Fecal microbiota transplantation influences microbiota without connection to symptom relief in irritable bowel syndrome patients (Aug 2024, n=49) FMT 

Fecal Microbiota Transplants

Michael Harrop

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https://www.nature.com/articles/s41522-024-00549-x

They essentially took a low-quality donor, measured that the donors microbes colonized the recipient, but didn't improve symptoms. This shouldn't be surprising.

Abstract​

Imbalanced microbiota may contribute to the pathophysiology of irritable bowel syndrome (IBS), thus fecal microbiota transplantation (FMT) has been suggested as a potential treatment. Previous studies on the relationship between clinical improvement and microbiota after FMT have been inconclusive.

In this study, we used 16S rRNA gene amplicon and shotgun metagenomics data from a randomized, placebo controlled FMT trial on 49 IBS patients to analyze changes after FMT in microbiota composition and its functional potential, and to identify connections between microbiota and patients’ clinical outcome.

As a result, we found that the successful modulation of microbiota composition and functional profiles by FMT from a healthy donor was not associated with the resolution of symptoms in IBS patients. Notably, a donor derived strain of Prevotella copri dominated the microbiota in those patients in the FMT group who had a low relative abundance of P. copri pre-FMT. The results highlight the multifactorial nature of IBS and the role of recipient’s microbiota in the colonization of donor’s strains.

Interestingly, we found that at 12-week time point, patients who responded to the treatment were less similar to the donor as compared to the patients who did not respond

These results suggest that it matters which donor strains colonize the recipient and also how they function in the recipient’s ecosystem.
A healthy universal donor was a young male who underwent medical evaluation and laboratory tests for screening

While the donor of our trial was healthy and chosen based on the recommended criteria (EU consensus), we did not use any additional selection criteria such as the birth mode.

Regardless, our donor fulfilled six out of 11 criteria defining the “super-donor”.

Hilarious. They're using El-Salhy's criteria to define super-donor.

0 results for "adverse events". It doesn't appear that they tracked them at all.

What a joke.

And it's published in Nature, which is one of the most prestigious science journals. So this is what the research system considers to be "the best of the best". That makes this good evidence to support my statements/critiques here: https://forum.humanmicrobiome.info/threads/the-fda-and-fmt-regulation-part-2-jul-2024-humanmicrobes-org-i-met-wit.520/post-1370
 
Format correct?
  1. Yes
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Just skimmed it but a few takeaways
  • The fact that they emphasized multiple times that their donor was chosen without regard to birth method means to me he was likely a C-section. Annoying that they gave very limited information about the donor too. I didn't even see age listed, just "young". Nothing about diet, lifestyle or BMI.
  • The conclusion seemed kind of like they were playing dumb with "oh all these studies on FMT for IBS found different results and we don't know why" when it couldn't be more obvious donor quality plays a role. They seem to downplay this a bit by suggesting matching as a possibly good alternative which is frustrating, probably because they want that to be true, because finding high donor quality is hard.
  • I also didn't see any consideration of upper-route or multiple FMTs possibly having a more beneficial effect, even with this non-ideal donor.
  • They mention specifically that high Bacteroidetes and low Rumminococcus are indicators of IBS but don't hypothesize that changing these abundances in the microbiome could resolve IBS... They focus way too much on Prevotella changing just because it's a significant result even though it was obvious from the outset changing Prevotella probably wouldn't do much for IBS symptoms
  • I haven't read many of these studies yet but if researchers do bowel lavage prior to every single FMT dose (if they are planning to do multiple) that's a huge limitation because they are wiping out the donor microbes that they literally just put in there which negates the power of multiple doses.

Hilarious. They're using El-Salhy's criteria to define super-donor.
Would you consider El-Salhy's donor in the May 2020 study a highly-effective donor as opposed to super-donor?
 
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Would you consider El-Salhy's donor in the May 2020 study a highly-effective donor as opposed to super-donor?
I don't have permission to say anything specific. Here's a relevant quote:

I'm growing more skeptical of published results. I think they're not properly tracking & reporting bad outcomes. They are likely brushing many detrimental side effects off as "unrelated" when they're not. And the quality of donors they're using doesn't match their reported outcomes.

Since we pay so much more than anyone else, virtually every donor that’s been covered in the news has applied to HM. Donors from all major clinics, stool banks, companies, and clinical trials. The vast majority do not qualify or rank high. And some who have been declared “super-donors” have had conditions themselves that are likely to be cured or transferred via FMT. That this quality of donor is the "best of the best" currently being used should be very alarming, as well as extremely depressing for those of us whose only/main hope is FMT.

https://www.humanmicrobes.org/blog/fda-fmt-regulation
 
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