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Intestinal Microbial and Metabolic Alterations Following Successful Fecal Microbiota Transplant for D-Lactic Acidosis

Bulik-Sullivan, Emily C.*; Roy, Sayanty; Elliott, Ryan J.; Kassam, Zain; Lichtman, Steven N.; Carroll, Ian M.*,§; Gulati, Ajay S.†,§,||

Journal of Pediatric Gastroenterology and Nutrition: October 2018 - Volume 67 - Issue 4 - p 483–487
doi: 10.1097/MPG.0000000000002043
Short Communication: Gastroenterology

ABSTRACT Fecal microbiota transplantation (FMT) involves the transfer of stool from a healthy individual into the intestinal tract of a diseased recipient. Although used primarily for recurrent Clostridium difficile infection, FMT is increasingly being attempted as an experimental therapy for other illnesses, including metabolic disorders. D-lactic acidosis (D-LA) is a metabolic disorder that may occur in individuals with short bowel syndrome when lactate-producing bacteria in the colon overproduce D-lactate. This results in elevated systemic levels of D-lactate, metabolic acidosis, and encephalopathy. In this study, we report the successful use of FMT for the treatment of recurrent D-LA in a child who was unresponsive to conventional therapies. Importantly, we also present profiles of the enteric microbiota, as well as fecal D-/L-lactic acid metabolites, before and longitudinally after FMT. These data provide valuable insight into the putative mechanisms of D-LA pathogenesis and its treatment.

*Department of Nutrition, School of Medicine

Department of Pediatrics, Division of Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC

OpenBiome, Somerville, MA

§Center for Gastrointestinal Biology and Disease, School of Medicine

||Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Address correspondence and reprint requests to Ajay S. Gulati, MD, University of North Carolina at Chapel Hill, 230 MacNider Hall; CB 7229, Chapel Hill, NC 27599 (e-mail:

Received 6 March, 2018

Accepted 5 May, 2018

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

R.J.E. and Z.K. are employees of OpenBiome. Z.K. is a research consultant and shareholder at Finch Therapeutics. All other authors have no sources of funding or conflicts of interest to disclose.

© 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,