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Healthy changes to microbiome persist after FMT for C. difficile infection
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Patients who underwent fecal microbiota transplantation for Clostridium difficile infection had healthy, dynamic short- and long-term changes to their microbiome, according to recent study data.
“Our study shows that there are both short- and long-term changes in the fecal microbiome following transplantation,” Michael J. Sadowsky, PhD, of the University of Minnesota, said in a press release. “The diversity and types of microbes present fall into a cloud of possibilities represented by those of ‘normal fecal microbiota.’ While we have many similarities in fecal microbiota among humans, in general, there are individual differences that make us all unique, but do not affect apparent gut functioning.”
Sadowsky and colleagues aimed to elucidate the stability of fecal microbiota after FMT by evaluating the microbial composition of stool samples from four patients with antibiotic-refractory recurrent C. difficile infection before and after FMT, which they all received from a single donor. They collected samples from these patients before and up to 151 days after FMT, every day through the first month and every week thereafter through the third month. Composition was analyzed using 16S rRNA gene sequencing, and the researchers then compared pre- and post-FMT composition of the four patients, as well as the pre-FMT composition of 10 additional patients, with 252 healthy controls from the Human Microbiome Project. They also compared temporal changes in recipients with changes in the donor samples.
The investigators found that rapid normalization of composition occurred after FMT, and the composition appeared most similar to the donor 1 day after the procedure. Afterward, however, the composition of both the donor and recipient microbiota diverged variably, but both remained healthy throughout the study period.
“The fecal microbiota of patients with [refractory C. difficile] continues to undergo change after FMT is performed, though these changes appear to fall within the range of normal variation of healthy individuals over time,” the researchers concluded. “Dynamic behavior is an intrinsic property of normal fecal microbiota and should be accounted for in comparing microbial communities among normal individuals and those with disease states,”
According to the press release, the researchers also said their findings may have regulatory implications for FMT because the FDA has “determined that fecal microbiota constitutes a ‘drug,’ and has stated that compositional certainty is going to be important. The dynamic nature of fecal microbiota seen in both the donor and the recipients suggests that this framework of regulation may not be applicable for [FMT].” – by Adam Leitenberger
Disclosure: Sadowsky and colleagues report they hold a patent related to the study.
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