Insight: Fecal Microbiota Transplantation in Inflammatory Bowel Disease

Couple of Bacteria
Resetting the intestinal bacteria can lead to great benefits.
One of the most interesting and unique therapies that have come out of the microbiota revolution is the fecal microbiota transplant. Despite a certain “yuck” factor, interest in this technique grows especially as clinical trials and case studies with a number of diseases are proving successful. How does it work with inflammatory bowel disease (IBD)?

Intestinal Microbiota

The intestinal tract is the home to at least 1014 bacteria, which are members of hundreds of different species and strains. Even though most of us already knew that fecal matter consisted mainly of bacteria since we were children, this particular field of research wasn’t particularly popular until the last few years. The reason had more to do with a lack of tools than interest. It is only now that we have high-throughput screening techniques and computational software that can deal with the data such a study generates.

Now that we have these tools at our fingertips, it’s now known that the composition of the intestinal microflora plays a huge role in modulating health. Starting with the very first exposures during birth until old age, we now know that the intestinal microbiota influence the immune system, metabolism and even our mental well-being.

In IBD, the intestinal microbiota is altered. Patients have reduced numbers of bacteria from the phyla Firmicutes and Bacteroidetes and increased numbers from Actinobacteria and Proteobacteria. Although it isn’t known if these changes cause IBD, or if IBD is caused by an infectious agent, the possibility of finding a cure is enough to spur on studies involving FMT.

Fecal Microbiota Transplantation (FMT)

Quite simply, FMT involves the transfer of a fecal solution collected from a healthy donor into the intestinal tract of a recipient. Donors are usually family members, and they are screened for infections and other health issues. Fecal matter is usually mixed with water or saline and administered immediately either through a colonoscopy procedure or a duodenal infusion that requires a tube entering from the nose.

FMT is an extremely effective treatment for Clostridium difficile infections with cure rates of over 80%. In IBD, the results are not so clear cut. An initial study was done in 1988 with an ulcerative colitis (UC) patient that resulted in a cure. This success was followed in 2003 with six more patients. Nowadays, enough patients have been treated to give us an idea of how effective this treatment could be. It appears that approximately 63% of UC patients enter remission after FMT. Follow up studies indicate that benefits can be retained in the long-term for some patients.

FMT is less studied in Crohn’s disease (CD), and it appears to be less successful. However, there’s still plenty of room to improve this technique in the future. Moreover, there are several clinical studies; located in China, Beth Israel Deaconess Medical Center and Seattle Children’s Hospital; now recruiting patients to look specifically at the use of FMT in CD.

References

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