Abstract
Fecal microbiota transplantation (FMT) by manual preparation has been applied to treat diseases for thousands of years. However, this method still endures safety risks and challenges the psychological endurance and acceptance of doctors, patients and donors. Population evidence showed the washed microbiota preparation with microfiltration based on an automatic purification system followed by repeated centrifugation plus suspension for three times significantly reduced FMT-related adverse events. This washing preparation makes delivering a precise dose of the enriched microbiota feasible, instead of using the weight of stool. Intraperitoneal injection in mice with the fecal microbiota supernatant obtained after repeated centrifugation plus suspension for three times induced less toxic reaction than that by the first centrifugation following the microfiltration. The toxic reactions that include death, the change in the level of peripheral white blood cells, and the proliferation of germinal center in secondary lymphoid follicles in spleen were noted. The metagenomic next-generation sequencing (NGS) indicated the increasing types and amount of viruses could be washed out during the washing process. Metabolomics analysis indicated metabolites with pro-inflammatory effects in the fecal microbiota supernatant such as leukotriene B4, corticosterone, and prostaglandin G2 could be removed by repeated washing. Near-infrared absorption spectroscopy could be served as a rapid detection method to control the quality of the washing-process. In conclusion, this study for the first time provides evidence linking clinical findings and animal experiments to support that washed microbiota transplantation (WMT) is safer, more precise and more quality-controllable than the crude FMT by manual.
Highlights
Fecal microbiota transplantation (FMT), an effective method of reconstructing the overall gut microbiota of patients, has a wide range of therapeutic indications (Zhang et al, 2018; Allegretti et al, 2019)
Clinical data from a total of 970 patients (478 with ulcerative colitis (UC) and 492 with Crohn’s disease (CD)) who underwent FMT was recorded into China microbiota transplantation system (CMTS) for over a oneyear follow-up (Fig. 1)
The relationship between fecal weight and the amount of enriched microbiota in donors Following the automatic preparation for washing microbiota, we explored the relationship between fecal weight and the amount of enriched microbiota
Summary
Fecal microbiota transplantation (FMT), an effective method of reconstructing the overall gut microbiota of patients, has a wide range of therapeutic indications (Zhang et al, 2018; Allegretti et al, 2019). It has been recommended for the treatment of recurrent Clostridioides difficile infection (CDI) in the clinical guideline, consensus and joint-experts recommendation (McDonald et al, 2018; Ng et al, 2019). The dose for delivering FMT is mainly based on the donors’ fecal weight, instead of the precise volume or amount of microbiota (Cammarota et al, 2019)
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