Fecal transplantation for ulcerative colitis: current evidence and future applications

ABSTRACT

Introduction: Established evidence suggests that gut microbiota plays a role in ulcerative colitis (UC). Fecal microbiota transplantation (FMT) is clearly recognized as a highly effective treatment for patients with recurrent Clostridium difficile infection and has been investigated also in patients with UC, with promising results.

Areas covered: Literature review was performed to select publications concerning current evidence on the role of gut microbiota in the pathogenesis of UC, and on the effectiveness of FMT in this disorder.

Expert opinion: The randomized controlled trials published investigating the use of FMT suggested a potential role for FMT in the treatment of mild to moderate UC. However, given several unanswered questions regarding donor selection, dose, route of administration and duration of therapy, this is not yet recommended as a viable therapy option. FMT has allowed for more in depth investigation with regards to the role the gut microbiota may be playing in UC. This knowledge is critical to identifying where FMT may appropriately fit in the UC treatment paradigm. As our understanding of the role the microbiome plays in this chronic disease, FMT, and then eventually defined microbes, will hopefully serve in a complementary role to conventional IBD therapies.

KEYWORDS:

• Ulcerative colitis
• inflammatory bowel disease
• fecal microbiota transplantation
• gut microbiota

Article Highlights

• A growing body of clinical and experimental data indicates the commensal microbiota as a key player in the inflammatory processes that sustain human and experimental UC.

• During intestinal chronic inflammation, the same cytokine can exert both classic pro-inflammatory properties, as well as protective, anti-inflammatory roles, which is primarily determined by the presence of receptor-bearing cells during the host’s disease state and by gut microbiota modulation. Based on this new rationale, innovative pathogenic theories can be formulated with crucial translational implications in regard to the treatment of UC.

• In this scenario, FMT has been investigated also in patients with mild to moderate UC, with promising results. However, variable study designs have made these studies difficult to compare.

• There is currently no consensus regarding where FMT will likely fit in the UC treatment paradigm and as such, recent consensus documents recommend that FMT should only be performed for UC in the context of a clinical trial.

• The continued desire for microbiome-based therapeutics for UC patients has led to ongoing research and progress towards more personalized medicine. FMT, and eventually the infusion of defined microbes, will hopefully serve in a complementary role to conventional UC therapies.

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Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.