Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2017; 23(48): 8570-8581
Published online Dec 28, 2017. doi: 10.3748/wjg.v23.i48.8570
Fecal microbiota transplantation induces remission of infantile allergic colitis through gut microbiota re-establishment
Sheng-Xuan Liu, Yin-Hu Li, Wen-Kui Dai, Xue-Song Li, Chuang-Zhao Qiu, Meng-Ling Ruan, Biao Zou, Chen Dong, Yan-Hong Liu, Jia-Yi He, Zhi-Hua Huang, Sai-Nan Shu
Sheng-Xuan Liu, Xue-Song Li, Meng-Ling Ruan, Biao Zou, Chen Dong, Jia-Yi He, Zhi-Hua Huang, Sai-Nan Shu, Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Yin-Hu Li, Chuang-Zhao Qiu, Yan-Hong Liu, Department of Microbial Research, WeHealthGene Institute, Shenzhen 518000, Guangdong Province, China
Wen-Kui Dai, Department of Computer Science, College of Science and Engineering, City University of Hong Kong, Hong Kong, China
Author contributions: Liu SX and Li YH contributed equally to this work; Shu SN and Huang ZH designed the research; Dai WK designed the follow-up plans and collected patients’ information with Li XS, Ruan ML, Zou B and Dong C after FMT; Qiu CZ, Liu YH and He JY performed bioinformatics analysis; Ruan ML and Zou B recorded patients’ and donors’ clinical data; Shu SN and Huang ZH conducted FMT.
Supported by National Clinical Key Specialty Construction Project (Pediatric Digestive Disease), No. [2011]873.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (IRB ID: TJ-C20140712).
Informed consent statement: All studied participants, or their legal guardians, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that they have no competing interests.
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: Sai-Nan Shu, MD, PhD, Associate Professor, Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Road, Wuhan 430030, Hubei Province, China. snshu@tjh.tjmu.edu.cn
Telephone: +86-27-83662688 Fax: +86-27-83662640
Received: September 5, 2017
Peer-review started: September 5, 2017
First decision: September 27, 2017
Revised: November 2, 2017
Accepted: November 8, 2017
Article in press: November 8, 2017
Published online: December 28, 2017
Processing time: 114 Days and 2.6 Hours
ARTICLE HIGHLIGHTS
Research background

Allergic colitis (AC), which is characterized as hematochezia and severe diarrhea, is caused by an intense allergic reaction of the digestive system. Currently, first-line therapies for AC patients are reducing exposure to suspicious allergens and applying hypoallergenic milk powder. However, some pediatric patients could not relieve from AC symptoms completely with routine treatment, and long-term illness causes adverse impact on nutrition absorption and physical development in the children.

Research motivation

Previous studies indicated that gut microbiota (GM) was closely related with the digestive system, neural system, and immune system in human. Meanwhile, the positive effects of fecal microbiota transplantation (FMT) have been confirmed in various gastrointestinal diseases, including Clostridium difficile infection (CDI), inflammatory bowel disease (IBD), and irritable bowel syndrome (IBS). However, FMT had not been applied to treat AC infants before. This research could provide important references for the treatment and research of infantile AC with FMT therapy.

Research objectives

The research aimed to detect the safety and efficiency of FMT treatment in AC, and compare GM composition before and after FMT treatment in the patients.

Research methods

The procedures of FMT, including selection of AC patients and donors, were conducted according to the guidelines established by the Institutional Review Board of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. Wilcoxon tests were adopted in the research.

Research results

In this study, the safety and efficacy of FMT treatment were investigated in 19 AC infants with GM analysis. The results indicated that the AC symptoms, which included rectal bleeding, diarrhea and hematochezia, were relieved rapidly by FMT treatment. During the 15 mo follow-up, no relapse was recorded except that eczema happened in one patient. After FMT treatment, the elevation of microbial diversity was detected in six of ten patients. Meanwhile, the relative abundances of Proteobacteria and Firmicutes were decreased (6/10) and increased (10/10), respectively, in the AC infants.

Research conclusions

This study documents the positive effect of FMT treatment on infantile AC remission, suggesting the potential of FMT in gastrointestinal allergic diseases. Individual-specific GM re-configuration also extended our understanding of FMT efficacy and associated mechanisms.

Research perspectives

Despite the aspiring results of FMT in pediatric AC, verified improvements with larger cohorts and longer follow-up are necessary. In parallel, GM analysis should be performed before and after FMT, to unravel keystone microbial components in the specific disease.

ACKNOWLEDGEMENTS

We thank the nurses who helped with sample collection at Tongji Hospital and the staff at WeHealthGene Institute who contributed to the project analysis.