IDDF2019-ABS-0252 Effect of multidonor intensive fecal microbiota transplantation by capsules for active uncreative colitis: a prospective trial

Background Fecal microbiota transplantation (FMT) can induce remission in patients with ulcerative colitis(UC). We aim to establish the efficacy of multidonor, easy way FMT by capsules in active UC, and identify the factors associated with response to therapy. Methods We conducted a prospective trial in Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China. A total of 28 adults with active UC (Mayo score 4–11) were enrolled in this trial, followed by capsules 3 days one week. One donor’s fecal microbiota was made into one capsule, and fecal microbiota transplantation was each derived from two or three unrelated donors. The primary outcome was steroid-free clinical remission with endoscopic remission or response. We performed 16S rDNA stool analysis to access associated microbial changes. Based on LC-MS/MS technology metabonomic researches were carried out to study metablome of the serum. Results The primary outcome with clinical remission was achieved in 16 out of 28 patients (57.14%), and 11 out of 22 patients(50%) had the musical healing. No adverse events were identified in these patients. The effects have no significant relationship with the age, gender, severity and extent of disease.FMT increased microbial diversity and altered composition. After FMT, unlike non-responders, the intestinal flora structure of responders was close to the donor, and the significant change began 1 week after transplantation. After FMT, responders had enrichment of Alloprevotella compared with non-responders and had increased levels of taurochenodeoxycholate and taurocholate. Escherichia-Shigella were decreased after FMT in responders, but no change in non-responders. The correlation analysis between the differential metabolites and the differential flora showed that the bile acid-related metabolites were positively correlated with the abundance of Alloprevotella and Prevotella_9. Conclusions Intensive-dosing, multidonor, FMT by capsules induces clinical remission in active ulcerative colitis and is associated with the changes of intestinal flora. Alloprecotella and bile acid-related metabolites were related to curative effect. The enrichment of Alloprevotella after FMT may be able to treat ulcerative colitis by regulating bile acid metabolism, improving mucosal permeability and regulating immunity. Future work should focus on the multi center verification and the relationship of immunity and gut microbiome.