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After becoming an established therapy for recurrent Clostridioides difficile infection (rCDI), faecal microbiota transplantation (FMT) has been investigated also in non-communicable disorders, including IBD, IBS, metabolic syndrome, neurological disease and others.1 While the transfer of a healthy biomass appears to be effective regardless of its composition in rCDI (which is an example of acute, elementary dysbiosis), increasing evidence suggests that the clinical success of FMT in chronic disorders is influenced by several factors, including donor microbiome composition2 or FMT working protocols,3 and that these effects may be mediated by the engraftment capacity of the donor microbiome into the recipient gut.4
Haifer et al 5 have published in the latest issue of Gut a subanalysis of a recent randomised trial (the LOTUS trial) of FMT for UC,6 where they had observed a significant variability of clinical efficacy between the two recruited donors (100% vs 36%). They have determined the differences in donor microbiome profiles by whole genome sequencing and untargeted metabolomics, validating results in another independent cohort, with a series of major findings.5 First, donors and patients with UC differed significantly in the composition and function of gut microbiota, in line with previous experiences. More strikingly, the stability in richness of donor species over time (assessed for up to 70 weeks), rather than richness itself, was associated with therapeutic efficacy. Along with this result, evenness of donor species was associated with higher donor engraftment as well as with clinical response, and the stability of less effective donor appeared to be …
Twitter @GiovanniCammar9, @gianluca1aniro
Contributors QL and GI have written the initial draft of the manuscript. All authors have critically reviewed the manuscript and approved the final version for submission.
Funding GC and GI would like to thank the Fondazione Roma for the invaluable support to their scientific research. This work was supported by the Ricerca Finalizzata Giovani Ricercatori 2018 of the Italian Ministry of Health (project GR-2018-12365734) to GI and by the BIOMIS grant of the Italian Ministry of Research to GC and GI. QL is supported by InnoHK, The Government of Hong Kong, Special Administrative Region of the People’s Republic of China.
Disclaimer The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Competing interests GC has received personal fees for acting as advisor for Ferring Therapeutics. GI has received personalfees for acting as speaker for Biocodex, Danone, Sofar, Malesci, Metagenics and Tillotts Pharma, and for acting as consultant/advisor for Ferring Therapeutics, Giuliani,Metagenics and Tillotts Pharma. QL is a named inventor of patent applications held by MagIC that is related to the treatment of bacterial infection with FMT.
Provenance and peer review Commissioned; externally peer reviewed.