A case report of improvement on ADHD symptoms after fecal microbiota transplantation with gut microbiome profiling pre- and post-procedure

Abstract

Background

Recent studies demonstrate the association of the gut microbiome in regulating interactions between the central nervous system and intestinal function. Individuals with attention-deficit hyperactivity disorder (ADHD) have been shown to have unique gut microbial signature, with depletion of beneficial commensal microbes. Fecal microbiota transplant (FMT) restores the imbalanced gut microbiome and may replete missing microbes to increase production of hormones and neurotransmitters regulating human behavior and cognition.

Research design & methods

Here, we present an interesting case of a 22-year-old woman treated with FMT primarily to treat recurrent Clostridioides difficile infection, which coincidentally alleviated her ADHD symptoms. We also present the pre- and post-FMT gut microbiota profiles conducted using shotgun metagenomic sequencing on the patient’s fecal samples to thereby highlight potential microbial-associated mechanisms associated with the relief of ADHD symptoms.

Results & conclusions

Our case report provides preliminary evidence regarding the use of FMT in a patient with C. difficile and ADHD. We speculate that gut microbiome modulation, in particular the gain or loss of specific microbial species and pathways involving the metabolism of SCFAs, tryptophan and GABA, may merit further exploration as a potential therapeutic strategy for ADHD.

Keywords:

• Fecal microbiota transplant
• hormones
• neurotransmitters
• gut microbiota profile
• shotgun metagenomic sequencing

Transparency

Declaration of funding

This study is supported by AMILI Pte. Ltd., Singapore.

Declaration of financial/other relationships

SLH, KYT and HS are employees of AMILI Pte. Ltd. and JWJL is one of the co-founders of AMILI Pte. Ltd. JD and RKMW declares no conflict of interest. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

JWJL: conception and organization of the research project. KYT, HS and RKMW: execution of the research project. SLH, JD and JWJL: analysis and interpretation. SLH: writing of the first draft of the manuscript. JD, JWJL, KYT and RKMW: review and critique of the manuscript. All authors: contributed to the article and approved the submitted version.

Acknowledgements

Authors would like to acknowledge Dr. Chong Chun Wie for his guidance in data analysis, and Dr. Nelson Lee for his clinical input and scoring.