Systematic review of donor and recipient predictive biomarkers of response to faecal microbiota transplantation in patients with ulcerative colitis
Nia Paddison Rees,
Walaa Shaheen,
Christopher Quince,
Chris Tselepis,
Richard D Horniblow,
Naveen Sharma,
Andrew D Beggs,
Tariq H Iqbal,
Mohammed Nabil Quraishi
Affiliations
Nia Paddison Rees
University of Birmingham Microbiome Treatment Centre, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, UK
Walaa Shaheen
University of Birmingham Microbiome Treatment Centre, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, UK
Christopher Quince
Earlham Institute, Norwich, UK
Chris Tselepis
University of Birmingham Microbiome Treatment Centre, Birmingham, UK; Institute of Clinical Sciences, School of Biomedical Sciences, University of Birmingham, UK
Richard D Horniblow
University of Birmingham Microbiome Treatment Centre, Birmingham, UK; Institute of Clinical Sciences, School of Biomedical Sciences, University of Birmingham, UK
Naveen Sharma
University of Birmingham Microbiome Treatment Centre, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Andrew D Beggs
University of Birmingham Microbiome Treatment Centre, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Tariq H Iqbal
University of Birmingham Microbiome Treatment Centre, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Microbiology and Infection, University of Birmingham, UK
Mohammed Nabil Quraishi
University of Birmingham Microbiome Treatment Centre, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Address for correspondence: Dr MN Quraishi; Department of Gastroenterology, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. Phone number: 01214243295
Summary: Background: Faecal microbiota transplantation (FMT) has previously been explored as a treatment for ulcerative colitis (UC) however, biomarkers that predict and / or are associated with clinical response are poorly defined. The aim of this systematic review was to identify donor and recipient clinical, microbial and metabolomic predictive biomarkers of response to FMT in UC. Methods: A systematic search of the relevant literature of studies exploring FMT in UC was conducted. Data on microbial diversity, taxonomic changes, metabolic changes, donor and recipient microbiota relationship and baseline predictors was examined. Findings: 2852 studies were screened, and 25 papers were included in this systematic review. Following FMT, alpha diversity was seen to increase in responders along with increases in the abundance of Clostridiales clusters (order) and Bacteroides genus. Metabolomic analysis revealed short chain fatty acid (SCFA) production as a marker of FMT success. Donors or FMT batches with higher microbial alpha diversity and a greater abundance of taxa belonging to certain Bacteroides and Clostridia clusters were associated with clinical response to FMT. Baseline clinical predictors of response in patients with UC included younger age, less severe disease and possibly shorter disease duration. Baseline recipient microbial predictors at response consisted of higher faecal species richness, greater abundance of Candida and donor microbial profile similarity. Interpretation: Distinct changes in gut microbiota profiles post-FMT indicate that certain baseline characteristics along with specific microbial and metabolomic alterations may predispose patients towards a successful therapeutic outcome. Opportunities towards a biomarker led precision medicine approach with FMT should be explored in future clinical studies. Funding: There no specific funding to declare.
