Therapy Used to Promote Disease Remission Targeting Gut Dysbiosis, in UC Patients with Active Disease

Abstract

Ulcerative colitis (UC) is a relapsing non-transmural chronic inflammatory disease of the colon characterized by bloody diarrhea. The etiology of UC is unknown. The goal is to reduce the inflammation and induce disease remission in UC patients with active disease. The aim of this study is to investigate the innovative treatment method used to promote disease remission in UC patients with active disease targeting gut dysbiosis. Immunosuppressants such as TNF-α blocker are used to promote disease remission in UC, but it is expensive and with side effects. Probiotic, prebiotic and diet are shown to be effective in maintaining disease remission. Fecal microbiota transplantation (FMT) might be the future therapy option to promote disease remission in UC patients with active disease. However, correct manufacturing and administration of the FMT are essential to achieve successful outcome. A few cohorts with FMT capsules show promising results in UC patients with active disease. However, randomized controlled clinical trials with long-term treatment and follow-up periods are necessary to show FMT capsules' efficacy to promote disease remission in UC patients.

Keywords: E. coli Nissle 1917; TNF-α blocker; VSL #3; fecal microbiota transplantation; immunosuppressant; prebiotic; probiotic; ulcerative colitis.

Figure 1

The first column shows the bowel transit time in patients with Inflammatory Bowel Disease (IBD)/UC in comparison with healthy people. As shown, the transit time is delayed by 30% in IBD patients. The second column shows luminal PH in IBD patients in comparison to healthy people. As shown, the PH is raised in duodenum/jejunum and significantly decreased in the colon of IBD patients in comparison to healthy people. The third column shows gastrointestinal microbiome in a healthy person in comparison to IBD patients. Increased prevalence of E. coli is seen in the small intestine and absent in colon in comparison to the healthy person. Absence of Lactobacillus, Bifidobacteria, Firmicutes, Clostridiates and Actinobacteria is also shown in the IBD patients. The fourth column shows suggested guidelines for FMT administration to achieve successful FMT therapy.