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Gastroenterology

Fecal microbiota transplant: mixed results

IBD
Gastroenterology

Since gut dysbiosis seems to be associated to IBD, microbiota modulation could be a new avenue for relevant therapeutic care. Two possible options: fecal microbiota transplant or use of probiotics.

Gastroenterology
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Donor tests for faecal microbiota transplant. Researcher holding a petri dish culture from sample testing of a donor stool. 

About this article

Created 17 September 2019
Updated 12 October 2021

Fecal microbiota transplant allows patients to receive approximatively 1011 bacteria per gram of stool, but also fungi, viruses and archaea. Its objective is to correct gut dysbiosis. The number of necessary attempts and results vary according to the individuals and their pathology, and the protocol requires seamless controls.13

Gut microbiota modulation is a potential treatment for IBD. In practice, this strategy could be carried out through fecal microbiota transplant (FMT). The fecal matter comes from one or several healthy donors and is then transplanted into the distal gastrointestinal tract of the patient thanks to a nasogastric tube, during a colonoscopic enema, or more recently through oral capsules. This protocol is already being successfully used in case of recurrent Clostridium difficile infections. But what about IBD?

Ulcerative Colitis

Although safety conditions of the first tests were satisfying and the therapy led to partial or total remission in some patients with ulcerative colitis (UC), other attempts were more controversial.14 The donor’s fecal composition quality, the number of transplants and early therapeutic care, could modulate the chances of success and appear as a post-hoc explanation of heterogeneity of results.

Crohn's disease (CD)

Studies conducted on Crohn’s disease (CD), although fewer in number, produced either positive (clinical and endoscopic remission) or neutral results.In the only study that did not show a significant disease reduction, patients still reported an improvement in their quality of life.14 To confirm the clinical efficacy of fecal transplant in Crohn’s disease, additional studies are still necessary.

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Many pending issues

Whatever the disease, several questions remain unanswered regarding: FMT engraftment, which could require several fecal transplants; the quality of the transplanted microbiota often obtained from donors living in countries where IBD prevalence rate is high; the restoration of microbiota altered functions after the transplant (for instance, production of protective short-chain fatty acids such as butyrate); and of course, the role of inflammation, either as a cause or consequence of dysbiosis.14

Sources

14 Weingarden AR, Vaughn BP. Intestinal microbiota, fecal microbiota transplantation, and inflammatory bowel disease. Gut Microbes. 2017;8(3):238-252.

Tags
Dysbiosis Gut health Fungi Microbiome Flora
    Focus
    Chronical inflammatory bowel diseases (IBD)
    • Dysbiosis in IBD
      • A bacterial dysbiosis characteristic of IBD
      • Each IBD has its own virome
      • Association between fungal dysbiosis and environment
    • Pathophysiology of dysbiosis
      • Role of the intestinal epithelium and the innate immune response
      • Focus on the role of antimicrobial peptides
    • What role could microbiota modulation play?
      • Fecal microbiota transplant: mixed results
      • Use of probiotics
    • Expert opinion
      • Pr. Philippe Seksik: Towards an innovative management of IBD
    Created 17 September 2019
    Updated 12 October 2021

    About this article

    To know more about this topic.

    Main topic

    IBD

    Medical practice

    Gastroenterology

    Content type

    Dossier detail
    Focus on the role of antimicrobial peptides
    Use of probiotics
    Focus

    Chronical inflammatory bowel diseases (IBD)

    Dysbiosis in IBD

    A bacterial dysbiosis characteristic of IBD Each IBD has its own virome Association between fungal dysbiosis and environment

    Pathophysiology of dysbiosis

    Role of the intestinal epithelium and the innate immune response Focus on the role of antimicrobial peptides

    What role could microbiota modulation play?

    Fecal microbiota transplant: mixed results Use of probiotics

    Expert opinion

    Pr. Philippe Seksik: Towards an innovative management of IBD
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