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Abstract Details
Allogenic Fecal Microbiota Transplantation in Patients With Nonalcoholic Fatty Liver Disease Improves Abnormal Small Intestinal Permeability: A Randomized Control Trial
Am J Gastroenterol. 2020 Jul;115(7):1055-1065. doi: 10.14309/ajg.0000000000000661.
Laura Craven1, Adam Rahman23, Seema Nair Parvathy4, Melanie Beaton23, Justin Silverman5, Karim Qumosani23, Irene Hramiak26, Rob Hegele267, Tisha Joy26, Jon Meddings8, Brad Urquhart2, Ruth Harvie9, Charles McKenzie27, Kelly Summers12, Gregor Reid129, Jeremy P Burton129, Michael Silverman124
Author information
1Department of Microbiology and Immunology, Western University, London, Ontario, Canada.
2Lawson Health Research Institute, London, Ontario, Canada.
3Division of Gastroenterology, London Health Sciences, London, Ontario, Canada.
4Division of Infectious Disease, St. Joseph's Health Care, London, Ontario, Canada.
5Program in Computational Biology and Bioinformatics, Duke University, Durham, North Carolina, USA.
6Division of Endocrinology, St Joseph's Health Care, London, Ontario, Canada.
7Department of Medical Biophysics, Western University, London, Ontario, Canada.
8Department of Medicine, University of Calgary, Alberta, Canada.
9The Canadian Centre for Microbiome and Probiotic Research, London, Ontario, Canada.
Abstract
Introduction: Nonalcoholic fatty liver disease (NAFLD) is an obesity-related disorder that is rapidly increasing in incidence and is considered the hepatic manifestation of the metabolic syndrome. The gut microbiome plays a role in metabolism and maintaining gut barrier integrity. Studies have found differences in the microbiota between NAFLD and healthy patients and increased intestinal permeability in patients with NAFLD. Fecal microbiota transplantation (FMT) can be used to alter the gut microbiome. It was hypothesized that an FMT from a thin and healthy donor given to patients with NAFLD would improve insulin resistance (IR), hepatic proton density fat fraction (PDFF), and intestinal permeability.
Methods: Twenty-one patients with NAFLD were recruited and randomized in a ratio of 3:1 to either an allogenic (n = 15) or an autologous (n = 6) FMT delivered by using an endoscope to the distal duodenum. IR was calculated by HOMA-IR, hepatic PDFF was measured by MRI, and intestinal permeability was tested using the lactulose:mannitol urine test. Additional markers of metabolic syndrome and the gut microbiota were examined. Patient visits occurred at baseline, 2, 6 weeks, and 6 months post-FMT.
Results: There were no significant changes in HOMA-IR or hepatic PDFF in patients who received the allogenic or autologous FMT. Allogenic FMT patients with elevated small intestinal permeability (>0.025 lactulose:mannitol, n = 7) at baseline had a significant reduction 6 weeks after allogenic FMT.
Discussion: FMT did not improve IR as measured by HOMA-IR or hepatic PDFF but did have the potential to reduce small intestinal permeability in patients with NAFLD.