PhD Defence: Treatment of bowel diseases with Faecal Microbiota Transplantation

Frederik Cold is defending his PhD thesis: Treatment of bowel diseases with Faecal Microbiota Transplantation.
 
Summary:
The gut microbiome is defined as the genetic material from all microorganisms and viral components in the gut. A correlation between the gut microbiome and numerous diseases, both affecting the gut and other organs has been reported. Therefore, fecal microbiota transplantation (FMT) is seen as a potential way to correct this and is being investigated as treatment of an increasing number of diseases.
 
FMT can be administered through different routes. The focus in this dissertation is on FMT delivered through capsules, which due to safety and logistical reasons is considered to have the highest potential for future treatment delivered through FMT.
From a case-series it is reported how 15 of 18 patients were cured for recurrent C. difficile infection (rCDI) following treatment with single-donor FMT capsules. Through a systematic review of all published studies where FMT capsules were used to treat rCDI it is reported that the treatment is highly effective (85%, 95% CI: 82-88) across studies and that differences in the way the treatment has been produced and delivered between studies does not significantly affect cure rates.
 
In another study, seven patients with the intestinal disease, ulcerative colitis (UC), were treated with daily FMT capsules for 50 days. All patients experienced improvements, but only four of the treated patients still had improvement of symptoms six months following treatment. The safety following FMT is primarily reported from studied without a control group and often only reported for up to one year following treatment. In a study with long-term follow-up of 280 patients for up to five years following treatment of rCDI it is reported that there were not any increased risks of long-term adverse effects following FMT, when compared to a comparable control group treated with a fixed cocktail of 12 bacterial strains.
 
The changes in the recipients gut microbiome following FMT is not fully understood. In a study investigating the changes in the gut microbiome following 12 days of FMT capsule treatment in patients with irritable bowel syndrome, it is reported that FMT caused major changes in the recipients gut microbiome with significant engraftment of donor bacteria and loss of pre-treatment bacteria for a minimum of six months. In conclusion FMT is safe, also long-term. When delivered through capsules FMT is effective in the treatment of rCDI and further there are promising results in the treatment of UC. FMT treatment causes major long-term changes in the recipients gut microbiome.
 
Assessment Committee:
Professor Magdy El-salhy, Bergen University, Norway
Professor Jens Kjeldsen, Odense Universitetshospital, Denmark
David B. Collinge, (Chairman), PLEN, University of Copenhagen, Denmark
 
Supervisor:
Professor Lars Hestbjerg Hansen, PLEN, University of Copenhagen, Denmark​
 
Contact:
Lisbeth Axelsen, liax@plen.ku.dk