Fecal microbiota preparation delivered by colonoscopy appears effective in UC

Last Updated: 2017-05-04

By Will Boggs MD

NEW YORK (Reuters Health) - A fecal microbiota preparation (FMP) delivered by colonoscopy appears safe and effective for increasing microbial diversity in patients with active ulcerative colitis (UC), according to a pilot study.

"Our study offers enthusiastic support for fecal microbiota transplantation (FMT) using a readily available FMP and a ‘real-world’ patient cohort that can be applied by gastroenterologists caring for patients with active UC,” Dr. Randy S. Longman from Weill Cornell Medicine, in New York City, told Reuters Health by email.

Recent studies suggest a role for FMT in inducing remission of UC, with the best results shown after six weekly fecal enemas. Nasoduodenal and single colonoscopic delivery were not effective in small studies.

Dr. Longman and colleagues evaluated the safety and efficacy of two-donor FMP delivered by colonoscopy in the terminal ileum and right colon in an open-label pilot study of 20 patients with active UC.

Seven patients (35%) achieved a clinical response, and three (15%) achieved clinical remission at week four, including two patients who achieved mucosal healing, the researchers report in Inflammatory Bowel Diseases, online April 25.

All week-four responders maintained improved disease activity scores at 12 weeks.

Among the seven (of 13) nonresponders followed to week 12, four achieved some improvement in disease activity scores and three were unchanged.

Both clinical responders and nonresponders had significantly enhanced microbial diversity at two weeks post-FMT that persisted at four weeks post-FMT.

“Donor (microbial composition) differences clearly segregated with clinical response,” Dr. Longman said. “These results support the possibility that specific microbes or a community of microbiota could be more effective in promoting mucosal healing in UC.”

Patients also showed significant reductions in interferon-gamma production and regulatory T cell numbers at week four compared with pre-FMT.

“The method and frequency of FMP delivery remain important variables,” Dr. Longman said. “The results of Moayyedi et al. suggest that enema is an effective method of transfer when provided weekly for six weeks. Our study shows that single colonoscopic delivery is also effective after 4 weeks. Further studies are needed to directly compare delivery method and frequency of repeat delivery.”

Finch Therapeutics employed two of theauthors, and another author was a research consultant and shareholder at Finch Therapeutics. Dr. Longman disclosed no conflicts of interest.

SOURCE: http://bit.ly/2pKSc9L

Inflamm Bowel Dis 2017.