FMT capsules may improve cognition for certain patients with hepatic encephalopathy
Click Here to Manage Email Alerts
LAS VEGAS — Fecal microbiota transplant capsules may improve cognition in patients with hepatic encephalopathy; however, results may vary by donor and recipient factors, according to a presentation at the ACG Annual Scientific Meeting.
“FMT is likely safe with rigorous screening protocol, though some patient subgroups with very advanced cirrhosis and decompensated disease potentially warrant exclusion of this treatment,” Patricia P. Bloom, MD, transplant hepatologist from the University of Michigan, said during the presentation. “It is possible reversing rifaximin (Xifaxan, Salix Pharmaceuticals) resistance is another mechanism by which FMT is effective in this condition.”
Bloom and colleagues performed an open-label study of 10 patients with hepatic encephalopathy on lactulose and rifaximin therapy who completed administration of FMT capsules. Patients were followed for 6 months. Patients were administered the capsules five times over 3 weeks. There were five healthy donors, and each provided FMT to one to three patents. A change in psychometric hepatic encephalopathy score (PHES) and serious events served as the primary outcomes. Shallow shotgun metagenomic sequencing was performed in serial stool samples.
Results showed that after FMT, the MELD score did not change (14 vs. 14; P = .51). There were 13 minor adverse events reports. In addition, there were three serious adverse events reported, of which two were unrelated to FMT. Bloom said after three doses, the PHES improved (+2.1; P < .05), and after five doses of FMT (+2.9; P = .007). In addition, PHES improved 4 weeks after the fifth dose of FMT (+3.1; P = .02).
“Interestingly, we found that two FMT responders lost the rifaximin resistance gene after getting FMT,” she said. “Perhaps making them more susceptible to their standard of care rifaximin treatment.”
The mean change in PHES varied from –1 to +6 by donor. Random forest analysis was used to identify two taxa and linear regression was used to predict PHES: Bifidobacterium adolescentis (adjusted R2 = 0.27) and B. angulatum (adjusted R2 = 0.25). They are both short-chain fatty acid (SCFA) producers.
Bloom said higher levels of Bifidobacterium and other known beneficial taxa were observed in patients who responded FMT at baselines and throughout the study. The lowest fecal SCFA levels were observed in the FMT donor with the poorest cognitive outcomes in recipients.
Venous ammonia did not change after five doses of FMT vs. baseline (73 µmol/L vs. 75 µmol/L; P = .73). In addition, serum tumor necrosis factor-alpha (P = .09), interleukin-6 (P = .55) or interferon gamma (P = .3) did not change.
Collapse
Bloom PP, et al. Abstract: S1062. Presented at: ACG Annual Scientific Meeting; Oct. 22-27, 2021; Las Vegas (hybrid meeting).
Read more about
Click Here to Manage Email Alerts