FAECAL microbiota transplantation (FMT) shows promise in treating ulcerative colitis (UC), with specific gut microbial families linked to treatment success. This study highlights the potential of monitoring microbiota dynamics to predict FMT outcomes early in therapy.
Ulcerative colitis is a chronic inflammatory bowel disease, and FMT has emerged as an experimental treatment to restore gut microbial balance. This study aimed to identify microbial families associated with FMT treatment success. Stool samples from 24 UC patients were analyzed, with participants randomized to pretreatment with budesonide or placebo before receiving four weekly FMTs. Samples were collected at nine time points, and clinical response was assessed at 14 weeks using the full Mayo score. Early withdrawal due to worsening symptoms was classified as non-response.
Of the 24 patients, nine (38%) achieved remission by week 14, while 15 showed partial or no response. Microbiota analysis identified five distinct clusters, with a Prevotellaceae-dominant cluster associated with poor FMT outcomes. Conversely, higher abundances of Ruminococcaceae and Lachnospiraceae were linked to successful treatment. These associations were evident at treatment initiation and persisted over time. Responders also exhibited significantly lower Simpson dominance, indicating greater microbial diversity.
These findings suggest that specific gut microbiota families, particularly Prevotellaceae, Ruminococcaceae, and Lachnospiraceae, play a critical role in FMT outcomes for UC patients. Monitoring these microbial families early in treatment could help predict success and guide clinical decisions. Future research should explore interventions to modulate these microbial populations, potentially enhancing FMT efficacy and improving patient care. This study underscores the importance of personalized microbiome-based approaches in managing UC.
Katheeja Imani, EMJ
Reference
Pinto S et al. Dynamics of gut microbiota after fecal microbiota transplantation in ulcerative colitis: success linked to control of Prevotellaceae. J Crohns Colitis. 2025;19(2):jjae137.
