FMT Fecal microbiota transplantation significantly improved respiratory failure of amyotrophic lateral sclerosis (ALS, May 2024, n=2)

Fecal Microbiota Transplants

Michael Harrop

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https://www.tandfonline.com/doi/full/10.1080/19490976.2024.2353396

ABSTRACT​

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that leads to respiratory failure, and eventually death. However, there is a lack of effective treatments for ALS.

Here we report the results of fecal microbiota transplantation (FMT) in two patients with late-onset classic ALS with a Japan ALS severity classification of grade 5 who required tracheostomy and mechanical ventilation. In both patients, significant improvements in respiratory function were observed following two rounds of FMT, leading to weaning off mechanical ventilation. Their muscle strength improved, allowing for assisted standing and mobility.

Other notable treatment responses included improved swallowing function and reduced muscle fasciculations. Metagenomic and metabolomic analysis revealed an increase in beneficial Bacteroides species (Bacteroides stercoris, Bacteroides uniformis, Bacteroides vulgatus), and Faecalibacterium prausnitzii after FMT, as well as elevated levels of metabolites involved in arginine biosynthesis and decreased levels of metabolites involved in branched-chain amino acid biosynthesis.

These findings offer a potential rescue therapy for ALS with respiratory failure and provide new insights into ALS in general.

Donor selection criteria were based on our previous protocol, and both patients received FMT from the same qualified donor, a 28-year-old woman.

Both patients received two rounds of FMT.

Before FMT, patients underwent intestinal preparation with sodium phosphate oral solution. The FMT procedure was performed at the bedside after a routine colonoscopy.
 
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