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The Effect of Allogenic Versus Autologous Fecal Microbiota Transfer on Symptoms, Visceral Perception and Fecal and Mucosal Microbiota in Irritable Bowel Syndrome: A Randomized Controlled Study
Örebro University, School of Medical Sciences. (Nutrition-Gut-Brain Interactions Research Centre)ORCID iD: 0000-0002-4204-6811
Örebro University, School of Medical Sciences. (Nutrition-Gut-Brain Interactions Research Centre)ORCID iD: 0000-0003-3887-9519
Örebro University, School of Medical Sciences. (Nutrition-Gut-Brain Interactions Research Centre)ORCID iD: 0000-0002-7173-5579
Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
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2019 (English)In: Clinical and Translational Gastroenterology, ISSN 2155-384X, E-ISSN 2155-384X, Vol. 10, no 4, article id e00034Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Fecal microbiota transfer (FMT) is suggested as a potential treatment for patients with irritable bowel syndrome (IBS). We aimed to study the effect of allogenic and autologous FMT on IBS symptoms, visceral sensitivity, and compositional changes in fecal and mucosa-adherent microbiota.

METHODS: Seventeen patients with IBS were randomized either to receive fecal material from a healthy donor (allogenic) or to receive their own fecal material (autologous). The fecal material was administered into the cecum by whole colonoscopy after bowel cleansing.

RESULTS: No significant differences were found between the allogenic and the autologous FMT regarding symptom scores. However, symptom scores of patients receiving allogenic fecal material significantly decreased after FMT compared with baseline (P 5 0.02), which was not the case in the autologous group (P50.16). Visceral sensitivity was not affected except for a small beneficial effect on urge scores in the autologous group (P < 0.05). While both fecal and mucosa-adherent microbiota of some patients shifted to their respective donor’s fecal microbiota, some patients showed no relevant microbial changes after allogenic FMT. Large compositional shifts in fecal and mucosa-adherent microbiota also occurred in the autologous group.

CONCLUSIONS: This study showed that a single FMT by colonoscopy may have beneficial effects in IBS; however, the allogenic fecal material was not superior to the autologous fecal material. This suggests that bowel cleansing prior to the colonoscopy and/or processing of the fecal material as part of the FMT routine contribute to symptoms and gut microbiota composition changes in IBS.

Place, publisher, year, edition, pages
Nature Publishing Group, 2019. Vol. 10, no 4, article id e00034
National Category
Gastroenterology and Hepatology
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-74035DOI: 10.14309/ctg.0000000000000034ISI: 000466787000001PubMedID: 31009405OAI: oai:DiVA.org:oru-74035DiVA, id: diva2:1313864
Funder
Swedish Nutrition Foundation (SNF)
Note

Funding Agencies:

SIAM Gravitation Grant  024.002.002 

Spinoza 2008 Award of the Netherlands Organization for Scientific Research (NWO) 

Available from: 2019-05-06 Created: 2019-05-06 Last updated: 2019-12-20Bibliographically approved
In thesis
1. Faecal Microbiota Transfer in Irritable Bowel Syndrome and Collagenous Colitis: Clinical outcomes and host-microbe interactions
Open this publication in new window or tab >>Faecal Microbiota Transfer in Irritable Bowel Syndrome and Collagenous Colitis: Clinical outcomes and host-microbe interactions
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Faecal microbiota transfer (FMT) aims at restoring a disturbed gut microbiotaby introducing faecal material from a healthy donor into a patient’s intestine. This approach is known as a safe and effective treatment in patients with recurrent Clostridioides difficile infection. This thesis describes the outcomes of two clinical studies in which FMT was investigated as a therapy for irritable bowel syndrome (IBS) patients andin collagenous colitis (CC) patients. Paper I showed that there were no significant differences in IBS symptom scores between patients receiving faecal material from a healthy donor (allogenic FMT) and patients receiving their own faecal material back (autologous FMT). However, unlike autologous FMT, allogenic FMT significantly decreased symptom scores compared to baseline. Additionally, allogenic FMT wasshown to alter the faecal as well as the mucosal microbiota of the IBSpatients. However, also the autologous FMT had an effect on the faecal and mucosal microbiota indicating that the bowel cleansing and/or theprocessing of the autologous faecal material affected the gut microbiota. Paper II showed that the allogenic FMT evoked a clearly different host response in IBS patients than the autologous FMT. Paper III showedthat allogenic FMT did not result in altered faecal metabolite profilesbut in disturbed interactions between the gut microbiota and its metabolites compared to autologous FMT. Paper IV describes the outcomes of the second clinical study in which repeated FMTs resulted inless diarrhoea in a subset of the treated CC patients.

Although symptoms improved in both clinical studies, the introduction of a new microbiota by FMT did not seem to be the miracle curefor IBS and CC. However, a subset of patients could benefit from FMT, and a future challenge is to identify this subset. The findings of this thesis are essential for designing further studies aimed at increasing FMT efficacy.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2020. p. 76
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 204
Keywords
Faecal microbiota transfer, irritable bowel syndrome, collagenous colitis, gut microbiota, visceral sensitivity, host-microbe interactions, gene expression, metabolites
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-77633 (URN)978-91-7529-316-5 (ISBN)
Public defence
2020-01-17, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2019-10-28 Created: 2019-10-28 Last updated: 2019-12-16Bibliographically approved

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Holster, SavanneLindqvist, Carl MårtenRepsilber, DirkKönig, JuliaBrummer, Robert Jan

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