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Faecal Microbiota Transplantation Engraftment After Budesonide or Placebo in Patients With Active Ulcerative Colitis
Emilie van Lingen1, Sam Nooij2, Elisabeth M Terveer2
1Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
Journal of Crohn'S & Colitis
|April 4, 2024
Summary
Faecal microbiota transplantation (FMT) for ulcerative colitis (UC) response is donor-dependent, not influenced by budesonide pretreatment. Specific microbial strains, rather than overall engraftment, may drive therapeutic benefits in UC patients.
Area of Science:
- Gastroenterology
- Microbiome research
- Immunology
Background:
- Faecal microbiota transplantation (FMT) shows variable efficacy in ulcerative colitis (UC).
- Donor variability and treatment regimens impact FMT outcomes in UC.
- Investigating rationally selected donors and budesonide pretreatment for active UC.
Purpose of the Study:
- To evaluate the effect of budesonide pretreatment on donor microbiota engraftment in UC patients.
- To assess the clinical efficacy of FMT with rationally selected donors.
- To determine the relationship between microbiota engraftment and clinical response in UC.
Main Methods:
- Randomized controlled trial in mild to moderate active UC patients (≥18 years).
- Three weeks of budesonide (9 mg) or placebo, followed by 4-weekly FMT infusions.
- Donor selection based on microbiota composition, Treg induction, and SCFA production; primary endpoint: donor microbiota engraftment.
Main Results:
- Budesonide pretreatment did not enhance donor microbiota engraftment or clinical response (p=0.56).
- Engraftment levels did not correlate with clinical response.
- One donor was associated with significant clinical response (80% responders, p<0.05) despite lower overall engraftment.
- Specific microbial taxa and donor composition correlated with clinical response.
Conclusions:
- Budesonide pretreatment did not significantly affect FMT engraftment or clinical outcomes in UC.
- Clinical response to FMT in UC appears to be donor-specific.
- Therapeutic effects of FMT may stem from specific microbial strains, not just overall engraftment, necessitating further mechanistic studies.
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