Clinical response in dogs with acute hemorrhagic diarrhea syndrome following randomized probiotic treatment or fecal microbiota transplant

Abstract

Probiotics and fecal microbiota transplants (FMTs) are two microbiome-targeted therapies that have been investigated for use in gastrointestinal diseases associated with dysbiosis. The aim of this study was to compare the effects of an oral multi-strain probiotic and enema-administered FMTs on clinical signs and serum lipopolysaccharide in dogs with acute hemorrhagic diarrhea syndrome (AHDS). A total of 18 client-owned dogs with a diagnosis of AHDS were enrolled in a randomized, blinded study at the time of hospital admission. The dogs were randomized into two groups: the probiotic group received a daily oral probiotic (200 × 10⁹ CFU/10kg q 24 h) for 14 days and a single sham enema; the FMT group received a single FMT via retention enema (10 mL/kg) and placebo oral capsule for 14 days. All dogs received concurrent standard-of-care therapy, including intravenous fluids and anti-emetics; no dogs received antimicrobials. The fecal score, disease severity scores, and serum lipopolysaccharide were measured on days 0, 3, and 14. Fourteen of eighteen enrolled dogs completed the study (n = 9 probiotics; n = 5 FMT). Lipopolysaccharide decreased on days 3 and 14 from baseline and correlated with fecal and disease severity scores. There was no difference in the duration or severity of clinical signs in dogs with AHDS following an enema-administered FMT compared to probiotic treatment. Further evaluation of serum lipopolysaccharide as a marker of disease severity and recovery is warranted.

Keywords: bacterial translocation; endotoxemia; gastrointestinal permeability; hemorrhagic gastroenteritis; microbiome.

Figure 1

Study timeline for 18 dogs with acute hemorrhagic diarrhea syndrome receiving either fecal microbiota transplant (FMT) or probiotic.

Figure 2

Line plot of serial serum lipopolysaccharide (LPS) concentrations in 18 dogs with acute hemorrhagic diarrhea syndrome receiving either fecal microbiota transplant (FMT) or probiotic. Data are expressed as median (range); data points represent individual dog values. Asterisk (*) indicates a significant difference (p < 0.05) when comparing baseline vs. days 3 and 14 and day 3 vs. day 14 in all dogs.

Figure 3

Line plot of serial fecal scores in 18 dogs with acute hemorrhagic diarrhea syndrome receiving either fecal microbiota transplant (FMT) or probiotic. Data are expressed as median (range); data points represent individual dog values. Asterisk (*) indicates a significant difference (p < 0.05) when comparing treatment groups on day 3. The shaded region denotes a normal fecal score, where a score ≥3.5 is considered diarrhea.

Figure 4

Line plot of serial disease severity scores from 18 dogs with acute hemorrhagic diarrhea syndrome receiving either fecal microbiota transplant (FMT) or probiotic. Data are presented as median (range); data points represent individual dog values. Asterisk (*) indicates a significant difference (p < 0.05) when comparing baseline vs. days 3 and 14 and day 3 vs. day 14 in all dogs.