Fecal microbiota transplantation induces remission of infantile allergic colitis through gut microbiota re-establishment

Abstract

Aim: To investigate the impact of fecal microbiota transplantation (FMT) treatment on allergic colitis (AC) and gut microbiota (GM).

Methods: We selected a total of 19 AC infants, who suffered from severe diarrhea/hematochezia, did not relieve completely after routine therapy or cannot adhere to the therapy, and were free from organ congenital malformations and other contraindications for FMT. Qualified donor-derived stools were collected and injected to the AC infants via a rectal tube. Clinical outcomes and follow-up observations were noted. Stools were collected from ten AC infants before and after FMT, and GM composition was assessed for infants and donors using 16S rDNA sequencing analysis.

Results: After FMT treatment, AC symptoms in 17 infants were relieved within 2 d, and no relapse was observed in the next 15 mo. Clinical improvement was also detected in the other two AC infants who were lost to follow-up. During follow-up, one AC infant suffered from mild eczema and recovered shortly after hormone therapy. Based on the 16S rDNA analysis in ten AC infants, most of them (n = 6) had greater GM diversity after FMT. As a result, Proteobacteria decreased (n = 6) and Firmicutes increased (n = 10) in post-FMT AC infants. Moreover, Firmicutes accounted for the greatest proportion of GM in the patients. At the genus level, Bacteroides (n = 6), Escherichia (n = 8), and Lactobacillus (n = 4) were enriched in some AC infants after FMT treatment, but the relative abundances of Clostridium (n = 5), Veillonella (n = 7), Streptococcus (n = 6), and Klebsiella (n = 8) decreased dramatically.

Conclusion: FMT is a safe and effective method for treating pediatric patients with AC and restoring GM balance.

Keywords: Fecal microbiota transplantation; Gut microbiota; Immune reaction; Infantile allergic colitis; Pediatric.

Figure 1

Colonoscopic inspection of four allergic colitis patients prior to fecal microbiota transplantation. Colonoscopic images of patients (AC1, AC3, AC9, and AC10) were obtained prior to FMT. AC: Allergic colitis; FMT: Fecal microbiota transplantation.

Figure 2

Shannon rarefaction curves of gut microbiota from ten allergic colitis infants and their donors. Each image represents one AC infant, and each curve represents one fecal sample from a patient or the corresponding donor. Sample ID has three parts: ‘R’ or ‘D’ indicates AC infants or donors, ’pre’ or ‘post’ represents the stools collected before or after FMT, and fecal collection date. Microbiota diversity in six patients (AC1, AC4, AC5, AC7, AC8, and AC9) increased after FMT treatment. AC: Allergic colitis; FMT: Fecal microbiota transplantation.

Figure 3

Microbiota similarity between allergic colitis infants and their donors. Values in red indicate low microbiota similarity between two samples. Blue represents high microbiota similarity. The microbiota compositions of patients (AC1, AC2, AC4, AC5, AC6, AC7, AC8, and AC10) were more similar to their donors’ composition after FMT treatment. One patient (AC9) had more and then less microbiota similarity and AC3 did not change in this regard. AC: Allergic colitis.