Diet Conditioning Before FMT Improves Outcomes in UC

TOPLINE:

Patients with ulcerative colitis (UC) who receive fecal microbiota transplantation (FMT) from diet-conditioned donors, and follow a healthy diet themselves, have more favorable microbial alterations than those who receive FMT alone.

METHODOLOGY:

• Results from the CRAFT UC randomized controlled trial showed that receiving FMT from diet-preconditioned donors plus adopting the UC exclusion diet (UCED) led to better clinical remission rates than receiving FMT alone (ie, without donor dietary conditioning) in adult patients with mild to moderate UC refractory to previous treatments.
• This post hoc analysis further compared the microbial profile and functional alterations in those who received FMT alone (n = 11) or FMT from diet-conditioned donors and who then continued with the UCED intervention themselves (n = 10).
• Patients received a single FMT by colonoscopy on day 1, followed by rectal enemas from donors on days 2 and 14. Patients in the dietary conditioning group also received a fruit and vegetable–rich UCED after FMT and for the following 12 weeks.
• Donors (n = 7; median age, 27.5 years) provided four or more stool samples both before and after receiving diet conditioning for 14 days.
• The microbial composition of the fecal samples was assessed using DNA shotgun metagenomic sequencing.

TAKEAWAY:

• The microbiota of patients with UC who received FMT from diet-conditioned donors followed by the UCED showed a shift toward the donors’ microbial composition; however, no such effects were observed in patients who received only FMT.
• FMT with the UCED increased the abundance of Eubacterium sp. AF22-8LB, a beneficial taxon associated with inactive UC, which correlated inversely with fecal calprotectin levels.
• FMT from diet-conditioned donors followed by the UCED was associated with the enrichment of pathways involved in the biosynthesis of branched-chain amino acids and ribonucleotides, which help maintain the integrity of the gut.

IN PRACTICE:

“Our findings provide support to further explore the additive benefit of FMT combined with dietary intervention for the treatment of UC,” the authors wrote.

SOURCE:

The study, led by Haim Leibovitzh, MD, Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, was published online in the Journal of Crohn’s and Colitis.

LIMITATIONS:

This study included a small number of patients. As both FMT and diet may alter the gut microbial composition and function, it was not entirely clear if the more favorable microbial profile associated with FMT plus the UCED was derived from the donors or was a result of dietary modifications by the recipients. The authors acknowledged that the results of this study need to be validated in larger external cohorts.

DISCLOSURES:

This work was supported by the ECCO Pioneer Prize; Litwin IBD Pioneer grant; and the Azrieli, Solomon, and Beker foundations. Two authors declared receiving fees and grants from several pharmaceutical companies.