scholarly journals A Systematic Review of Fecal Microbiota Transplant for the Management of Pouchitis

2020 ◽  
Vol 2 (2) ◽  
Author(s):  
Maia Kayal ◽  
Thomas Lambin ◽  
Rachel Pinotti ◽  
Marla C Dubinsky ◽  
Ari Grinspan
Keyword(s):  
Systematic Review ◽  
Clinical Response ◽  
Activity Index ◽  
Fecal Microbiota ◽  
Quality Data ◽  
Total Proctocolectomy ◽  
Rrna Gene ◽  
Efficacy And Safety ◽  
Fecal Microbiota Transplant ◽  
Promising Therapeutic Approach

Abstract Background Manipulation of the pouch microbiota via fecal microbiota transplant (FMT) has been theorized to be a promising therapeutic approach for pouchitis. The goal of this systematic review was to summarize the available, high-quality data on the efficacy and safety of FMT for acute and chronic pouchitis. Methods A systematic electronic literature search was conducted on Embase, MEDLINE, Scopus, and Cochrane CENTRAL. Randomized controlled trials and observational studies that assessed the efficacy and safety of FMT for the treatment of acute and/or chronic pouchitis in patients with ulcerative colitis who underwent total proctocolectomy with ileal pouch-anal anastomosis were included. Results Four studies involving the use of FMT for chronic pouchitis were considered eligible for data extraction. No study involving the use of FMT for the management of acute pouchitis was identified. In 1 study, 3/5 (75%) patients achieved sustained clinical remission at 3 months. In the remaining 3 studies, 2/8, 1/11, and 1/5 patients achieved clinical response defined as a decrease in pouchitis disease activity index at least 3. Stool donor engraftment as determined by 16s rRNA gene sequencing occurred only in those patients with clinical response. Conclusions The 4 studies that met inclusion criteria for this systematic review indicate FMT is safe in chronic pouchitis, however largely not efficacious. These data are limited by study heterogeneity. Additional studies are required to guide the use of FMT in patients with acute and chronic pouchitis.

scholarly journals Effect of Fecal Microbiota Transplant on Symptoms of Psychiatric Disorders: A Systematic Review

2020 ◽  
Author(s):  
Arthi Chinna Meyyappan ◽  
Evan Forth ◽  
Caroline Wallace ◽  
Roumen Milev
Keyword(s):  
Fecal Microbiota ◽  
Efficacy And Safety ◽  
Gi Tract ◽  
Eligibility Criteria ◽  
Fecal Microbiota Transplant ◽  
Psychiatric Illnesses ◽  
Bidirectional Signaling ◽  
Key Terms ◽  
The Brain ◽  
Larger Sample

Abstract Background: The Gut-Brain-Axis is a bidirectional signaling pathway between the gastrointestinal (GI) tract and the brain. The hundreds of trillions of microorganisms populating the gastrointestinal tract are thought to modulate this connection, and have far reaching effects on the immune system, central and autonomic nervous systems, and GI functioning. These interactions have also been linked to various psychiatric illnesses such as depression, anxiety, substance abuse, and eating disorders. It is hypothesized that techniques aimed at strengthening and repopulating the gut microbiome, such as Fecal Microbiota Transplant (FMT), may be useful in the prevention and treatment of psychiatric illnesses. Methods: A systematic search of five databases was conducted using key terms related to FMT and psychiatric illnesses. All results were then evaluated based on specific eligibility criteria. Results: Twenty-one studies met the eligibility criteria and were analysed for reported changes in mood and behavioural measures indicative of psychiatric wellbeing. The studies included were either entirely clinical (n=7), preclinical with human donors (n=7), or entirely preclinical (n=7). All studies found a decrease in depressive and anxiety-like symptoms and behaviours resulting from the transplantation of healthy microbiota. The inverse was also found, with the transmission of depressive and anxiety-like symptoms and behaviours resulting from the transplantation of microbiota from psychiatrically ill donors to healthy recipients. Conclusion: There appears to be strong evidence for the treatment and transmission of psychiatric illnesses through FMT. Further research with larger sample sizes and stronger scientific design is warranted in order to fully determine the efficacy and safety of this potential treatment.

scholarly journals 2434. Proton Pump Inhibitor Use on Efficacy of Fecal Microbiota Transplant Administered by Trans-Oral Routes for Clostridioides Difficile Infection: A Systematic Review and Analysis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S841-S842
Author(s):  
Annie S Hong ◽  
Wen Yuan Yu ◽  
Jenny M Hong ◽  
Mohamed Azab ◽  
Gordon V Ohning ◽  
...  
Keyword(s):  
Systematic Review ◽  
Proton Pump ◽  
Primary Outcome ◽  
Fecal Microbiota Transplantation ◽  
Case Reports ◽  
Fecal Microbiota ◽  
Cochrane Library ◽  
Fecal Microbiota Transplant ◽  
Clostridioides Difficile ◽  
Significant Difference

Abstract Background Current guidelines include fecal microbiota transplantation (FMT) in the management of recurrent Clostridioides difficile infections (CDI). However, FMT protocols are often facility dependent, and one variable is whether proton pump inhibitors (PPI) are given during preparation. Theoretically, PPIs reduce acidity and protects the transplanted microbiome for the most potent dose. On the other hand, PPIs have also been shown to negatively alter the microbiome and increase the risk of CDI. We conducted a systematic review of the literature to study PPI use on the efficacy of FMT delivered by the trans-oral route. Methods We searched PubMed/Medline, Cochrane Library, Embase, Scopus, and Web of Science through December 16th, 2018 using variations of keywords “fecal microbiota transplant” and “Clostridium difficile infection” with 4210 results. Two independent authors reviewed and excluded studies with unrelated topics, abstracts, case reports, or a low level of evidence. Studies with data on trans-oral FMT, PPI use, and the success rate were included. Final review yielded 11 studies including randomized controlled, case–control, cohort, retrospective and prospective trials. The primary outcome was the rate of FMT failure, defined as recurrence of symptoms with positive CDI testing at follow-up. Results Out of 233 included patients, 131 received a PPI per FMT protocol resulting in 27 cases of treatment failure. There were 23 cases of recurrence out of 102 patients who did not receive pre-FMT PPI. The primary outcome occurred in 20.6% in the group with PPI use vs. 22.6% in the group without (RR 0.91; CI 0.56 - 1.50). Limitations include the lack of studies directly comparing outcomes with respect to PPI use, and inability to control possible confounders such as chronic PPI use, amount of stool transplanted, and pre-FMT antibiotics. Conclusion We did not find a significant difference in efficacy between FMT protocols with regard to PPI use. It is possible that the theoretical benefit from increased survival of transplanted microbiota is offset by negative effects associated with PPIs. We suggest that routine use of PPIs in FMT be reconsidered in the absence of clear benefit. Further investigation is needed to optimize protocols for safety and efficacy. Disclosures All authors: No reported disclosures.

scholarly journals The Efficacy and Safety of Fecal Microbiota Transplant for Recurrent Clostridiumdifficile Infection: Current Understanding and Gap Analysis

2020 ◽  
Vol 7 (5) ◽  
Author(s):  
Mark H Wilcox ◽  
Barbara H McGovern ◽  
Gail A Hecht
Keyword(s):  
Gap Analysis ◽  
Treatment Guidelines ◽  
Current Knowledge ◽  
Fecal Microbiota ◽  
Adverse Event Reporting ◽  
Efficacy And Safety ◽  
Fecal Microbiota Transplant ◽  
Symptomatic Disease ◽  
Wide Range ◽  
Suppressive Antibiotic Therapy

Abstract The leading risk factor for Clostridioides (Clostridium) difficile infection (CDI) is broad-spectrum antibiotics, which lead to low microbial diversity, or dysbiosis. Current therapeutic strategies for CDI are insufficient, as they do not address the key role of the microbiome in preventing C. difficile spore germination into toxin-producing vegetative bacteria, which leads to symptomatic disease. Fecal microbiota transplant (FMT) appears to reduce the risk of recurrent CDI through microbiome restoration. However, a wide range of efficacy rates have been reported, and few placebo-controlled trials have been conducted, limiting our understanding of FMT efficacy and safety. We discuss the current knowledge gaps driven by questions around the quality and consistency of clinical trial results, patient selection, diagnostic methodologies, use of suppressive antibiotic therapy, and methods for adverse event reporting. We provide specific recommendations for future trial designs of FMT to provide improved quality of the clinical evidence to better inform treatment guidelines.

scholarly journals A50 TRANSFER OF DEPRESSIVE-LIKE PHENOTYPE TO GNOTOBIOTIC MICE DEPENDS ON MICROBIAL FEATURES SPECIFIC TO INDIVIDUAL PATIENTS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 59-60
Author(s):  
J Hanuschak ◽  
M P Louis-Auguste ◽  
G De Palma ◽  
E Verdu ◽  
R Anglin ◽  
...  
Keyword(s):  
Bacterial Species ◽  
Preference Test ◽  
Tail Suspension Test ◽  
Fecal Microbiota ◽  
Sucrose Preference ◽  
Rrna Gene ◽  
Fecal Microbiota Transplant ◽  
Total N ◽  
Significant Difference ◽  
Sucrose Preference Test

Abstract Background Major depressive disorder (MDD) affects approximately 4.4% of the global population. Despite its high prevalence, little is known about the mechanisms underlying this disorder. Recent studies in both humans and rodents have suggested that the intestinal microbiota may play a role in depression. Altered microbiota composition has been found in a subset of MDD patients. Preclinical studies have suggested that fecal microbiota transplant using pooled MDD patient samples can induce depressive-like behaviour in rodents. We have previously shown that the use of different microbiota donors with irritable bowel syndrome results in the induction of different phenotypes in recipient mice. Thus, we have hypothesized that pooling microbiota samples abrogates features that are unique to individual donors. Aims (1) Investigate whether the transfer of individual MDD patient microbiota can induce depressive-like behaviour in germ-free (GF) mice (2) Identify features of individual MDD patient microbiota that are associated with the depressive-like phenotype Methods GF NIH Swiss mice of both sexes (min. n=10 per group, total n=110) were colonized with either fecal microbiota from a single donor, MDD patient (MDD1-4) or matched healthy control (HC1-4), or pooled fecal microbiota from MDD1-4 or HC1-4. Mouse behaviour was assessed, using the open field test, three chamber sociability assay, tail suspension test, and sucrose preference test. Stool samples were collected throughout the experiment for 16S rRNA gene sequencing. Results Mice colonized with microbiota from patient MDD1 exhibited depressive-like behaviour, as assessed by the sucrose preference test and sociability assay, when compared to mice colonized with HC1 microbiota. This was not true for mice colonized with individual microbiota from the other three patients (MDD2-4) or with pooled MDD microbiota. Comparative analysis of the 16S data revealed a significant difference in Faith’s Phylogenetic Diversity between MDD1 microbiota and pooled MDD microbiota. Four bacterial species were found to be significantly associated with the depressive-like phenotype in mice: Bacteroides acidifaciens, Bacteroides ovatus, unclassified species of Phascolarctobacterium (Veillonellacae family), and Eggerthella lenta. The relative abundances of these species did not differ significantly between the two pooled groups. Conclusions Microbiota from some, but not all, MDD patients can induce a depressive-like phenotype in GF mice. The ability to induce depressive-like behaviour in GF mice is lost when microbiota from multiple patients is pooled. Specific bacterial species may be responsible for the successful transfer of the depressive-like phenotype to mice. Funding Agencies NIH

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