The taxonomic composition of the donor intestinal microbiota is a major factor influencing the efficacy of faecal microbiota transplantation in therapy refractory ulcerative colitis.. UC-FMT-study

Background: Faecal microbiota transplantation (FMT) is an experimental approach for the treatment of patients with ulcerative colitis (UC) refractory to standard medical therapy. Although there is growing evidence from randomized studies that FMT is effective for the treatment of UC there is a large discrepancy between study results. Factors affecting FMT response in UC are unknown. This is an open controlled trial of repeated FMT after antibiotic pre-treatment (FMT-group) versus antibiotic pre-treatment only (AB-group) in 27 therapy refractory UC patients over 90 days. The primary endpoint was the treatment response as assessed by the total Mayo score. Secondary endpoints were to find a specific microbial pattern in responders versus non responders to FMT and between donors by 16S rRNA gene based microbiota analysis. Results: In the FMT-group 59% of patients showed a response and 24% a remission to FMT. Response to FMT was mainly influenced by the taxonomic composition of the donor’s microbiota. Stool of donors with a high bacterial diversity and a high relative abundance of Akkermansia muciniphila, unclassified Ruminococcaceae, and Ruminococcus spp. were more likely to induce remission. In contrast antibiotic treatment alone (AB-group) was poorly tolerated, probably because of a sustained decrease of intestinal microbial richness. Conclusion: Our protocol of repeated FMT after antibiotic pretreatment lead to remarkable clinical result in this patient population, which is difficult to treat since all patients failed either to previous immunosuppressive or biologic therapy or even to both therapies. The taxonomic composition of the donor’s intestinal microbiota is a major factor influencing the efficacy of FMT in UC patients. This finding might explain the large variation in response rates of previous trials. The design of specific microbial preparation might lead to new treatments for UC. More information on statistics and bioinformatic tools applied to the dataset and metadata information can one found at: https://github.com/LGPW/FMT_in_TRUC_APT2017