Reconstitution of the gut microbiota of antibiotic-treated patients by autologous fecal microbiota transplant

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Science Translational Medicine  26 Sep 2018:
Vol. 10, Issue 460, eaap9489
DOI: 10.1126/scitranslmed.aap9489

Transplant x 2

Patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) receive antibiotics to prevent and treat bacterial infections. Antibiotics, however, also damage the intestinal microbiota by killing beneficial commensal bacteria that inhibit pathogens and promote immune defenses. Loss of gut microbiota diversity increases the risk of adverse outcomes, including infections and graft-versus-host disease. Taur and colleagues conducted a randomized clinical trial to demonstrate the effectiveness of collecting and freezing feces before allo-HSCT, followed by fecal thawing and autologous fecal microbiota transplantation (auto-FMT) after stem cell engraftment. The authors show that auto-FMT reconstitutes major commensal bacterial populations, thereby reestablishing the patient’s gut microbiota diversity and composition.


Antibiotic treatment can deplete the commensal bacteria of a patient’s gut microbiota and, paradoxically, increase their risk of subsequent infections. In allogeneic hematopoietic stem cell transplantation (allo-HSCT), antibiotic administration is essential for optimal clinical outcomes but significantly disrupts intestinal microbiota diversity, leading to loss of many beneficial microbes. Although gut microbiota diversity loss during allo-HSCT is associated with increased mortality, approaches to reestablish depleted commensal bacteria have yet to be developed. We have initiated a randomized, controlled clinical trial of autologous fecal microbiota transplantation (auto-FMT) versus no intervention and have analyzed the intestinal microbiota profiles of 25 allo-HSCT patients (14 who received auto-FMT treatment and 11 control patients who did not). Changes in gut microbiota diversity and composition revealed that the auto-FMT intervention boosted microbial diversity and reestablished the intestinal microbiota composition that the patient had before antibiotic treatment and allo-HSCT. These results demonstrate the potential for fecal sample banking and posttreatment remediation of a patient’s gut microbiota after microbiota-depleting antibiotic treatment during allo-HSCT.

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