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Fecal microbiota transplantation is safe and tolerable in patients with multiple sclerosis: A pilot randomized
Kait F Al, Laura J Craven, Shaeley Gibbons1
1Department of Microbiology and Immunology, Western University, London, ON, Canada.
Background:
Patients with MS have an altered gut microbiota compared to healthy individuals, as well as elevated small intestinal permeability, which may be contributing to the development and progression of the disease.
Objective:
We sought to investigate if fecal microbiota transplantation was safe and tolerable in MS patients and if it could improve abnormal intestinal permeability.
Methods:
Nine patients with MS were recruited and provided monthly FMTs for up to six months. The primary outcome investigated was change in peripheral blood cytokine concentrations. The secondary outcomes were gut microbiota composition, intestinal permeability, and safety (assessed with EDSS and MRI).
Results:
The study was terminated early and was subsequently underpowered to assess whether peripheral blood cytokines were altered following FMTs. FMTs were safe in this group of patients. Two of five patients had elevated small intestinal permeability at baseline that improved to normal values following FMTs. Significant, donor-specific, beneficial alterations to the MS patient gut microbiota were observed following FMT.
Conclusion:
FMT was safe and tolerable in this cohort of RRMS patients, may improve elevated small intestinal permeability, and has the potential to enrich for an MS-protective microbiota. Further studies with longer follow-up and larger sample sizes are required to determine if FMT is a suitable therapy for MS.
Insights
Fecal microbiota transplantation (FMT) is safe for multiple sclerosis (MS) patients and may improve gut permeability. FMT also showed potential to enrich MS-protective gut bacteria, warranting further investigation.
Area of Science:
- Microbiology
- Immunology
- Neurology
Background:
- Multiple sclerosis (MS) is associated with gut dysbiosis and increased intestinal permeability.
- These gut alterations may play a role in MS pathogenesis and progression.
Purpose of the Study:
- To evaluate the safety and tolerability of fecal microbiota transplantation (FMT) in MS patients.
- To assess the impact of FMT on intestinal permeability and gut microbiota composition in MS.
Main Methods:
- Nine relapsing-remitting MS (RRMS) patients received monthly FMT for up to six months.
- Primary outcome: changes in peripheral blood cytokines. Secondary outcomes: gut microbiota, intestinal permeability, and safety (EDSS, MRI).
Main Results:
- FMT was safe and well-tolerated in RRMS patients.
- Two of five patients with elevated intestinal permeability showed improvement to normal levels post-FMT.
- Significant, donor-specific, beneficial alterations in gut microbiota composition were observed.
Conclusions:
- FMT is a safe and tolerable intervention for RRMS patients.
- FMT may improve elevated intestinal permeability and enrich for an MS-protective microbiota.
- Larger, longer-term studies are needed to confirm FMT's therapeutic potential for MS.
