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Fecal Microbiota Transplantation for Ulcerative Colitis: A Systematic Review and Meta-Analysis

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Ulcerative Colitis
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Posted 7/1/2017 2:44 PM (GMT 0)
/www.ncbi.nlm.nih.gov/pmc/articles/PMC4905678/

This has probably been posted before, but I just came across it. I thought I would post again for those that it may interest.

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Results

Twenty five studies (2 randomized controlled trials, 15 cohort studies, and 8 case studies) with 234 UC patients were included. Overall, 41.58% (84/202) patients achieved clinical remission (CR) and 65.28% (126/193) achieved clinical response. Among the cohort studies, the pooled estimate of patients who achieved CR and clinical response were 40.5% (95% CI 24.7%-58.7%), and 66.1% (95% CI 43.7%-83.0%). Most adverse events were slight and self-resolving. The analyses of gut microbiota in 7 studies showed that FMT could increase microbiota diversity and richness, similarity, and certain change of bacterial composition.

Conclusion

FMT provides a promising effect for UC with few adverse events. Successful FMT may be associated with an increase in microbiota diversity and richness, similarity, and certain change of bacterial composition.
Posted 7/1/2017 5:43 PM (GMT 0)
This is something I'd consider in a heartbeat. I wonder how advanced the disease has to be for consideration though? anyone know?
Posted 7/2/2017 4:46 AM (GMT 0)
I really wonder if FMT will ever move from "interesting study results" to "standardized, generally available therapy." So many variables in donors it's hard to see how this gets accepted as a therapy, without dramatic results (e.g., like CDI treatment).

It really seems that studies are needed to discover WHY FMT works, when it does work. E.g., what specific microbes in the transfer are improving the patients conditions? Then standardized probiotics could be developed to mimic FMT.

Sounds very difficult to tease out the right microbes from the hundreds of species, all interacting.
Posted 7/2/2017 6:28 AM (GMT 0)
Mark, I have some questions I've been wondering about. Maybe you can answer them.

We know that when we take a probiotic like VSL3, the bacteria are transient and pass out of our bodies after several days. Even a sporting probiotic like coagulans stays in our bodies for six or eight days. They don't repopulate the gut.

Yet, with these fecal transplants it seems the flora does repopulate - at least in some cases. I've read that sometimes people need several procedures to achieve success. Is that because they don't "take" the first couple of times?

I get that there are a lot more strains in the donor feces, and these are the strains that are natural to a healthy donor's gut. Is that it?
Posted 7/2/2017 10:57 AM (GMT 0)
There are at least two reasons I can see why FMT is not 100% effective.
There are probably many more variables both known and unknown.

Stool bacteria are not necessarily mucosa associated bacteria.

When they did the procedures we dont know how careful they were to exclude
oxygen,many gut bacteria are strict anaerobes.

Some other variables might be, the state of immune activation, clean out procedure,
male vs female donor.

Old Mike
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