- Fecal Incontinence
|Protocol for faecal microbiota transplantation in ulcerative colitis (FMTUC): a randomised feasibility study
Jitsumura M1, Cunningham AL1, Hitchings MD2, Islam S3, Davies AP4, Row PE5, Riddell AD6, Kinross J7, Wilkinson TS2, Jenkins GJ8, Williams JG9, Harris DA1. BMJ Open. 2018 Oct 18;8(10):e021987. doi: 10.1136/bmjopen-2018-021987.
1 Department of Colorectal Surgery, Singleton Hospital, Swansea, UK.
2 Medical Microbiology and Infectious Diseases, Swansea University Medical School, Swansea, UK.
3 Swansea Trial Unit, Swansea University, Swansea, UK.
4 Public Health Wales Microbiology, Singleton Hospital, Swansea University Medical School, Swansea, UK.
5 Biochemistry Group, Swansea University Medical School, Swansea, UK.
6 Department of Colorectal Surgery, Redcliffe Hospital, Brisbane, Queensland, Australia.
7 Department of Surgery and Cancer, St. Mary's Hospital, Imperial College London, London, UK.
8 Molecular Carcinogenesis, Institute of Life Science, Swansea University Medical School, Swansea, UK.
9 Institute of Life Science 2, Swansea University Medical School, Swansea, UK.
BACKGROUND: The interaction of the gut microbiota with the human host is implicated in the pathogenesis of inflammatory and immunological diseases including ulcerative colitis (UC). Faecal microbiota transplantation (FMT) as a method of restoring gut microbial diversity is of increasing interest as a therapeutic approach in the management of UC. The current literature lacks consensus about the dose of FMT, route of administration and duration of response.
METHODS AND ANALYSIS: This single-blinded randomised trial will explore the feasibility of FMT in 30 treatment-naïve patients with histologically confirmed distal UC limited to the recto-sigmoid region (up to 40 cm from the anal verge). This study aims to estimate the magnitude of treatment response to FMT under controlled conditions. The intervention (FMT) will be administered by rectal retention enema. It will test the feasibility of randomising patients to: (i) single FMT dose, (ii) five daily FMT doses or (iii) control (no FMT dose). All groups will receive standard antibiotic gut decontamination and bowel preparation before FMT. Recruitment will take place over a 24-month period with a 12-week patient follow-up. Trial objectives include evaluation of the magnitude of treatment response to FMT, investigation of the clinical value of metabolic phenotyping for predicting the clinical response to FMT and testing the recruitment rate of donors and patients for a study in FMT. This feasibility trial will enable an estimate of number of patients needed, help determine optimal study conditions and inform the choice of endpoints for a future definitive phase III study.
ETHICS AND DISSEMINATION: The trial is approved by the regional ethics committee and is sponsored by Abertawe Bro Morgannwg University's Health Board. Written informed consent from all patients will be obtained. Serious adverse events will be reported to the sponsor. Trial results will be disseminated via peer review publication and shared with trial participants.
TRIAL REGISTRATION NUMBER: ISRCTN 58082603; Pre-results.