Gut microbial ethanol production in patients with Auto-brewery syndrome and treatment with fecal microbiota transplantation

We conducted a prospective, observational study of 22 patients with Auto-brewery Syndrome, 21 unaffected household partners, and 22 healthy controls. Comprehensive clinical assessments and taxonomic and functional profiling of the fecal microbiota by shotgun metagenomic sequencing analysis were performed. Bioreactor cultures demonstrated that gut microbes from patients with Auto-brewery Syndrome produce ethanol in vitro and can accurate distinguish patient stool samles from their household partners. Patients' microbiota exhibited gene enrichment in several metabolic pathways associated with ethanol production, including the mixed acid fermentation pathway, heterolactic fermentation pathway, and ethanolamine utilization pathway. One patient was successfully treated with fecal microbiota transplantation, with correlations between gut microbiota composition, function, and symptoms.