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The gut microbiota includes trillions of microorganisms that colonize the human gastrointestinal tract, including bacteria, archaea, viruses, and fungi. This complex ecosystem plays a critical role in maintaining intestinal and systemic health. Most of these microbes inhabit the large intestine, establishing a relatively stable and diverse community that contributes to gut homeostasis through various metabolic, immunological, and protective mechanisms.Dominant bacterial phyla, such as...
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Dynamics in Circulating Immune Cell Subsets After Fecal Microbiota Transplantation for Recurrent Clostridioides

Lotte Lindgreen Eriksen1,2, Sidsel Støy1,2,3, Mette Mejlby Hansen1

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Faecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (rCDI) causes minor, temporary immune cell changes. Clinical cure in rCDI patients correlates with increased circulating gut-homing T cells.

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Area of Science:

  • Immunology
  • Microbiology
  • Gastroenterology

Background:

  • Faecal microbiota transplantation (FMT) is a successful treatment for recurrent Clostridioides difficile infection (rCDI).
  • Early adverse reactions to FMT suggest a role for cellular immune responses.
  • Understanding immune dynamics post-FMT is crucial for predicting outcomes and reactions.

Purpose of the Study:

  • To compare early peripheral immune cell subset changes in rCDI patients receiving FMT plus antibiotics versus antibiotics alone.
  • To investigate the relationship between immune cell dynamics and clinical outcomes after FMT.

Main Methods:

  • Randomized trial comparing FMT plus vancomycin (n=20) versus vancomycin alone (n=15) for rCDI.
  • Analysis of peripheral blood immune cell subsets (innate and adaptive) via flow cytometry at baseline and one week post-treatment.
  • Detailed analysis of gut-homing memory and effector T cells, including regulatory T cells (Tregs) and NKT cells.

Main Results:

  • FMT induced subtle, transient changes in immune cell subsets within one week.
  • A decrease in regulatory T cells (Tregs) was observed early after FMT, indicating rapid dynamics.
  • Natural Killer T (NKT) cells transiently increased within 24 hours post-FMT, returning to baseline by one week.
  • Clinical resolution of rCDI, irrespective of treatment, was associated with decreased non-classical monocytes and a shift towards gut-homing effector T cells.

Conclusions:

  • FMT in rCDI patients leads to subtle and transient peripheral immune cell dynamics.
  • Regulatory T cells (Tregs) and NKT cells show responsiveness to FMT and warrant further investigation.
  • Increased circulating gut-homing T cells may be linked to successful cure of Clostridioides difficile infection.