Current Evidence for the Management of Inflammatory Bowel Diseases Using Fecal Microbiota Transplantation

Fecal microbiota transplantation (FMT) is a novel therapeutic procedure aiming at restoring a normal intestinal microbiota by application of fecal microorganisms from a healthy subject into the gastrointestinal tract of a patient. FMT is the most effective treatment for recurrent Clostridium difficile infections (CDI). These infections also occur in patients with inflammatory bowel diseases (IBDs), where case series demonstrated a successful treatment of CDI by FMT in 83-92% of patients. The effect of FMT on the activity of IBD has mainly been investigated in ulcerative colitis (UC) patients, including 3 randomized controlled trials. So far, 2 randomized controlled trials showed a superiority of FMT compared to placebo in inducing remission in UC, while 1 study found no significant difference to placebo. The variation in response to FMT between these studies as well as in the uncontrolled trials might be explained by many differences in the way of FMT application, patient pretreatment and patient and donor selection. The data for the use of FMT in Crohn's disease and pouchitis are sparse; currently, no conclusion can be drawn regarding the effectiveness of FMT in these indications. It needs to be noted that cases of IBD activation after FMT have been reported. So far, FMT can only be recommended to be used for the treatment of concomitant CDI in IBD in clinical practice. For treating IBD irrespective of CDI, FMT should be only used in clinical trials. Current forms of FMT, especially protocols using repeated application, are very time and personnel consuming. Future trends are the use of defined stable microbiota preparations, in particular oral preparations, which will enable better and larger controlled trails for investigating FMT in IBD.

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Fecal microbiota transplantation results in bacterial strain displacement in patients with inflammatory bowel diseases

FEBS Open Bio ◽

10.1002/2211-5463.12744 ◽

2019 ◽

Vol 10 (1) ◽

pp. 41-55 ◽

Cited By ~ 3

Author(s):

Manli Zou ◽

Zhuye Jie ◽

Bota Cui ◽

Honggang Wang ◽

Qiang Feng ◽

...

Keyword(s):

Inflammatory Bowel Diseases ◽

Bacterial Strain ◽

Fecal Microbiota Transplantation ◽

Fecal Microbiota ◽

Bowel Diseases ◽

Inflammatory Bowel

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Inflammatory Bowel Diseases: The Role of Gut Microbiota

Current Pharmaceutical Design ◽

10.2174/1381612826666200420144128 ◽

2020 ◽

Vol 26 (25) ◽

pp. 2951-2961 ◽

Cited By ~ 5

Author(s):

Cristiana De Musis ◽

Lucia Granata ◽

Marcello Dallio ◽

Agnese Miranda ◽

Antonietta G. Gravina ◽

...

Keyword(s):

Gut Microbiota ◽

Intestinal Microbiota ◽

Inflammatory Bowel Diseases ◽

Intestinal Inflammation ◽

Fecal Microbiota Transplantation ◽

Fecal Microbiota ◽

Trigger Factor ◽

Sequencing Analysis ◽

Bowel Diseases ◽

Inflammatory Bowel

: Inflammatory bowel diseases (IBD) are chronic multifactorial diseases characterized by partially unclear pathogenic mechanisms including changes in intestinal microbiota. Despite the microbiota, alteration is well established in IBD patients, as reported by 16RNA sequencing analysis, an important goal is to define if it is just a consequence of the disease progression or a trigger factor of the disease itself. To date, gut microbiota composition and gut microbiota-related metabolites seem to affect the host healthy state both by modulating metabolic pathways or acting on the expression of different genes through epigenetic effects. Because of this, it has been suggested that intestinal microbiota might represent a promising therapeutic target for IBD patients. : The aim of this review is to summarize both the most recent acquisitions in the field of gut microbiota and its involvement in intestinal inflammation together with the available strategies for the modulation of microbiota, such as prebiotics and/or probiotics administration or fecal microbiota transplantation.

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Probiotics, Prebiotics and Synbiotics in Inflammatory Bowel Diseases

Journal of Clinical Medicine ◽

10.3390/jcm10112466 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2466

Author(s):

Katarzyna Akutko ◽

Andrzej Stawarski

Keyword(s):

Inflammatory Bowel Diseases ◽

Fecal Microbiota Transplantation ◽

Inflammatory Diseases ◽

Symptomatic Treatment ◽

Fecal Microbiota ◽

Intestinal Microbiome ◽

Alternative Form ◽

Bowel Diseases ◽

Probiotic Strains ◽

Inflammatory Bowel

Inflammatory bowel diseases (IBD), which include Crohn’s disease (CD) and ulcerative colitis (UC), are chronic inflammatory diseases of the digestive tract with periods of remission and relapses. The etiopathogenesis of IBD is multifactorial and has not been fully understood. Hence, only symptomatic treatment of these diseases is possible. The current pharmacological treatment has variable efficacy and is associated with the risk of significant side effects. Therefore, there is a constant need to search for new types of therapies with a high safety profile. Considering that the qualitative and quantitative profile of the gastrointestinal microbiome is often different in patients with IBD than in healthy individuals, there is a need for looking for therapies aimed at restoring intestinal microbiome homeostasis. Thus, the use of strictly defined probiotics, prebiotics and synbiotics may become an alternative form of IBD therapy. There is evidence that treatment with certain probiotic strains, e.g., VSL#3 and Escherischia coli Nissle 1917, is an effective form of therapy to induce remission in patients with mild to moderate UC. So far, the effectiveness of the use of probiotics, prebiotics and synbiotics in inducing or maintaining remission in patients with CD has not been confirmed. There are also reports of possible beneficial effects of fecal microbiota transplantation (FMT) on the course of IBD, especially UC. Further, well-planned studies on a large group of patients are needed to determine the role of specific probiotic strains, prebiotics, synbiotics and FMT in the treatment of IBD in adults and in children.

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Butyrate and the Fine-Tuning of Colonic Homeostasis: Implication for Inflammatory Bowel Diseases

International Journal of Molecular Sciences ◽

10.3390/ijms22063061 ◽

2021 ◽

Vol 22 (6) ◽

pp. 3061

Author(s):

Naschla Gasaly ◽

Marcela A. Hermoso ◽

Martín Gotteland

Keyword(s):

Inflammatory Bowel Diseases ◽

Barrier Function ◽

Cell Types ◽

Fine Tuning ◽

Current Evidence ◽

Aryl Hydrocarbon ◽

Gut Barrier Function ◽

Bowel Diseases ◽

Inflammatory Processes ◽

Inflammatory Bowel

This review describes current evidence supporting butyrate impact in the homeostatic regulation of the digestive ecosystem in health and inflammatory bowel diseases (IBDs). Butyrate is mainly produced by bacteria from the Firmicutes phylum. It stimulates mature colonocytes and inhibits undifferentiated malignant and stem cells. Butyrate oxidation in mature colonocytes (1) produces 70–80% of their energetic requirements, (2) prevents stem cell inhibition by limiting butyrate access to crypts, and (3) consumes oxygen, generating hypoxia and maintaining luminal anaerobiosis favorable to the microbiota. Butyrate stimulates the aryl hydrocarbon receptor (AhR), the GPR41 and GPR109A receptors, and inhibits HDAC in different cell types, thus stabilizing the gut barrier function and decreasing inflammatory processes. However, some studies indicate contrary effects according to butyrate concentrations. IBD patients exhibit a lower abundance of butyrate-producing bacteria and butyrate content. Additionally, colonocyte butyrate oxidation is depressed in these subjects, lowering luminal anaerobiosis and facilitating the expansion of Enterobacteriaceae that contribute to inflammation. Accordingly, gut dysbiosis and decreased barrier function in IBD seems to be secondary to the impaired mitochondrial disturbance in colonic epithelial cells.

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The Role of Carrageenan in Inflammatory Bowel Diseases and Allergic Reactions: Where Do We Stand?

Nutrients ◽

10.3390/nu13103402 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3402

Author(s):

Barbara Borsani ◽

Raffaella De Santis ◽

Veronica Perico ◽

Francesca Penagini ◽

Erica Pendezza ◽

...

Keyword(s):

Inflammatory Bowel Diseases ◽

Experimental Models ◽

Gelling Agent ◽

Current Evidence ◽

Allergic Reactions ◽

Processed Foods ◽

Bowel Diseases ◽

Inflammatory Bowel

Carrageenan (CGN) is a high molecular weight polysaccharide extracted from red seaweeds, composed of D-galactose residues linked in β-1,4 and α-1,3 galactose-galactose bond, widely used as a food additive in processed foods for its properties as a thickener, gelling agent, emulsifier, and stabilizer. In recent years, with the spread of the Western diet (WD), its consumption has increased. Nonetheless, there is a debate on its safety. CGN is extensively used as an inflammatory and adjuvant agent in vitro and in animal experimental models for the investigation of immune processes or to assess the activity of anti-inflammatory drugs. CGN can activate the innate immune pathways of inflammation, alter the gut microbiota composition and the thickness of the mucus barrier. Clinical evidence suggests that CGN is involved in the pathogenesis and clinical management of inflammatory bowel diseases (IBD), indeed food-exclusion diets can be an effective therapy for disease remission. Moreover, specific IgE to the oligosaccharide α-Gal has been associated with allergic reactions commonly referred to as the “α-Gal syndrome”. This review aims to discuss the role of carrageenan in inflammatory bowel diseases and allergic reactions following the current evidence. Furthermore, as no definitive data are available on the safety and the effects of CGN, we suggest gaps to be filled and advise to limit the human exposure to CGN by reducing the consumption of ultra-processed foods.

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Evaluation of metabolites levels in feces of patients with inflammatory bowel diseases

Biomeditsinskaya Khimiya ◽

10.18097/pbmc20206603233 ◽

2020 ◽

Vol 66 (3) ◽

pp. 233-240

Author(s):

E.S. Zhgun ◽

Y.V. Kislun ◽

T.N. Kalachniuk ◽

V.A. Veselovsky ◽

A.S. Urban ◽

...

Keyword(s):

Fatty Acids ◽

Inflammatory Bowel Diseases ◽

Intestinal Microflora ◽

Fecal Microbiota ◽

Unknown Etiology ◽

Published Data ◽

Resonance Spectroscopy ◽

Healthy Donors ◽

Bowel Diseases ◽

Inflammatory Bowel

Inflammatory bowel diseases (IBD), which include ulcerative colitis (UC) and Crohn's disease (CD), are chronic intestinal inflammatory disorders with an unknown etiology. They are characterized by chronic recurrent inflammation of the intestinal mucosa and lead to a significant decrease in the quality of life and death of patients. IBD are associated with suppression of normal intestinal microflora, including a decrease in bacteria, producers of short chain fatty acids (SCFAs), exhibiting anti-inflammatory and protective properties. Among the various methods of intestinal microflora correction, fecal microbiota transplantation (FMT), which engrafts the fecal microbiota from a healthy donor into a patient recipient, is of a particular interest. As a result, a positive therapeutic effect is observed, accompanied by the restoration of the normal intestinal microflora of the patient. A significant drawback of the method is the lack of standardization. Metabolites produced by intestinal microflora, namely SCFAs, allow objective assessment of the functional state of the intestinal microbiota and, consequently, the success of the FMT procedure. Using gas chromatography and nuclear magnetic resonance spectroscopy techniques, we have analyzed concentrations and molar ratios of SCFAs in fecal samples of 60 healthy donors. Results were in good accord when comparing two methods as well as with published data. Analysis of SCFAs in feces of patients with UC (19 patients) and CD (17 patients) revealed a general decrease in the concentration of fatty acids in the experimental groups with significant fluctuations in the values in experimental groups compared to control group of healthy donors. On the limited group of IBD patients (6 patients with UC and 5 patients with CD) concentration of SCFAs before and within 30 days of observation after FMT was determined. It was shown that FMT had a significant impact on the SCFAs levels within 1 month term; tendency to reach characteristics of healthy donors is unambiguously traced for both diseases.

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