Category: Gastrointestinal

Faecal Transplants Safe in the Long Term for C. Diff Treatment

A new study from the Mayo Clinic has provided more evidence for the safety and efficacy of faecal microbiota transplantation (FMT) in treating Clostridioides difficile infection (CDI).

Recruiting 609 patients diagnosed with CDI, 20% of whom were overweight or obese and 22.8% had inflammatory bowel disease (IBD), FMT was performed with a stool product from a common donor. At a short term follow-up, >60% of patients had diarrhoea, <33% had constipation, and 9.5% reported additional CDI episodes after one year. At long-term follow up (median 3.7 years), there 73 new diagnoses out of 477 patients, 13% had gastrointestinal problems, 10% had weight gain, and 11.8% had new unrelated infections.

However, this was marked by the appearance of additional medical conditions such as weight gain and irritable bowel syndrome, which the authors indicated should be investigated further. The study also did not use a standardised questionnaire for IBS, making those results harder to generalise, and there was no control group. However, administering questionnaires over an extended period to all participants instead of only a brief period shortly after FMT explains why there are fewer symptoms reported compared to other studies.  

A separate study with 207 patients receiving FMT showed 143 new diagnoses after the procedure, with a mean follow-up of 34 months. The researchers conducting this second study attribute the ability of FMT to reduce CDI to enhancements in CD4+ T cell and antibody-mediated immunity to C. difficile toxins such as TcdB.

“These results are important for the design of disease monitoring strategies and highlight that future study of how FMT influences pathogen specific immunity is warranted: specifically, determining if effectively restoring the TcdB specific cellular repertoire to healthy control proportions contributes to treatment success of FMT,” the researchers wrote.

These studies add to the growing body of evidence that show FMT combined with antibiotics is an effective way to treat CDI.

Source: MedPage Today

Journal information (first source): Saha S, et al. Long-term safety of fecal microbiota transplantation for recurrent Clostridioides difficile infection, Gastroenterol 2021; DOI: 10.1053/j.gastro.2021.01.010. 

Journal information (second source): Cook L, et al. Fecal microbiota transplant treatment for recurrent Clostridioides difficile infection enhances adaptive immunity to TcdB, Gastroenterol 2021; DOI: 10.1101/2020.06.05.20114876.

Gut Immune Cells Protect The Brain in MS Flare-ups

Scientists from the University of California, San Francisco, have observed gut immune cells moving up out of the gastrointestinal tract to the brain during multiple sclerosis (MS) flareups, where they seem to exert some protective effects.

In MS, other immune cells attack the myelin sheath, resulting in flare-ups, where they experience memory problems, vision loss, pain and other problems. These flare-ups subside after some days, but it is not known why the disease switches back and forth between flare-up and remission.

The new research revealed that the flare-ups were brought under control with the unlikely assistance of gut immune cells, which produce Immunoglobulin-A (IgA) and act as the immune system’s first line of defence in the GI tract. Some of these cells actually leave the gut and migrate to the brain, where it appears they reduce inflammation.

“It was a very new idea,” said lead author, Sergio Baranzini, PhD, neurology professor at the UCSF Weill Institute for Neurosciences, . “Nobody thought to look for this type of immune cell.”

The gut immune cells were found only in cerebrospinal fluid of MS sufferers when they experienced a flare-up, and not in remission. Recent research indicated that an unhealthy GI microbiome was involved in MS, and the researchers determined that these immune cells only attacked potentially damaging bacteria, not the myelin sheath.

It is anticipated that this discovery may bring insights into new therapies to treat the disease. 

Source: Medical Xpress

Gut Microbiome is Linked to Pulmonary Disease

A link has been shown between the gut microbiome and chronic obstructive pulmonary disease (COPD), a lung disease with an often poor prognosis.

Senior author Prof Phil Hansbro, Director of the Centenary University of Technology Sydney Centre for Inflammation, said, “It’s already known that the lung microbiome is a contributing factor in COPD. We wanted to see if the gut environment was also somehow involved–to determine whether the gut could act as a reliable indicator of COPD or if it was connected in some way to the development of the disease.”

Stool samples of COPD patients showed elevated levels of the bacteria Streptococcus and Lachnospiraceae. Additionally a unique metabolite signature was identified in individuals with COPD, created by the chemical by-products of the metabolic process.

First author Dr Kate Bowerman from the University of Queensland said, “Our research indicates that the gut of COPD patients is notably different from healthy individuals. This suggests that stool sampling and analysis could be used to non-invasively diagnose and monitor for COPD,” she said.
“The ‘gut-lung axis’ describes the common immune system of the lung and gastrointestinal tract. This means that activity in the gut can impact activity in the lung. Our COPD findings suggest that the gut microbiome should now also be considered when looking for new therapeutic targets to help treat lung disease,” Prof Hansbro said.

Source: Medical Xpress