Step-up fecal microbiota transplantation strategy: a pilot study for steroid-dependent ulcerative colitis.
Step-up fecal microbiota transplantation strategy: a pilot study for steroid-dependent ulcerative colitis.
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DOI：
10.1186/s12967-015-0646-2
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发表时间：
2015-09-12
影响因子：
7.4
通讯作者：
Zhang F
中科院分区：
文献类型：
--
作者：
Cui B;Li P;Xu L;Zhao Y;Wang H;Peng Z;Xu H;Xiang J;He Z;Zhang T;Nie Y;Wu K;Fan D;Ji G;Zhang F
如果单次粪便微生物群移植（FMT）未能诱导缓解，那么对于难治性溃疡性结肠炎（UC）使用FMT的策略仍不明确。本研究旨在评估一种设计的升级FMT策略对类固醇依赖性UC的疗效和安全性。
15名类固醇依赖性UC患者入选，并采用升级FMT策略进行治疗。收集了至少3个月的随访临床数据。通过16S rRNA测序分析患者和相关供体在FMT前后的粪便微生物群组成。
14名患者中有8名（57.1%）在升级FMT后临床症状改善，并能够停用类固醇。1名患者失访。在有反应的8名患者中，5名（35.7%）接受了1次FMT治疗，1名（7.1%）接受了2次FMT，2名（14.2%）接受了2次FMT以及一个预定疗程的类固醇治疗。8名有反应的患者中有4名（28.6%）在随访期间（3 - 18个月）维持长期缓解。6名患者（42.9%）未达到临床改善标准，仍依赖类固醇，尽管其中3名有短暂或部分改善。微生物群分析显示FMT极大地改变了其组成，并且在治疗成功的患者中出现了与供体高度相似的微生物群组成。在治疗和随访期间未发生严重不良事件。
升级FMT策略作为类固醇依赖性UC患者的一种治疗策略显示出前景，可能是因为成功地重构了肠道微生物组成。
试验注册：ClinicalTrials.gov，编号NCT01790061
本文的在线版本（doi:10.1186/s12967 - 015 - 0646 - 2）包含补充材料，授权用户可获取。
The strategy of using fecal microbiota transplantation (FMT) for refractory ulcerative colitis (UC) remains unclear if single FMT failed to induce remission. This study aimed to evaluate the efficacy and safety of a designed step-up FMT strategy for the steroid-dependent UC. Fifteen patients with steroid-dependent UC were enrolled, and treated with step-up FMT strategy. Follow-up clinical data was collected for a minimum of 3 months. Fecal microbiota composition before and post FMT of patients and related donors were analyzed by 16S rRNA sequencing. Eight of fourteen (57.1 %) patients achieved clinical improvement and were able to discontinue steroids following step-up FMT. One patient was lost to follow-up. Among the 8 patients who responded, five (35.7 %) received one FMT therapy, one (7.1 %) received two FMTs, and two (14.2 %) received two FMTs plus a scheduled course of steroids. Four (28.6 %) of the 8 patients who responded maintained long-term remission during follow-up (3–18 months). Six patients (42.9 %) failed to meet the criteria of clinical improvement and maintained steroid dependence, though three experienced transient or partial improvement. Microbiota analysis showed that FMT altered the composition greatly, and a microbiota composition highly similar to that of the donor emerged in the patients with successful treatment. No severe adverse events occurred during treatment and follow-up. Step-up FMT strategy shows promise as a therapeutic strategy for patients with steroid-dependent UC, likely due to the successful restructuring of gut microbial composition. Trial registration: ClinicalTrials.gov, Number NCT01790061 The online version of this article (doi:10.1186/s12967-015-0646-2) contains supplementary material, which is available to authorized users.