Could autologous fecal microbiota transplant reverse antibiotic-induced dysbiosis?

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According to an American study, autologous fecal microbiota transplant (auto-FMT) in patients undergoing allogeneic hematopoietic stem cell transplant leads to a complete restoration of the gut microbiota affected by the concomitant antibiotic treatment.

 

Allogeneic hematopoietic stem cell transplant (HSCT) is associated with an antibiotic treatment aiming at preventing or reducing infections. This treatment is necessary, but it depletes the intestinal microbiota and increases the risk of complications (systemic infection, graft-versus-host disease…) and death. Patients’ heightened susceptibility to disease led researchers to study the potential benefits of auto-FMT to reverse this antibiotic-induced dysbiosis. The diversity of the intestinal microbiota of 25 patients (14 who received auto-FMT and 11 control subjects) treated with antibiotics after undergoing HSCT, was analyzed over time.

Complete restoration following fecal transplant

Result: subjects who underwent auto-FMT all achieved full restoration of their original gut microbiota on D+100 following the stem cell transplant, especially regarding the levels of bacteria from Lachnospiraceae and Ruminococcaceae families as well as Bacteroidetes phylum (commensal bacteria playing a well-known role in immune regulation). In contrast, the 11 control subjects only partially recovered their original bacterial populations. This finding corroborates the results of previous works carried out in more than 700 patients, suggesting that bacterial diversity starts to slowly recover around D+50 following allogeneic HSCT and that it is not complete on D+100.

Restoration of bacterial functions

Metagenomic analyses confirmed that the restoration of commensal bacterial populations is associated with the restoration of their beneficial functions and the reduction of negative effects related to antibiotic-induced dysbiosis such as antimicrobial peptides resistance, stimulation of pathways associated to microbial virulence, biofilm formation, depletion of some microbial metabolic pathways… By fighting against the disruptive effects of antibiotic treatment, autologous fecal transplant provides therapeutic benefits that could be used to improve the survival rate of patients undergoing allogeneic HSCT.

 

Sources:

Y. Taur, K. Coyte, J. Schluter, et al. Reconstitution of the gut microbiota of antibiotic-treated patients by autologous fecal microbiota transplant. Sci. Transl. Med. 10, eaap9489 (2018).

Photos credits :

Assistance Publique – Hôpitaux de Paris (Saint-Antoine Hospital)