Intestinal microecological transplantation for a patient with chronic radiation enteritis: A case report

Abstract

Background: The gut microbiota is strongly associated with radiation-induced gut damage. This study aimed to assess the effectiveness and safety of intestinal microecological transplantation for treating patients with chronic radiation enteritis.

Case summary: A 64-year-old female with cervical cancer developed abdominal pain, diarrhea, and blood in the stool 1 year after radiotherapy. An electronic colonoscopy was performed to diagnose chronic radiation enteritis. Two courses of intestinal microecological transplantation and full-length 16S rRNA microbiological analysis were performed. The patient experienced short- and long-term relief from symptoms without adverse effects. Whole 16S rRNA sequencing revealed significant differences in the intestinal flora's composition between patient and healthy donors. Pathogenic bacteria, such as Escherichia fergusonii and Romboutsia timonensis, were more in the patient. Beneficial bacteria such as Faecalibacterium prausnitzii, Fusicatenibacter saccharivorans, Ruminococcus bromii, and Bifidobacterium longum were more in the healthy donors. Intestinal microbiota transplantation resulted in a significant change in the patient's intestinal flora composition. The composition converged with the donor's flora, with an increase in core beneficial intestinal bacteria, such as Eubacterium rectale, and a decrease in pathogenic bacteria. Changes in the intestinal flora corresponded with the patients' alleviating clinical symptoms.

Conclusion: Intestinal microecological transplantation is an effective treatment for relieving the clinical symptoms of chronic radiation enteritis by altering the composition of the intestinal flora. This study provides a new approach for treating patients with chronic radiation enteritis.

Keywords: Cancer; Case report; Chronic radiation enteritis; Gut microbial transplantation; Intestinal microecology; Quality of life.

Figure 1

Patient's electron colonoscopy.

Figure 2

α-diversity Chao index. Fecal microbiota transplantation (FMT)_0: Before gut microbiota transplantation; FMT_1: During course 1 of gut microbiota transplantation; FMT_2: During course 2 of gut microbiota transplantation. ASV: Amplicon sequence variant; FMT: Fecal microbiota transplantation.

Figure 3

β-diversity principal coordinate analysis analysis. Fecal microbiota transplantation (FMT)_0: Before gut microbiota transplantation; FMT_1: During course 1 of gut microbiota transplantation; FMT_2: During course 2 of gut microbiota transplantation. PCoA: Principal coordinate analysis; ASV: Amplicon sequence variant; FMT: Fecal microbiota transplantation.

Figure 4

Sequences were classified at the phylum level. Fecal microbiota transplantation (FMT)_0: Before gut microbiota transplantation; FMT_1: During course 1 of gut microbiota transplantation; FMT_2: During course 2 of gut microbiota transplantation. FMT: Fecal microbiota transplantation.

Figure 5

Differential bacteria at the species level. A: Fecal microbiota transplantation (FMT)_0 vs donor variability analysis of bacterial flora - species level. FMT_0: Before gut microbiota transplantation; B: FMT_0 vs FMT_1_1 colony variability analysis at the species level. FMT_1_1: On day 1, after the first course of gut microbial transplantation; C: FMT_0 vs fecal microbiota transplantation 1 60 colony variability analysis at the species level. FMT_1_60: Following the transplantation, was conducted on day 60.