Donor Species Richness Determines Faecal Microbiota Transplantation Success in Inflammatory Bowel Disease

Abstract

Background and aims: Faecal microbiota transplantation is a successful therapy for patients with refractory Clostridium difficile infections. It has also been suggested as a treatment option for inflammatory bowel disease, given the role of the intestinal microbiota in this disease. We assessed the impact of faecal microbiota transplantation in patients with inflammatory bowel disease and studied predictors of clinical (non-)response in microbial profiles of donors and patients.

Methods: Fourteen refractory patients (8 with ulcerative colitis and 6 with Crohn's disease) underwent ileocolonoscopy with faecal microbiota transplantation through a nasojejunal (n = 9) or rectal (n = 5) tube. Efficacy was assessed by endoscopic healing at week 8, clinical activity scores and C-reactive protein measurement. Faecal microbiota was analysed by 16S rDNA pyrosequencing.

Results: There was no significant improvement among the 6 patients with Crohn's disease at week 8 following faecal microbiota transplantation. One patient experienced temporary clinical remission for 6 weeks. In contrast, 2/8 patients with ulcerative colitis had endoscopic remission at week 8, and of the 6 remaining patients with ulcerative colitis, 1 reported temporary remission for 6 weeks. The donor microbiota richness and the number of transferred phylotypes were associated with treatment success. Persistent increased C-reactive protein 2 weeks after transplantation was predictive of failure of response.

Conclusion: Faecal microbiota transplantation led to endoscopic and long-term (>2 years) remission in 2 out of 8 ulcerative colitis patients. Higher donor richness was associated with successful transplant. Therefore, faecal microbiota transplantation with donor prescreening could be a treatment option for selected refractory ulcerative colitis patients.

Keywords: Faecal microbiota transplantation (FMT); Oscillibacter; Roseburia.

Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Figures

Figure 1.

Endoscopic images of inflammatory bowel disease patients at baseline and 8 weeks after faecal microbiota transplantation. (a) Three representative Crohn’s disease patients showing lack of endoscopic improvement. (b) Representative endoscopic images of the patient with ulcerative colitis-like Crohn’s disease showing partial endoscopic healing. (c) Representative endoscopic images of ulcerative colitis patients showing complete endoscopic remission.

Figure 2.

C-reactive protein (CRP) values over time for responders (blue) and non-responders (red) to faecal microbiota transplantation (FMT). A significant difference between successful and non-successful FMT was already observed by week 2 (p = 0.0159). R, number of responders for whom the CRP value was available; NR, number of non-responders for whom the CRP value was available.

Figure 3.

Baseline richness associated with treatment success. Bacterial richness at baseline by comparing the number of operational taxonomic units (OTUs) in (a) samples of donors, (b) Crohn’s disease patients and (c) ulcerative colitis patients. On the x-axis the samples are separated based on (partial) response to the faecal microbiota transplantation.

Figure 4.

Markers of successful faecal microbiota transplantation (FMT). Evolution over time of phylotypes that were transferred in patients with (partial) response to FMT.