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FMT improved cognitive function in hepatic encephalopathy
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AMSTERDAM — A cohort of 10 men with hepatic encephalopathy experienced improvement in several outcomes, including cognitive function, after fecal microbiota transplantation from the same donor, according to data presented at the International Liver Congress.
“FMT from a rationally selected donor was safe, associated with lower hospitalizations, especially related to recurrent HE and improved cognitive tests among cirrhotic patients with recurrent HE,” Jasmohan S. Bajaj, MD, associate professor in the department of internal medicine and the division of gastroenterology at Virginia Commonwealth University in Richmond said. “Hepatic encephalopathy is the most elegant model of the gut, liver, and brain axis.”
The researchers aimed to define the safety profile of FMT on liver and cognitive function in a cohort of 20 patients. Ten patients were treated with the standard of care pharmacotherapies, and 10 were treated with FMT. Patients in the FMT group were given an aggressive regimen of antibiotics prior to the procedure.
“The antibiotics we gave them completely devastated the gut microbiota,” Bajaj said. “What FMT was able to do was restore all that havoc that was created by the antibiotics. We wanted to know if that destruction could be quenched by FMT. It was not only quenched, but resulted in something better.”
Results showed 11 hospital admissions in the standard therapy group and two admissions in the FMT group. Eight patients in the standard therapy group were admitted, compared with two in the FMT group. Six hepatic encephalopathy-related admissions occurred with the standard of care; there were none in the FMT arm.
“Eighty percent of the standard of care group were hospitalized, which is what you’d expect in this very sick population,” Bajaj said. “They were destined to be a burden on the health care system, their families and themselves.”
Bajaj said that hepatic encephalopathy is associated with ongoing recurrence despite the use of standard of care therapies: lactulose and rifaximin.
“The natural history of this disease is recurrence, recurrence and recurrence. ... These patients are often exposed to antibiotics and then antibiotic-resistant infections occur,” Bajaj said. “It’s a vicious circle that we hope to break with FMT.”
Infections and variceal bleeding were some of the complications that occurred with the standard regimen and an initial concern of FMT was the possibility of infection.
“What we were really worried about were the infections,” Bajaj said. “The only infections were found in the standard of care group.”
Cognitive function improved with FMT, as demonstrated by the Stroop app previously presented by Bajaj as a tool of measurement.
Bajaj reported that all of the FMT treatments came from a single donor screened by OpenBiome for all the microbiota missing from the HE patients. “This is a precision medicine approach,” he said.
He further concluded that the procedure should be studied in women, in those without pre-FMT antibiotics and patients with higher MELD scores. – by Rob Volansky
Reference:
Bajaj JS, et al. Abstract PS-085. Presented at: International Liver Congress; April 19-24, 2017; Amsterdam.
Disclosure: Bajaj reports no relevant financial relationships.