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Journal articleBaunwall SMD, Lee MM, Eriksen MK, et al., 2020,
Faecal microbiota transplantation for recurrent Clostridioides difficile infection: an updated systematic review and meta-analysis
, EClinicalMedicine, Vol: 29-30, Pages: 1-12, ISSN: 2589-5370BackgroundFaecal microbiota transplantation (FMT) is effective for recurrent Clostridioides difficile infection (CDI), but inconsistent effect rates and uncertain evidence levels have warranted caution. To clarify, we aimed to establish the evidence of FMT for recurrent CDI, updated across different delivery methods, treatment regimens, and in comparison with standard antibiotics.MethodsIn this updated systematic review and meta-analysis, we searched PubMed, Scopus, Embase, Web of Science, Clinical Key, and Svemed+ for FMT literature published in English until November 11, 2019. We included observational and clinical trials with or without antibiotic comparators and excluded studies with below 8 weeks follow-up and fewer than 15 patients. The primary outcome was clinical outcome by week 8. We comprehensively extracted patient and procedural data. In a random-effects meta-analysis, we estimated the clinical effect for repeat or single FMT, different delivery methods, and versus antibiotics. We rated the evidence according to the Cochrane and GRADE methods. The PROSPERO preregistration number is CRD42020158112.FindingsOf 1816 studies assessed, 45 studies were included. The overall clinical effect week 8 following repeat FMT (24 studies, 1855 patients) was 91% (95% CI: 89–94%, I2=53%) and 84% (80–88%, I2=86%) following single FMT (43 studies, 2937 patients). Delivery by lower gastrointestinal endoscopy was superior to all other delivery methods, and repeat FMT significantly increased the treatment effect week 8 (P<0·001). Compared with vancomycin, the number needed to treat (NNT) for repeat FMT was 1·5 (1·3–1·9, P<0·001) and 2.9 (1·5–37·1, P=0·03) for single FMT. Repeat FMT had high quality of evidence.InterpretationHigh-quality evidence supports FMT is effective for recurrent CDI, but its effect varies with the delivery method and the number of administrations. The superior NNT for F
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Journal articleSegal JP, Mak JWY, Mullish BH, et al., 2020,
The gut microbiome: an under-recognised contributor to the Covid-19 pandemic?
, Therapeutic Advances in Gastroenterology, Vol: 13, Pages: 1-14, ISSN: 1756-2848The novel Coronavirus infection (COVID-19) caused by the SARS-CoV-2 virus, Covid-19 has rapidly spread across the globe, culminating in major global morbidity and mortality. As such, there has been a rapid escalation in scientific and clinical activity aimed at increasing our comprehension of this virus. This volume of work has led to early insights into risk factors associated with severity of disease, and mechanisms that underpin the virulence and dynamics involved in viral transmission. These insights ultimately may help guide potential therapeutics to reduce the human, economic and social impact of this pandemic. Importantly, the gastrointestinal (GI) tract has emerged as an important organ for propensity to and severity of Covid-19 infection. Furthermore, the gut microbiome has been linked to a variety of diseases and manipulation of the gut microbiome is an attractive potential therapeutic target for a number of diseases. While the data profiling the gut microbiome in Covid-19 infection to date are limited, they support the possibility of several routes of interaction between Covid-19, the gut microbiome, ACE2 expression in the small bowel and colon and gut inflammation. This article will explore the evidence that implicates the gut microbiome as a contributing factor to the pathogenesis, severity and disease course of Covid-19 and speculate about the gut microbiome’s capability as a therapeutic avenue against Covid-19.
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Journal articleMolinaro A, Bel Lassen P, Henricsson M, et al., 2020,
Imidazole propionate is increased in diabetes and associated with dietary patterns and altered microbial ecology
, Nature Communications, Vol: 11, ISSN: 2041-1723Microbiota-host-diet interactions contribute to the development of metabolic diseases. Imidazole propionate is a novel microbially produced metabolite from histidine, which impairs glucose metabolism. Here, we show that subjects with prediabetes and diabetes in the MetaCardis cohort from three European countries have elevated serum imidazole propionate levels. Furthermore, imidazole propionate levels were increased in subjects with low bacterial gene richness and Bacteroides 2 enterotype, which have previously been associated with obesity. The Bacteroides 2 enterotype was also associated with increased abundance of the genes involved in imidazole propionate biosynthesis from dietary histidine. Since patients and controls did not differ in their histidine dietary intake, the elevated levels of imidazole propionate in type 2 diabetes likely reflects altered microbial metabolism of histidine, rather than histidine intake per se. Thus the microbiota may contribute to type 2 diabetes by generating imidazole propionate that can modulate host inflammation and metabolism.
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Conference paperMiguens Blanco J, Selvarajah U, Liu Z, et al., 2020,
Identification of New Associations Between Psoriatic Arthritis and the Gut Microbiota. the Mi-PART, a Phenomic Study
, ACR Convergence 2020, Publisher: Wiley, ISSN: 2326-5205 -
Journal articleMartinez-Gili L, McDonald JAK, Liu Z, et al., 2020,
Understanding the mechanisms of efficacy of fecal microbiota transplant in treating recurrent <i>Clostridioides difficile</i> infection and beyond: the contribution of gut microbial-derived metabolites
, Gut Microbes, Vol: 12, Pages: 1810531-1810531, ISSN: 1949-0976 -
Journal articleAllegretti JR, Kelly CR, Grinspan A, et al., 2020,
Outcomes of fecal microbiota transplantation in patients with inflammatory bowel diseases and recurrent Clostridioides difficile infection
, Gastroenterology, Vol: 159, Pages: 1982-1984, ISSN: 0016-5085There has been an increase in the burden of Clostridioides difficile infection (CDI),1 especially in high-risk populations such as patients with inflammatory bowel disease (IBD).2 The prevalence of CDI in the IBD population is up to 8-fold higher than comparable controls, with increased rates of recurrence and CDI-associated mortality.3 In addition, CDI may induce an IBD flare, and worsen disease severity and clinical course.4Fecal microbiota transplantation (FMT) is a guideline recommended therapy for recurrent CDI5; however, supportive randomized trials excluded patients with IBD. In retrospective trials of patients with IBD, FMT failure rates had been reported to be approximately 25% to 30%.6 In addition, Khoruts and colleagues reported that patients with IBD and CDI were more likely to fail FMT,7 leading to further uncertainty regarding the safety and efficacy of FMT in IBD patients with concurrent CDI. Accordingly, we conducted the first prospective study examining the efficacy of FMT among patients with IBD and CDI.MethodsWe conducted an open-label, prospective, single-arm, multicenter cohort study at 4 tertiary care FMT referral centers (Brigham and Women’s Hospital, Indiana University, Brown University, and Mount Sinai Hospital; NCT03106844). Patients with a confirmed diagnosis of IBD and 2 or more confirmed CDI episodes within 12 months, including the most recent episode occurring within 3 months, were enrolled. In keeping with CDI clinical guidelines,5 polymerase chain reaction or glutamate dehydrogenase with toxin enzyme immunoassay were permitted for the qualifying CDI episode. Patients with a total or subtotal colectomy, isolated ileal or small bowel Crohn’s disease, those pregnant or breastfeeding, those treated with vancomycin or metronidazole for more than 60 days, or those who had undergone a prior FMT within 12 months were excluded. Baseline IBD and CDI data were collected. All patients underwent a single FMT via colonoscopy. Four robus
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Journal articleCraven LJ, McIlroy JR, Mullish BH, et al., 2020,
Letter: Intestinal microbiota transfer – Updating the nomenclature to increase acceptability
, Alimentary Pharmacology and Therapeutics, Vol: 52, Pages: 1622-1623, ISSN: 0269-2813This article is linked to Lai et al paper. To view this article, visit https://doi.org/10.1111/apt.15116
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Book chapterGhani R, Mullish BH, 2020,
Decision: Considerations for Use of Fecal Microbiota Transplantation in Special Patient Populations
, The 6 Ds of Fecal Microbiota Transplantation: A Primer from Decision to Discharge and Beyond, Editors: Allegretti, Kassam, Publisher: Slack Incorporated, ISBN: 9781630917500 -
Book chapterMullish BH, 2020,
The Role of Fecal Microbiota Transplantation in the Treatment of Obesity, Metabolic Syndrome, and Nonalcoholic Fatty Liver Disease
, The 6 Ds of Fecal Microbiota Transplantation: A Primer from Decision to Discharge and Beyond, Editors: Allegretti, Kassam, Publisher: Slack Incorporated, ISBN: 9781630917500 -
Journal articleAlexander JL, Mullish BH, 2020,
A Guide to the Gut Microbiome and its Relevance to Critical Care
, British Journal of Nursing, Vol: 29, Pages: 1106-1112, ISSN: 0966-0461<jats:p> Although it is well-established that particular bacteria may cause gastroenteritis and other infections when present in the gut, it is only recently that scientists have made significant inroads into understanding the huge number of other bacteria and additional microbes that live within the gastrointestinal tract, referred to as the gut microbiome. In particular, it is now recognised that bacteria within the gut microbiome have a wide variety of roles in maintaining different aspects of human health, and that disturbances of these bacteria may potentially cause or contribute to a number of different medical conditions, including particular infections, certain cancers, and chronic conditions, including inflammatory bowel disease. Moreover, there is increasing awareness that these bacteria help determine how the body responds to medication, including antibiotics and chemotherapy. There has been growing interest in different approaches to alter the gut microbiome as a novel approach to medical therapy. This article provides an overview of the importance of the gut microbiome, with a particular focus on critical care. </jats:p>
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