Temporal bacterial community dynamics vary among ulcerative colitis patients after fecal microbiota transplantation.
OBJECTIVE
Fecal microbiota transplantation (FMT) from healthy donors, which is an effective alternative for treatment of Clostridium difficile-associated disease, is being considered for several disorders such as inflammatory bowel disease, irritable bowel syndrome, and metabolic syndrome. Disease remission upon FMT is thought to be facilitated by an efficient colonization of healthy donor microbiota, but knowledge of the composition and temporal stability of patient microbiota after FMT is lacking.


METHODS
Five patients with moderately to severely active ulcerative colitis (Mayo score ≥6) and refractory to standard therapy received FMT via nasojejunal tube and enema. In addition to clinical activity and adverse events, the patients' fecal bacterial communities were monitored at multiple time points for up to 12 weeks using 16S rRNA gene-targeted pyrosequencing.


RESULTS
FMT elicited fever and a temporary increase of C-reactive protein. Abundant bacteria from donors established in recipients, but the efficiency and stability of donor microbiota colonization varied greatly. A positive clinical response was observed after 12 weeks in one patient whose microbiota had been effectively augmented by FMT. This augmentation was marked by successive colonization of donor-derived phylotypes including the anti-inflammatory and/or short-chain fatty acid-producing Faecalibacterium prausnitzii, Rosebura faecis, and Bacteroides ovatus. Disease severity (as measured by the Mayo score) was associated with an overrepresentation of Enterobacteriaceae and an underrepresentation of Lachnospiraceae.


CONCLUSIONS
This study highlights the value of characterizing temporally resolved microbiota dynamics for a better understanding of FMT efficacy and provides potentially useful diagnostic indicators for monitoring FMT success in the treatment of ulcerative colitis.
Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Wien, Austria.
Sieglinde
S
Angelberger
Walter
W
Reinisch
Athanasios
A
Makristathis
Cornelia
C
Lichtenberger
Clemens
C
Dejaco
Pavol
P
Papay
Gottfried
G
Novacek
Michael
M
Trauner
Alexander
A
Loy
David
D
Berry
D000328:Adult; D001439:Bacteroides / Q000235:genetics; D002097:C-Reactive Protein; D003013:Clostridium / Q000235:genetics; D003093:Colitis, Ulcerative / Q000382:microbiology / Q000628:therapy*; D004733:Enema; D004755:Enterobacteriaceae / Q000235:genetics; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D054892:Metagenome / Q000235:genetics*; D008875:Middle Aged; D012336:RNA, Ribosomal, 16S / Q000032:analysis*; D013997:Time Factors; D014180:Transplantation; D055815:Young Adult
D012336:RNA, Ribosomal, 16S; D002097:C-Reactive Protein