in active UC patients, Firmicutes showed no significant changes. Single fresh FMT could effectively reconstruct the composition of gut microbiota in active UC and maintain stability level with increased Bacteroidetes and decreased Proteobacteria abundance. FMT significantly reduced the relative abundance of Escherichia and increased the relative abundance of Prevotella at genera level. Pyruvate metabolism, glyoxylate and dicarboxylate metabolism, pantothenate and CoA biosynthesis showed significantly differences. Conclusions: Single fresh FMT is an effective and safe strategy to induce long-term remission in patients with active UC and could be expected to be an alternative induction therapy for recurrent UC, even primary UC.

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Role of Faecal Microbiota Transplantation for Maintenance of Remission in Patients With Ulcerative Colitis: A Pilot Study

Cited by 128 publications

References 52 publications

Fecal microbiota transplantation ameliorates active ulcerative colitis

Fecal microbiota transplantation ameliorates active ulcerative colitis

Acceptability, tolerability, and safety of fecal microbiota transplantation in patients with active ulcerative colitis (AT&S Study)

Long-term efficacy and safety of single fecal microbiota transplantation for recurrent active ulcerative colitis

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