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FMT restores microbial diversity post-antibiotics in patients with cirrhosis
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Fecal microbial transplant restored antibiotic-associated disruption in microbial diversity and function among a cohort of patients with advanced cirrhosis treated with Xifaxan and lactulose, according to a study published in Hepatology.
“Patients with cirrhosis are often exposed to multiple courses of antibiotics during their course of repeated hospitalizations,” Jasmohan S. Bajaj, MD, from the Virginia Commonwealth University, and colleagues wrote. This can lead to specific changes in microbial diversity, composition, and functionality that could have adverse effects on the host. These changes are ... largely reversed by one dose of rectal FMT.”
The FDA-monitored phase 1 safety trial included patients with decompensated cirrhosis and hepatic encephalopathy who were undergoing therapy with Xifaxan (rifaximin, Salix Pharmaceuticals) and lactulose. The researchers randomly assigned 10 patients to receive FMT and 10 patients to undergo standard of care therapy for 6 months.
Patients in the FMT group received one dose from a donor who was “particularly enriched” in Lachnospiraceae and Ruminococcaceae “because these were the taxa lowest in the [hepatic encephalopathy] patients compared to controls,” according to Bajaj and colleagues. FMT was safe and well tolerated in the treatment group.
After antibiotic therapy, patients demonstrated a collapse in the Lachnospiraceae and Ruminococcaceae families and a significant reduction in fecal bile acid levels (BAs) and fecal short chain fatty acids (SCFA). These changes were restored to pre-antibiotic baseline levels in the FMT groups, whereas the standard of care group demonstrated no changes at follow-up.
“Our study extends prior trials in individuals who do not have cirrhosis with respect to SCFA-producing taxa and secondary BAs after FMT, into the cirrhosis realm,” Bajaj and colleagues wrote. “Therefore, the ability of one dose of FMT to restore the metabolic capability to secrete SCFAs and modulate BA profiles is important to rebuild resilience in the gut microbiota, even in this population with a skewed dysbiotic baseline.” – by Talitha Bennett
Disclosure: Bajaj reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.