Autologous FMT capsules from EEN-treated pediatric CD patients face challenges as maintenance therapy

A recent study shows that after achieving remission in pediatric Crohn’s disease using exclusive enteral nutrition, the use of autologous fecal microbiota transfer capsules showed potential, but challenges like high pathogens and inconsistent stool quality raised concerns about its viability as a long-term treatment. The study by Hannes Hoelz, Jeannine Heetmeyer, Anastasia Tsakmaklis, and many others was published on April 2, 2023.

According to the study, transferring fecal microbiota from a healthy source has proven effective in treating persistent Clostridioides difficile infections. This method is also being explored as a potential remedy for conditions like inflammatory bowel disease (IBD) due to imbalances in gut bacteria. Positive results have been observed in ulcerative colitis and Crohn’s disease, with the latter showing prolonged remission when higher donor bacterial strains are adopted. Yet, choosing the right donor is complex due to varying factors influencing success. The study states that even though this transfer method generally has a safe track record, concerns remain about potential disease relapse and long-term impacts, such as the introduction of bacteria linked to cancer or metabolic issues like obesity.

Although using exclusive enteral nutrition (EEN) has shown significant success in inducing remission in children with Crohn’s disease, the challenge remains in sustaining these benefits once the child resumes a standard diet, the study notes. One innovative solution might be the use of self-derived fecal microbiota capsules made from stool samples taken during the EEN-driven remission phase. The procedure involves children providing these samples from their homes, which are then sent under controlled conditions for processing.

During the trial, fecal samples were provided by seven pediatric patients following a minimum of three weeks of nutritional therapy, according to the study. Capsules were created successfully for most of the deliveries, but there were inconsistencies in the stool's weight and texture. Importantly, the capsule-making process did not significantly alter the microbial makeup of the original samples. However, less than optimal microbial diversity was noted in some samples, and a considerable number of samples tested positive for potential pathogens or drug-resistant genes. The study states that these findings suggest that while innovative, using such capsules might face challenges, especially when considering long-term maintenance therapy for pediatric Crohn’s patients.

MDPI: Hannes Hoelz, et al., Is Autologous Fecal Microbiota Transfer after Exclusive Enteral Nutrition in Pediatric Crohn’s Disease Patients Rational and Feasible? Data from a Feasibility Test, Nutrients (2023). https://doi.org/10.3390/nu15071742