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FMT induces remission in pediatric patients with Crohn's disease
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Children with Crohn’s disease achieved remission after fecal microbiota transplant, recent study data found.
“The fecal microbiome is likely the cause or trigger of the immune response in IBD,” David L. Suskind, MD, from the department of pediatrics, division of gastroenterology at Seattle Children’s Hospital, told Healio Gastroenterology. “Therapies which affect the fecal microbiome such as FMT, have the potential to change our current treatment paradigm by altering the fecal microbiome instead of using medications which suppress the immune response.”
David L. Suskind
Aiming to evaluate the tolerability, preliminary safety and potential efficacy of FMT in treating pediatric CD, Suskind and colleagues performed a prospective open-label study involving nine patients (aged 12-21 years; Pediatric Crohn’s Disease Activity Index [PCDAI] scores, 10-29) recruited from Seattle Children’s Hospital outpatient gastroenterology clinics.
The transplant donor for each patient was one of the donor’s parents, and it was administered via nasogastric tube. Patients had clinical follow-up at 2, 6 and 12 weeks, and PCDAI, C-reactive protein and fecal calprotectin were evaluated at each follow-up visit. DNA extraction and metagenomic sequencing of stool samples also were performed to evaluate for FMT engraftment and fecal microbiome similarity between donors and recipients.
PCDAI scores indicated that seven patients were in clinical remission at 2 weeks, and five patients who did not receive additional therapy were still in clinical remission at 6 and 12 weeks. Mean PCDAI scores improved from 19.7 ± 7.2 at baseline to 6.4 ± 6.6 at 2 weeks and to 8.6 ± 4.9 at 6 weeks. Mean PCDAI scores for patients who did not receive additional therapy were 8.8 ± 5.2 at 6 weeks and 11.1 ± 7.5 at 12 weeks. All adverse events were mild, excluding a single patient with moderate abdominal pain after FMT. Metagenomic evaluation showed FMT engraftment in seven patients. Patients who did not engraft, or who had microbiome similarity to their donor had no or modest improvement.
Despite limitations, including possible participant bias, the relative effects of pretreatment with Xifaxan (rifaximin, Salix Pharmaceuticals) and polyethylene glycol 3350 and the small sample size, “this study suggests a further link between the fecal microbiota and [Crohn’s disease],” the researchers wrote.
“Further study is still required to find out the true efficacy and potential side effects of FMT for Crohn’s disease,” Suskind said. – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
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