Fecal microbiota transplantation in capsules for the treatment of steroid refractory and steroid dependent acute graft vs. host disease: a pilot study

Ilan Youngster, Adi Eshel, Mika Geva, Ivetta Danylesko, Israel Henig, Tsila Zuckerman, Shalev Fried, Ronit Yerushalmi, Noga Shem-Tov, Joshua A. Fein, David Bomze, Avichai Shimoni, Omry Koren, Roni Shouval*, Arnon Nagler

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Acute graft-versus-host disease (aGvHD) is a serious complication of allogeneic hematopoietic stem-cell transplantation with limited treatment options. The gut microbiome plays a critical role in aGvHD pathogenesis. Fecal microbiota transplantation (FMT) has emerged as a potential therapeutic approach to restore gut microbial diversity. In this prospective pilot study, 21 patients with steroid-resistant or steroid-dependent lower gastrointestinal aGvHD received FMT in capsule form. At 28 days after the first FMT, the overall response rate was 52.4%, with 23.8% complete and 28.6% partial responses. However, sustained responses were infrequent, with only one patient remaining aGvHD-free long-term. FMT was generally well-tolerated. Microbiome analysis revealed dysbiosis in pre-FMT patient stool samples, with distinct microbial characteristics compared to donors. Following FMT, there was an increase in beneficial Clostridiales and a decrease in pathogenic Enterobacteriales. These findings highlight the potential of FMT as a treatment option for steroid-resistant aGvHD. Trial registration number NCT #03214289.

Original languageEnglish
Pages (from-to)409-416
Number of pages8
JournalBone Marrow Transplantation
Volume59
Issue number3
DOIs
StatePublished - Mar 2024

Funding

FundersFunder number
Gassner Fund for Medical Research
National Institutes of Health
National Cancer InstituteK08CA282987
Dahlia Greidinger Anti-Cancer Fund
Sheba Medical Center

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