FMT Dynamics of Gut Microbiota after Fecal Microbiota Transplantation in Ulcerative Colitis: Success Linked to Control of Prevotellaceae (Sep 2024, n=24) "Nine patients (38%) reached remission at week 14. The donor with the least engraftment was the most successful"

[Michael Harrop]

https://academic.oup.com/ecco-jcc/advance-article/doi/10.1093/ecco-jcc/jjae137/7748263

Abstract​

Background
Fecal microbiota transplantation (FMT) is an experimental treatment for ulcerative colitis (UC). We aimed to study microbial families associated with FMT treatment success

Methods
We analyzed stools from 24 UC patients treated with four FMTs weekly after randomization for pretreatment during three weeks with budesonide (n = 12) or placebo (n = 12). Stool samples were collected nine times pre-, during, and post FMT. Clinical and endoscopic response was assessed 14 weeks after initiation of the study using the full Mayo score. Early withdrawal due to worsening of UC symptoms was classified as non-response.

Results
Nine patients (38%) reached remission at week 14, and 15 patients had a partial response or non-response at or before week 14. With a Dirichlet Multinomial Mixture model we identified five distinct clusters based on the microbiota composition of 180 longitudinally collected patient samples and 27 donor samples. A Prevotellaceae-dominant cluster was associated with poor response to FMT treatment. Conversely, the families Ruminococcaceae and Lachnospiraceae were associated with a successful clinical response. These associations were already visible at the start of the treatment for a subgroup of patients and were retained in repeated measures analyses of family-specific abundance over time. Responders were also characterized by a significantly lower Simpson dominance compared to non-responders.

Conclusions
The success of FMT treatment of UC patients appears to be associated with specific gut microbiota families, such as control of Prevotellaceae. Monitoring the dynamics of these microbial families could potentially be used to inform treatment success early during FMT.

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• 0 results for "adverse" (events). So it doesn't appear that they were tracked and reported at all. They were tracked & reported in the previous sister study.
• "Withdraw" and "worse" are only mentioned once, in the abstract.

The effects of pretreatment, donor, and age were negligible and therefore not included in the model.

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Patients received a weekly FMT for four times (at end of week 3, 4, 5, and 6) from the Netherlands Donor Feces Bank (NDFB), either from donor D07 or donor D08 following standard protocols for donor screening, sample collection, sample preparation, sample storage and FMT infusion.

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that donor D08 was the more successful donor; however, intriguingly, this was the donor with the least engraftment. This observation suggests that the persistent transfer of microbes may not be the prime reason for clinical success.

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It appears to be a follow-up to this study:
Fecal Microbiota Transplantation engraftment after budesonide or placebo in patients with active ulcerative colitis using pre-selected donors: a randomized pilot study (Apr 2024, n=24) "clinical response appeared donor-dependent"