Could Autologous Fecal Microbial Transplantation Be a Treatment Option in Patients with Intestinal Graft-Versus-Host Disease:Lessons Learned From an Experience in Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) includes various forms of disorders;however, Crohn’s disease (CD) and ulcerative colitis (UC) are twomajor types of this disease. Ulcerative colitis is characterized byexpansion mucosal inflammation in the colon, while Crohn’s disease ischaracterized by patchy, transmural inflammation, which may affect allparts of the gastrointestinal tract. There are some evidence about the roleof genetic and immune disorders and environmental factors, such as achange in the fecal microbiota, in the pathogenesis of IBD. Commensalmicrobiota could promote IBD through changes in the composition of themucosal-associated bacteria, which is known as dysbiosis; deregulatedinduction of immune system in the intestine; and genomic instabilityand induction of mutations in the host by their metabolites and toxins.Dysbiosis increases gut permeability to bacterial products and promotesinflammatory disorders through induction of the immune system.Clostridium difficile infection (CDI) in patients with IBD is associatedwith more severe disease, longer hospital admission, higher treatmentcosts, higher risk of colectomy and mortality rate. Fecal microbiotatransplantation (FMT) is one of the treatment choices in patients withrecurrent CDI, especially among those with underlying diseases. Inthis presentation we report three unsuccessful FMT procedures in IBDpatients with recurrent CDI. All the patients were subjected to FMT byheterologous samples. Our results did not support FMT as a treatmentoption to subside the induced inflammatory response in these patients.These findings could propose usage of autologous instead of heterologousFMT for patients with intestinal graft-versus-host disease (GvHD), when itis suggested as a therapeutic option.

کلیدواژه ها:

Graft versus Host disease ، Fecal Microbial Transplantation ، Inflammatory disorder