Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2017; 23(7): 1319-1324
Published online Feb 21, 2017. doi: 10.3748/wjg.v23.i7.1319
Clinical and immunologic effects of faecal microbiota transplantation in a patient with collagenous colitis
Sezin Günaltay, Lech Rademacher, Elisabeth Hultgren Hörnquist, Johan Bohr
Sezin Günaltay, Elisabeth Hultgren Hörnquist, Johan Bohr, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, SE-70185 Örebro, Sweden
Lech Rademacher, Johan Bohr, Division of Gastroenterology, Department of Medicine, Örebro University Hospital, SE-70185 Örebro, Sweden
Lech Rademacher, Department of Medicine, Avesta Hospital, SE-774 82 Avesta, Sweden
Author contributions: Bohr J performed the first two fecal microbiota transplantations and collected colonic mucosal biopsies; Rademacher L performed the third; Günaltay S carried out experiments and data analyses; Günaltay S, Rademacher L and Bohr J drafted the manuscript; Günaltay S, Rademacher L, Hultgren Hörnquist E and Bohr J created the study design, coordination, and data analyses; Günaltay S, Rademacher L, Hultgren Hörnquist E and Bohr J finalized the manuscript; all authors read and approved the final manuscript.
Supported by Örebro University Hospital Research Foundation (Nyckelfonden).
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at Örebro University in Örebro, Sweden.
Informed consent statement: The patient was informed of the study protocol before treatment and colonoscopy, and gave her written consent to donate tissue samples for research purposes and undergo treatment with FMT.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this case report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Johan Bohr, MD, PhD, Division of Gastroenterology, Department of Medicine, Örebro University Hospital, SE-70185 Örebro, Sweden. johan.bohr@regionorebrolan.se
Telephone: +46-19-6021000 Fax: +46-19-6021774
Received: September 27, 2016
Peer-review started: September 28, 2016
First decision: October 20, 2016
Revised: November 20, 2016
Accepted: January 2, 2017
Article in press: January 3, 2017
Published online: February 21, 2017
Processing time: 145 Days and 21 Hours
Abstract

One to six percent of patients with microscopic colitis are refractory to medical treatment. The effect of faecal microbiota transplantation (FMT) in active collagenous colitis (CC) has, to the best of our knowledge, never been reported before. Here, we report the effect of repeated FMT in a patient with CC. The patient presented with severe symptoms including profuse diarrhea and profound weight loss. Although she responded to budesonide in the beginning, she became gradually refractory to medical treatment, and was therefore treated with FMT. The patient remained in remission for 11 mo after the third faecal transplantation. The immunomodulatory effect of the therapy was evaluated using flow cytometry, which showed alterations in the profile of intraepithelial and lamina propria lymphocyte subsets after the second transplantation. Our observations indicate that FMT can have an effect in CC, which support the hypothesis that luminal factors, influencing the intestinal microbiota, are involved in the pathogenesis of CC.

Keywords: Faecal microbiota transplantation; Microbiota; Collagenous colitis; Flow cytometry; Lymphocytes

Core tip: Collagenous colitis (CC) is characterized by chronic watery diarrhea and inflammation in the colonic mucosa. The treatment is based on budesonide or immunomodulatory treatment in moderate to severe cases. However, some patients do not respond to the treatment. The aim of this article is to report the effect of repeated faecal microbiota transplantation in a CC patient who remained in remission 11 mo after the repeated transplantations, which also caused alterations in the lymphocyte subsets.