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Temporal Bacterial Community Dynamics Vary Among Ulcerative Colitis Patients After Fecal Microbiota Transplantation

Angelberger, Sieglinde MD1; Reinisch, Walter MD1; Makristathis, Athanasios PhD2; Lichtenberger, Cornelia1; Dejaco, Clemens MD1; Papay, Pavol MD1; Novacek, Gottfried MD1; Trauner, Michael MD1; Loy, Alexander PhD3; Berry, David PhD3

American Journal of Gastroenterology: October 2013 - Volume 108 - Issue 10 - p 1620–1630
doi: 10.1038/ajg.2013.257
Inflammatory Bowel Disease
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OBJECTIVES: Fecal microbiota transplantation (FMT) from healthy donors, which is an effective alternative for treatment ofClostridium 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–producingFaecalibacterium prausnitzii,Rosebura faecis, andBacteroides ovatus. Disease severity (as measured by the Mayo score) was associated with an overrepresentation ofEnterobacteriaceaeand an underrepresentation ofLachnospiraceae.

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.

1 Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Wien, Austria

2 Department of Clinical Microbiology, Institute of Hygiene and Medical Microbiology, Medical University Vienna, Wien, Austria

3 Department of Microbial Ecology, Faculty of Life Science, University of Vienna, Wien, Austria

Correspondence: Alexander Loy, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University Vienna, Währinger Gürtel 18-20, A-1090 Wien, Austria. E-mail: walter.reinisch@meduniwien.ac.at

Correspondence: Alexander Loy, Department of Microbial Ecology, Faculty of Life Science, University of Vienna, Althanstrasse 14, A-1090 Wien, Austria. E-mail: loy@microbial-ecology.net

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A823

Received 18 October 2012; accepted 22 March 2013

published online 24 September 2013

© The American College of Gastroenterology 2013. All Rights Reserved.
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