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Faecal microbiota transfer in patients with microscopic colitis - a pilot study in collagenous colitis
Savanne Holster1, Julia Rode1, Johan Bohr2
1Nutrition-Gut-Brain Interactions Research Centre, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.
Objectives:
Faecal microbiota transfer (FMT) consists of the infusion of donor faecal material into the intestine of patients with the aim to restore a disturbed gut microbiota.
Methods:
In this pilot study (NCT03275467), the effect of three repeated FMTs (day 0, two weeks, four weeks) was studied and followed up for six months in nine collagenous colitis (CC) patients, using two stool donors.
Results:
Five patients had an active disease at the time of baseline sampling. The primary endpoint (remission at six weeks, defined as <3 stools whereof <1 watery stool per day) was achieved by two of these patients, and by one at eight weeks. Overall, in all nine patients, FMT did not result in a significant reduction of watery stools, assessed by daily diary. However, diarrhoea (assessed by gastrointestinal symptom rating scale) was significantly improved at four (p = .038) and eight weeks (p = .038), indigestion at eight (p = .045) and 12 weeks (p = .006), disease-related worries at four (p = .027) and eight weeks (p = .027), and quality of life at six months (p = .009). FMT resulted in an increased number of lamina propria lymphocytes, possibly indicating an initial mucosal immune activation. No serious adverse events, no systemic effects, and no changes in faecal calprotectin and psychological symptoms were observed.
Conclusions:
FMT is able to improve symptoms in a yet undefined subset of CC patients. Further studies could help to characterise this subset and to understand if these results can be generalised to all microscopic colitis patients.
Insights
Faecal microbiota transfer (FMT) improved diarrhea and quality of life in collagenous colitis patients, though remission rates varied. Further research is needed to identify which patients benefit most from this gut microbiota restoration therapy.
Area of Science:
- Gastroenterology
- Microbiome Research
- Immunology
Background:
- Collagenous colitis (CC) is a subtype of microscopic colitis characterized by inflammation of the colon.
- Faecal microbiota transfer (FMT) aims to restore gut microbiota balance by infusing donor stool.
- Current treatment options for CC have limitations, necessitating exploration of novel therapies.
Purpose of the Study:
- To evaluate the efficacy and safety of repeated FMT in patients with collagenous colitis.
- To assess the impact of FMT on clinical symptoms, endoscopic findings, and quality of life in CC patients.
- To explore potential immune responses following FMT in the colonic mucosa.
Main Methods:
- A pilot study involving nine CC patients who received three repeated FMTs over six months.
- Patients were monitored for clinical remission, symptom severity (diarrhea, indigestion), disease-related worries, and quality of life.
- Analysis included daily symptom diaries, gastrointestinal symptom rating scale, and assessment of lamina propria lymphocytes.
Main Results:
- Two out of five patients with active disease achieved remission at six weeks; one at eight weeks.
- FMT did not significantly reduce watery stools but significantly improved diarrhea, indigestion, disease-related worries, and quality of life.
- FMT led to increased lamina propria lymphocytes, suggesting potential mucosal immune activation, with no serious adverse events reported.
Conclusions:
- FMT can improve symptoms in a subset of collagenous colitis patients.
- The study highlights the potential of FMT for managing CC symptoms, particularly diarrhea and quality of life.
- Further research is required to define the specific patient subset that benefits from FMT and to generalize findings to all microscopic colitis patients.
