Safety and efficacy of fecal microbiota transplantation for autoimmune diseases and autoinflammatory diseases: A systematic review and meta-analysis

Liuting Zeng; Ying Deng; Kailin Yang; Junpeng Chen; Qi He; Hua Chen

doi:10.3389/fimmu.2022.944387

Safety and efficacy of fecal microbiota transplantation for autoimmune diseases and autoinflammatory diseases: A systematic review and meta-analysis

Front Immunol. 2022 Sep 30:13:944387. doi: 10.3389/fimmu.2022.944387. eCollection 2022.

Authors

Liuting Zeng¹, Ying Deng¹, Kailin Yang², Junpeng Chen³, Qi He⁴, Hua Chen¹

Affiliations

¹ Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.
² Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, Hunan University of Chinese Medicine, Changsha, China.
³ School of Mechanical Engineering, Hunan University of Science and Technology, Xiangtan, China.
⁴ People's Hospital of Ningxiang City, Ningxiang City, China.

Abstract

Objective: To evaluate the safety and efficacy of fecal microbiota transplantation for autoimmune diseases and autoinflammatory diseases.

Methods: Relevant literature was retrieved from the PubMed database, Embase database, Cochrane Library database, etc. The search period is from the establishment of the database to January 2022. The outcomes include clinical symptoms, improvement in biochemistry, improvement in intestinal microbiota, improvement in the immune system, and adverse events. Literature screening and data extraction were independently carried out by two researchers according to the inclusion and exclusion criteria, and RevMan 5.3 software was used for statistics and analysis.

Results: Overall, a total of 14 randomized controlled trials (RCTs) involving six types of autoimmune diseases were included. The results showed the following. 1) Type 1 diabetes mellitus (T1DM): compared with the autologous fecal microbiota transplantation (FMT) group (control group), the fasting plasma C peptide in the allogenic FMT group at 12 months was lower. 2) Systemic sclerosis: at week 4, compared with one of two placebo controls, three patients in the experimental group reported a major improvement in fecal incontinence. 3) Ulcerative colitis, pediatric ulcerative colitis, and Crohn's disease: FMT may increase clinical remission, clinical response, and endoscopic remission for patients with ulcerative colitis and increase clinical remission for patients with Crohn's disease. 4) Psoriatic arthritis: there was no difference in the ratio of ACR20 between the two groups.

Conclusion: Based on current evidence, the application of FMT in the treatment of autoimmune diseases is effective and relatively safe, and it is expected to be used as a method to induce remission of active autoimmune diseases.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021235055, identifier CRD42021235055.

Keywords: autoimmune diseases; autoinflammatory diseases; fecal microbiota transplantation; meta-analysis; systemic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Autoimmune Diseases* / etiology
Autoimmune Diseases* / therapy
C-Peptide
Child
Colitis, Ulcerative* / therapy
Crohn Disease* / etiology
Fecal Microbiota Transplantation / adverse effects
Fecal Microbiota Transplantation / methods
Hereditary Autoinflammatory Diseases* / etiology
Humans

Substances

C-Peptide