Human data backs FMT to improve brain functions and reduce healthcare burden

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Faecal microbiota transplants (FMT) could significantly reduce hospitalisations and improve signs of cognitive impairment caused by severe liver disease, new human data suggests.

Transplantation of faecal bacteria from a healthy donor into patients that suffer from a decline in brain functions due to severe liver disease (known as hepatic encephalopathy) could improve cognitive function compared with standard of care treatment for the condition, according to data presented at The International Liver Congress 2017 in Amsterdam.

Led by Dr Jasmohan Bajaj from Virginia Commonwealth University in the USA, the team behind the trial found that the number of hospitalisations following FMT plus antibiotics was significantly less (two) compared to the standard of care arm (11).

Specifically, they said a significant reduction in hospitalisations due to recurrent hepatic encephalopathy was seen (six in the standard of care and none in the faecal transplant arm).

"Hepatic encephalopathy is a serious condition and a leading cause of re-admission to hospital due to recurrence, despite standard of care treatment," said Bajaj. "In patients with hepatic encephalopathy, a faecal transplant improves brain function more than standard of care as well as reducing the number of hospital admissions, including those for recurrent hepatic encephalopathy.”

Better than ‘standard of care’

Researchers randomised 20 men with cirrhosis who experienced recurrent episodes of hepatic encephalopathy prior to the start of the study, to treatment with lactulose and rifaximin (standard of care treatment), or, broad spectrum antibiotics for five days plus a single faecal transplant from a healthy donor along with continuing the standard of care.

The transplant was given as an enema. Patients were followed for up to 150 days after randomisation.

FMT plus antibiotic treatment was found to be well tolerated without any serious side effects. Furthermore, Bajaj and his team said the faecal transplant plus antibiotic therapy restored antibiotic-associated changes in the body's bacterial composition.

There was significant cognitive improvement in the FMT group on the Psychometric Hepatic Encephalopathy Score (PHES) and the Stroop App (another test of cognitive dysfunction) as compared to the standard of care group.

Faecal transplant also increased beneficial strains of bacteria, including Bifidobacteriaceae and Lactobacillacea, while no changes to microbiome or metabolomics were seen in the standard of care arm.

"This is the first randomised trial to show that faecal transplantation may be of benefit to patients with hepatic encephalopathy,” said d Prof Tom Karlsen from Oslo University Hospital Rikshospitalet, Norway. “The encouraging findings open new avenues of research to determine how to best manipulate the gut microbiota in patients with hepatic encephalopathy. They also show proof-of-concept for the likely beneficial impact of such interventions.”

“Faecal transplantation is an innovative and promising approach to treat this condition, and we look forward to more studies being conducted to confirm our results,” added Bajaj.

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