Faecal microbial transplantation in inflammatory bowel disease

Česká verzia

Authors: J. Březina; L. Bajer; J. Špičák; P. Drastich
Authors place of work: Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha
Published in the journal: Gastroent Hepatol 2016; 70(1): 51-56
Category: IBD: Review Article
doi: https://doi.org/10.14735/amko201651

Summary

The etiopathogenesis of inflammatory bowel disease (IBD) is not yet fully understood. One theory proposes that IBD onset is an overreaction of the gut immune system to some parts of the gut microbiome. Thus, one therapeutic approach is to employ a faecal microbiota transplant (FMT) to change the composition of the gut microbiome. FMT involves transplanting fecal matter or stool from a healthy donor to a recipient, leading to the reestablishment of gut microbiome homeostasis for a certain period of time. FMT is a standard, clinical procedure that is highly effective for the treatment of recurrent clostridium difficile colitis. FMT in IBD is an experimental method used only in clinical trials. Recent studies have shown that FMT has a highly variable effect on disease remission and clinical response. Two randomized control studies providing no compelling evidence for the effectiveness of FMT in patients with ulcerative colitis have been published recently. However, studies of FMT treatment of ulcerative colitis suggest that beneficial effects depend on the donor having a rich and diversified microbiome, method of administration, and the frequency of FMT. Finally, the effectiveness of FMT treatment of Crohn’s disease has not yet been investigated thoroughly; however, the data so far indicate minimal beneficial effects of FMT for Crohn’s disease patients. To sum up, FMT is a safe method with minimum adverse effects when the donor is carefully selected. Although FMT treatment of ulcerative colitis is only moderately effective, it represents a safe and promising therapeutic approach. However, there is an urgent need for a more thorough investigation of FMT in larger cohorts of patients to clarify the effectiveness, remission induction rate, necessary number of FMT, long term safety, and proper application of FMT.

Key words:
Crohn’s disease – faecal bacterial transplantation – inflammatory bowel disease – clostridium difficile colitis – microbiome – ulcerative colitis

The author declares he has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
15. 1 .2016

Accepted:
29. 1. 2016

Zdroje

1. Frank DN, Pace NR. Gastrointestinal microbiology enters the metagenomics era. Curr Opin Gastroenterol 2008; 24(1): 4– 10.

2. Qin J, Li R, Raes J et al. A human gut microbial gene catalogue established by metagenomic sequencing. Nature 2010; 464(7285): 59– 65. doi: 10.1038/ nature08821.

3. Zhang F, Luo W, Shi Y et al. Should we standardize the 1,700-year-old fecal microbiota transplantation? Am J Gastroenterol 2012; 107(11): 1755. doi: 10.1038/ ajg.2012.251.

4. Eiseman B, Silen W, Bascom GS et al. Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis. Surgery 1958; 44(5): 854– 859.

5. van Nood E, Vrieze A, Nieuwdorp M et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med 2013; 368(5): 407– 415. doi: 10.1056/ NEJMoa1205037.

6. Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infect Dis 2011; 53(10): 994– 1002. doi: 10.1093/ cid/ cir632.

7. Hamilton MJ, Weingarden AR, Sadowsky MJ et al. Standardized frozen preparation for transplantation of fecal microbiota for recurrent Clostridium difficile infection. Am J Gastroenterol 2012; 107(5): 761– 767. doi: 10.1038/ ajg.2011.482.

8. Postigo R, Kim JH. Colonoscopic versusnasogastric fecal transplantation for the treat-ment of Clostridium difficile infection: a review and pooled analysis. Infection 2012; 40(6): 643– 648. doi: 10.1007/ s15010-012-0307-9.

9. Persky SE, Brandt LJ. Treatment of recurrent Clostridium difficile- associated diarrhea by administration of donated stool directly through a colonoscope. Am J Gastroenterol 2000; 95(11): 3283– 3285.

10. Yoon SS, Brandt LJ. Treatment of refractory/ recurrent C. difficile-associated disease by donated stool transplanted via colonoscopy: a case series of 12 patients. J Clin Gastroenterol 2010; 44(8): 562– 566. doi: 10.1097/ MCG.0b013e3181dac035.

11. Angelberger S, Reinisch W, Makristathis Aet al. Temporal bacterial community dynamics vary among ulcerative colitis patients after fecal microbiota transplantation. Am J Gastroenterol 2013; 108(10): 1620– 1630. doi: 10.1038/ ajg.2013.257.

12. Youngster I, Russell GH, Pindar C et al.Oral, capsulized, frozen fecal microbiota transplantation for relapsing Clostridium difficile infection. Jama 2014; 312(17): 1772– 1778. doi: 10.1001/ jama.2014.13875.

13. Schwartz M, Gluck M, Koon S. Norovirus gastroenteritis after fecal microbiota transplantation for treatment of Clostridium difficile infection despite asymptomatic donors and lack of sick contacts. Am J Gastroenterol 2013; 108(8): 1367. doi: 10.1038/ ajg.2013.164.

14. Brandt LJ, Aroniadis OC, Mellow M et al.Long-term follow-up of colonoscopicfecal microbiota transplant for recurrent Clostridium difficile infection. Am J Gastroenterol 2012; 107(7): 1079– 1087. doi: 10.1038/ ajg.2012.60.

15. Nagalingam NA, Lynch SV. Role of the microbiota in inflammatory bowel diseases. Inflamm Bowel Dis 2012; 18(5): 968– 984. doi: 10.1002/ ibd.21866.

16. DuPont AW, DuPont HL. The intestinal microbiota and chronic disorders of the gut. Nat Rev Gastroenterol Hepatol 2011; 8(9): 523– 531. doi: 10.1038/ nrgastro.2011.133.

17. Sartor RB. Microbial influences in inflammatory bowel diseases. Gastroenterology 2008; 134(2): 577– 594. doi: 10.1053/ j.gastro.2007.11.059.

18. Vernia P. Butyrate in the treatment of ulcerative colitis. Digest Liver Dis 2007; 1 (Suppl 1): 27– 30. doi: 10.1016/ S1594-5804(08)60008-X.

19. Hamer HM, Jonkers DM, Vanhoutvin SA et al. Effect of butyrate enemas on inflammation and antioxidant status in the colonic mucosa of patients with ulcerative colitis in remission. Clin Nutr 2010; 29(6): 738– 744. doi: 10.1016/ j.clnu.2010.04.002.

20. Lix LM, Graff LA, Walker JR et al. Longitudinal study of quality of life and psychological functioning for active, fluctuating, and inactive disease patterns in inflammatory bowel disease. Inflamm Bowel Dis 2008; 14(11): 1575– 1584. doi: 10.1002/ ibd.20511.

21. Bennet JD, Brinkman M. Treatment of ulcerative colitis by implantation of normal colonic flora. Lancet 1989; 1(8630): 164.

22. Anderson JL, Edney RJ, Whelan K. Systematic review: faecal microbiota transplantation in the management of inflammatory bowel disease. Aliment Pharmacol Ther 2012; 36(6): 503– 516. doi: 10.1111/ j.1365-2036.2012.05220.x.

23. Rossen NG, MacDonald JK, de Vries EM et al. Fecal microbiota transplantation as novel therapy in gastroenterology: a systematic review. World J Gastroenterol 2015; 21(17): 5359– 5371. doi: 10.3748/ wjg.v21.i17.5359.

24. Vermeire S, Joossens M, Verbeke K et al. Donor species richness determines faecal microbiota transplantation success in inflammatory bowel disease. J Crohns Colitis 2015; jjv203. doi: 10.1093/ ecco-jcc/ jjv203.

25. Moayyedi P, Surette MG, Kim PT et al. Fecal microbiota transplantation induces remission in patients with active ulcerative colitis in a randomized controlled trial. Gastroenterology 2015; 149(1): 102– 109. doi: 10.1053/ j.gastro.2015.04.001.

26. Rossen NG, Fuentes S, van der Spek MJet al. Findings from a randomized controlled trial of fecal transplantation for patients with ulcerative colitis. Gastroenterology 2015; 149(1): 110–118. doi: 10.1053/ j.gastro.2015.03.045.

27. Gordon H, Harbord M. A patient with severe Crohn‘s colitis responds to Faecal Microbiota Transplantation. J Crohn Colitis 2014; 3(8): 256– 257. doi: 10.1016/ j.crohns.2013.10.007.