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Early fecal microbiome transfer after donor defecation determines response in patients with moderate to severe ulcerative colitis

Abstract

Background

Fecal microbiome transfer (FMT) targeting gut microbiome dysbiosis is an emerging therapy for ulcerative colitis (UC). There is however no consensus on protocols for performing FMT in UC, especially in relation to time after donor feces defecation.

Methods

This is a single-center retrospective analysis of patients with moderate-severe UC (total Mayo Clinic score ≥6 and endoscopic Mayo Clinic subscore of ≥2) treated with FMT between September 2017 and December 2019 at Dayanand Medical College and Hospital, Ludhiana, India. Fresh fecal samples from unrelated healthy voluntary donors were administered through colonoscopy at weeks 0, 2, 6, 10, 14, 18, and 22. Time interval between donor feces defecation and FMT procedure was recorded for each FMT session and the mean time of seven sessions was designated aika. Impact of aika on clinical response and safety of FMT was evaluated.

Results

During the study period, 123 adult patients (mean age 33.75±11.97 years, 61.8% [n=76] males) with moderate-severe UC (mean total Mayo Clinic and endoscopic Mayo Clinic scores 7.49±1.60 and 2.50±0.50, respectively) were treated with FMT. The mean aika was 2.29±0.75 h. The aika was smaller in patients who responded to FMT as compared to non-responders (2.13±0.75 h vs. 2.71±0.76 h, p=0.0002) as well as in patients achieving clinical remission (2.15±0.76 h vs. 2.42±0.76 h, p=0.05). There was no significant impact of aika on adverse effects except for the incidence of borborygmi after FMT, which was higher in patients with aika ≤2 h.

Conclusion

Early FMT after donor feces defecation favorably impacts the clinical response rates in patients with active UC.

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Acknowledgements

Professor Perttu Arkkila, Department of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland.

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Authors and Affiliations

Authors

Contributions

Arshdeep Singh: conceptualization, data curation, formal analysis, methodology, project administration, writing original draft, writing review and editing, approval of final manuscript. Ramit Mahajan: project administration, supervision, visualization, writing review and editing, approval of final manuscript. Bhavjeet Kaur Kahlon: data curation, writing original draft, writing review and editing, approval of final manuscript. Ashvin Singh Dhaliwal: data curation, writing original draft, writing review and editing, approval of final manuscript. Vandana Midha: conceptualization, methodology, project administration, supervision, visualization, writing review and editing, approval of final manuscript. Varun Mehta: writing review and editing, approval of final manuscript. Namita Bansal: Data curation, formal analysis, approval of final manuscript. Dharmatma Singh: data curation, formal analysis, approval of final manuscript. Ajit Sood: conceptualization, methodology, project administration, supervision, visualization, writing review and editing, approval of final manuscript.

Corresponding author

Correspondence to Ajit Sood.

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Conflict of interest

ArS, RM, BKK, ASD, VM, VMe, NB, DS, and AS declare no competing interests.

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The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Singh, A., Mahajan, R., Kahlon, B.K. et al. Early fecal microbiome transfer after donor defecation determines response in patients with moderate to severe ulcerative colitis. Indian J Gastroenterol (2022). https://doi.org/10.1007/s12664-022-01257-0

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Keywords

  • Fecal microbiota transplantation
  • FMT
  • FMT protocols
  • Gut microbiome
  • Ulcerative colitis