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: firstname.lastname@example.org).
Received 6 March, 2018
Accepted 5 May, 2018
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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.