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Mixed-donor faecal microbiota transplantation was associated with increased butyrate-producing bacteria for obesity
  1. Zhilu Xu1,2,
  2. Joyce Wing Yan Mak1,2,
  3. Yu Lin1,2,
  4. Keli Yang1,2,
  5. Qin Liu1,2,
  6. Fen Zhang1,2,
  7. Louis Lau1,2,
  8. Whitney Tang1,2,
  9. Jessica YL Ching1,2,
  10. Hein M Tun2,3,
  11. Paul Chan2,4,
  12. Francis K L Chan1,2,
  13. Siew C Ng1,2
  1. 1Microbiota I-Center (MagIC), Hong Kong SAR, China; Department of Medicine and Therapeutics, Institute of Digestive Disease, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
  2. 2Centre for Gut Microbiota Research, The Chinese University of Hong Kong, Hong Kong SAR, China
  3. 3The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
  4. 4Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China
  1. Correspondence to Professor Siew C Ng, Microbiota I-Centre (MagIC Centre), Hong Kong SAR, China; siewchienng{at}

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We read with interest the recent article by Haifer et al (Gut, 2022, 2022–3 27 742), which reported that donor gut microbiome stability and species evenness were associated with higher donor species engraftment in patients with UC following faecal microbiota transplantation (FMT). This has brought us one step closer towards the selection of optimal FMT donors. However, the high prevalence of extended‐spectrum beta‐lactamase organisms and the COVID‐19 pandemic have restricted the recruitment of FMT donors.1 An alternative means to increase the stability and species evenness is to pool the stool samples from multiple eligible FMT donors, which has been shown to be associated with higher clinical efficacy in UC.2 In obesity-related metabolic disorders, outcomes following FMT have been variable.3–8 Although the underlying mechanisms are unclear, the efficacy of FMT is likely to be affected by both donor and recipient microbiota composition.4 9–12 Therefore, we performed a pilot study of single-donor faecal microbiota transplantation (sFMT) and compared the findings with our previous mixed-donor faecal microbiota transplantation (mFMT) study,8 with the aim to determine microbiome factors associated with response to FMT in obese subjects (NCT03789461).

Nine obese subjects received faecal infusions from a single lean donor, whereas 38 obese subjects received faecal infusions from two to five lean donors (table 1 and online supplemental table S1). Overall, FMT was safe and well tolerated (online supplemental table S2). After FMT, 13.2% of mFMT recipients (responders) and none of the sFMT recipients achieved ≥10% weight loss (mean±SD, mixed-donor 3.1%±4.8%, single-donor 4.8%±1.7%; online supplemental figure S1). mFMT recipients showed significant reductions of low-density lipoprotein and total cholesterol at weeks 24 and 52 since …

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  • Contributors ZX performed the experiments and data analyses and drafted the manuscript. YL assisted in data analysis. KY, QL and FZ assisted in sample preparation and experiments. JWYM and LL conducted faecal microbiota transplantation in the clinic. WT and JYLC assisted in clinical data and specimen management. HMT, PC, FKLC and SCN designed and supervised the clinical study, revised the manuscript and provided critical intellectual contribution.

  • Funding This study received funding support from InnoHK, The Government of Hong Kong, Special Administrative Region of the People’s Republic of China (grant number not available (NA)).

  • Competing interests FKLC is the co-founder, non-executive Board Chairman and shareholder of GenieBiome Ltd. FKLC is Board Member of CUHK Medical Centre. FKLC has received fees as an advisor and honoraria as a speaker for Eisai Co. Ltd., AstraZeneca, Pfizer Inc., Takeda Pharmaceutical Co., and Takeda (China) Holdings Co. Ltd. FKLC receives patent royalties through his affiliated institutions in the applications of microbiome. SCN is a scientific co-founder and shareholder of GenieBiome Ltd. SCN has served as an advisory board member for Pfizer, Ferring, Janssen, and Abbvie and received honoraria as a speaker for Ferring, Tillotts, Menarini, Janssen, Abbvie, and Takeda. SCN has received research grants through her affiliated institutions from Olympus, Ferring, and Abbvie. SCN receives patent royalties through her affiliated institutions in the applications of microbiome. ZX, and WT are part-time employee of GenieBiome Ltd. JYLC received personal fees from GenieBiome Ltd. SCN, FKLC, ZX, QL are named inventors of patent applications held by the CUHK and MagIC that covers the therapeutic and diagnostic use of microbiome related to FMT or obesity.All other co-authors declare no competing interests.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

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