Pectin enhances the effect of fecal microbiota transplantation in ulcerative colitis by delaying the loss of diversity of gut flora

Abstract

Background: Fecal microbiota transplantation (FMT) induces remission in ulcerative colitis (UC). However, the treatment effect of FMT diminishes over time. Maintaining the diversity of the gut flora for long periods may improve the effects of FMT in UC. Pectin, which can be fermented by gut microbiota into short-chain fatty acids, is postulated to shape the composition and maintain the balance of gut microbiota following transplantation. This study investigated whether pectin could enhance the effects of FMT in UC patients.

Results: Three FMT patients and four FMTP patients achieved the primary outcome. The Mayo scores of the FMTP group were lower than those of the FMT group at weeks 4 and 12 (P = 0.042 and P = 0.042, respectively). There were no differences in the diversity of the gut flora between the two groups at weeks 4 and 12; however, the composition of the gut flora of the FMTP group was more similar than the FMT group to that of the donor at all-time points post-treatment.

Conclusions: Pectin decreased the Mayo score by preserving the diversity of the gut flora following FMT for UC.

Trial registration: Current Controlled Trial NCT02016469 . Registered 10 November 2013.

Keywords: Diversity; Fecal microbiota transplantation; Mayo score; Pectin; Ulcerative colitis.

Fig. 1

Changes in clinical indicators over time for the FMT and FMTP groups. a-d Erythrocyte sedimentation rate, C-reactive protein levels, Inflammatory Bowel Disease Questionnaire score, and fecal calprotectin levels for the two groups prior to treatment and at weeks 4 and 12 post-treatment. e Mayo scores at weeks 4 and week 12 post-treatment. f Comparison of community diversity in the two groups

Fig. 2

Fecal flora composition of the FMT and FMTP groups after transplantation. a and b Fecal flora composition at the genus level for the two groups 4 weeks post-transplantation. c and d Fecal flora composition at the genus level of the two groups 12 weeks post-transplantation

Fig. 3

More samples closer to the donor in group FMTP than in group FMT after treatment in the PCA picture showing FMTP is more effective in maintaining the diversity of the flora

Fig. 4

Pearson correlation coefficient (r) between OTU values of each sample and the donor were calculated and compared to make out whether post-treatment r of the sample and donor were greater than pre-treatment. 55.56 % of the post-treatment samples had larger r with the donor than untreated samples in FMTP group (a) but only 46.67 % in FMT group (b)