Een tip: Wie advies wilt over hoe het microbioom te verbeteren zou contact op kunnen nemen met deze website: Www.microbiome-Center.nl Voor zowel artsen als individuele burgers staat een groep van artsen en wetenschappers klaar om u een persoonlijk advies te geven.

20 april 2024: Zie enkele artikelen op onze website met poeptransplantatie in de titel: https://kanker-actueel.nl/search.html?search_text=poeptransplantatie&search_in=title

20 april 2024: zie ook dit artikel: https://kanker-actueel.nl/gerichte-dieet-aanpak-met-uitsluiting-van-specifieke-voedingsstoffen-geeft-snel-resultaat-en-herstel-bij-kinderen-en-jongeren-met-een-actief-stadium-van-de-ziekte-van-crohn-na-1-maand-is-grootste-deel-van-de-klachten-al-weg.html

20 april 2024: Bron: LUMC

Een poeptransplantatie via een sonde met bewerkte ontlasting van gezonde donoren in de darmen van chronisch zieke mensen met de ziekte van Crohn (Clostridiodis difficile) onderdrukt de resistentie tegen bv antibiotica en nog beter doet de bacteriën die de resistentie veroorzaken verdwijnen. Ook blijkt uit een test na drie jaar bij de behandelde patiënten dat de resistentie nog steeds was opgeheven. Dat blijkt uit onderzoek van Liz Terveer, arts-microbioloog bij het LUMC en hoofd van de Nederlandse Donor Feces Bank (NDFB).

Extra interessant is dat Liz Terveer ook gaat onderzoeken wat het effect kan zijn van een poeptransplantatie bij patiënten met een melanoom die immuuntherapie krijgen: 

Een citaat uit een persbericht van het LUMC:

Terveer gaat verder met haar onderzoek door andere typen patiënten te betrekken bij poeptransplantatie. "We zijn nu een studie gestart met het Antoni van Leeuwenhoek Ziekenhuis om te kijken of dezelfde behandeling ook aanslaat bij patiënten met uitgezaaide melanomen om het effect van de immuuntherapie die zij krijgen te versterken. De gedachte daarachter is dat een poeptransplantatie zo'n sterke immuunrespons opwekt dat het eigen immuunsysteem van een patiënt de kankercellen veel adequater gaat opruimen."

Nog een citaat:

In het LUMC is drie jaar onderzoek verricht naar de mogelijkheid van poeptransplantatie bij chronisch zieke mensen. Terveer: "Dit hebben we gedaan bij alle patiënten die zich hadden aangemeld bij onze donorbank voor een fecestransplantatie. We hebben hun poep op kweek gezet en de persoonlijke gemeenschap van bacteriën in kaart gebracht. Zo kregen we een compleet beeld van de darmomgeving van iedere patiënt. Zo'n omgeving is te vergelijken met een ziek ecosysteem, waarin we de biodiversiteit willen herstellen door nieuwe soorten in te voeren. In dit geval brachten we gefilterde ontlasting van een donor via een sonde in bij de patiënt."

Het gevolg was dat patiënten na drie weken geen of een sterk verlaagde hoeveelheid resistente bacteriën bij zich droegen. Terveer: "Een mooi en snel resultaat. Een deel van de mensen hebben we drie jaar lang gevolgd en we weten nu dat het effect ook duurzaam is.">>>>>>lees het hele persbericht

Het originele studierapport is gratis in te zien met veel details en grafieken:

Long-term beneficial effect of faecal microbiota transplantation on colonisation of multidrug-resistant bacteria and resistome abundance in patients with recurrent Clostridioides difficile infection

Genome Medicine volume 16, Article number: 37 (2024) Cite this article

Abstract

Background

Multidrug-resistant (MDR) bacteria are a growing global threat, especially in healthcare facilities. Faecal microbiota transplantation (FMT) is an effective prevention strategy for recurrences of Clostridioides difficile infections and can also be useful for other microbiota-related diseases.

Methods

We study the effect of FMT in patients with multiple recurrent C. difficile infections on colonisation with MDR bacteria and antibiotic resistance genes (ARG) on the short (3 weeks) and long term (1–3 years), combining culture methods and faecal metagenomics.

Results

Based on MDR culture (n = 87 patients), we notice a decrease of 11.5% in the colonisation rate of MDR bacteria after FMT (20/87 before FMT = 23%, 10/87 3 weeks after FMT). Metagenomic sequencing of patient stool samples (n = 63) shows a reduction in relative abundances of ARGs in faeces, while the number of different resistance genes in patients remained higher compared to stools of their corresponding healthy donors (n = 11). Furthermore, plasmid predictions in metagenomic data indicate that patients harboured increased levels of resistance plasmids, which appear unaffected by FMT. In the long term (n = 22 patients), the recipients’ resistomes are still donor-like, suggesting the effect of FMT may last for years.

Conclusions

Taken together, we hypothesise that FMT restores the gut microbiota to a composition that is closer to the composition of healthy donors, and potential pathogens are either lost or decreased to very low abundances. This process, however, does not end in the days following FMT. It may take months for the gut microbiome to re-establish a balanced state. Even though a reservoir of resistance genes remains, a notable part of which on plasmids, FMT decreases the total load of resistance genes.

Conclusions

Our study points towards possibilities and limitations of the use of FMT for the eradication of MDR bacteria in the gut. Based on pre- and post-FMT resistome analysis (including a unique LTFU of 1–3 years), we find that FMT induces significant changes in the recipient resistome, that may be associated with a reduction in the abundance of Enterobacterales. However, we also find that specific recipient-ARGs persist. The clinical consequences of this persistence were not included in this study and require further analyses in large cohort of FMT-treated patients. To better assess the possible benefits in MDR eradication, we need larger (randomised controlled) trials and multi-omics studies combined with classical microbiological methods that can link ARGs to bacterial taxa, and to the host’s gut ecosystem. Additionally, the use of local, national and international registries for FMT can help collect long-term data to assess infection risks in different patient populations [81, 82]. Besides keeping track of MDR-related outcomes, these registries facilitate evaluation of other long-term microbiota-related risks, such as CDI recurrence or procarcinogenic bacteria [49, 83, 84]. Finally, studies with control patients and more diverse patients are needed to explain the resistome differences and obtain more generalisable results. This will pave the way for evaluating the feasibility of FMT to control antibiotic resistance in infection-susceptible patients.

Availability of data and materials

Sequencing reads generated for this study are available in the European Nucleotide Archive under project numbers PRJEB64622 (https://www.ebi.ac.uk/ena/browser/view/PRJEB64622) [48], PRJEB44737 (https://www.ebi.ac.uk/ena/browser/view/PRJEB44737) [50], and PRJEB64621 (https://www.ebi.ac.uk/ena/browser/view/PRJEB64621) [51]. Code to reproduce analyses and generate figures are available at Zenodo (https://doi.org/https://doi.org/10.5281/zenodo.10276220) [60].

Acknowledgements

We wish to express our gratitude to Eric K.L. Berssenbrugge and Ingrid M.G.J. Sanders from the Experimental Bacteriology group at the LUMC for culturing the MDR bacteria. We thank Prof. Dr. Hein W. Verspaget of the Netherlands Donor Feces Bank for continuous support and supervision. Also, our thanks go to GenomeScan B.V. for providing the DNA sequencing. Finally, we thank the Experimental Bacteriology group and the Center for Microbiome Analyses and Therapeutics of the LUMC for fruitful work discussions, and in particular Dr. Wiep Klaas Smits for feedback on the manuscript.

Funding

The Netherlands Donor Feces Bank have received an unrestricted research grant from Vedanta Biosciences.

Author information

Authors and Affiliations

  1. Netherlands Donor Feces Bank, Leiden University Center of Infectious Diseases (LUCID) Medical Microbiology and Infection Prevention, Leiden University Medical Center, PO Box 9600, Postzone E4-P, Leiden, 2300RC, Netherlands

    Sam Nooij, Karuna E. W. Vendrik, Josbert J. Keller & Elisabeth M. Terveer

  2. Center for Microbiome Analyses and Therapeutics, LUCID Research, Leiden University Medical Center, Leiden, Netherlands

    Sam Nooij, Karuna E. W. Vendrik, Romy D. Zwittink, Quinten R. Ducarmon, Ed J. Kuijper & Elisabeth M. Terveer

  3. Department of Gastroenterology, Haaglanden Medical Center, The Hague, Netherlands

    Josbert J. Keller

  4. Present address: Centre for Infectious Disease Control, Netherlands Institute for Public Health and the Environment, Bilthoven, The Netherlands

    Karuna E. W. Vendrik & Romy D. Zwittink

Consortia

on behalf of the Netherlands Donor Feces Bank study group

Contributions

SN, KEWV, RDZ, EJK and EMT conceptualised and designed the study. QRD, EJK and EMT supervised the study. KEWV, JJK, EJK and EMT supervised treatment of patients. KEWV collected clinical and microbiological data and performed analyses. SN performed genomics, metagenomics and statistical analyses and drafted the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sam Nooij.

Ethics declarations

Ethics approval and consent to participate

Written informed consent was obtained from all patients and donors for use of their faecal samples and follow-up data. Ethical approval was granted for the protocols and practice of the NDFB by the local medical ethics committee at the Leiden University Medical Center (reference P15.145, and long-term follow-up: B21.49). This study conforms to the principles of the Helsinki declaration.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.


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chronisch zieke mensen, resistente bacterien, poeptransplantatie, Liz Terveer, arts-microbioloog bij het LUMC, darmbacterien


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