Fecal microbiota transplantation in patients with metabolic syndrome and obesity: A randomized controlled trial

Alberto Machado da Ponte Neto; Aniele Cristine Ott Clemente; Paula Waki Rosa; Igor Braga Ribeiro; Mateus Pereira Funari; Gabriel Cairo Nunes; Luana Moreira; Luiz Gustavo Sparvoli; Ramon Cortez; Carla Romano Taddei; Márcio C Mancini; Eduardo Guimarães Hourneaux de Moura

doi:10.12998/wjcc.v11.i19.4612

Fecal microbiota transplantation in patients with metabolic syndrome and obesity: A randomized controlled trial

World J Clin Cases. 2023 Jul 6;11(19):4612-4624. doi: 10.12998/wjcc.v11.i19.4612.

Affiliations

¹ Departament of Gastroenterology, Faculdade de Medicina, Universidade de Sao Paulo, Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, São Paulo 05403-010, SP, Brazil.
² Department of Endocrinology, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo 05403-010, SP, Brazil.
³ Departament of Gastroenterology, Faculdade de Medicina, Universidade de Sao Paulo, Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, São Paulo 05403-010, SP, Brazil. igorbraga1@gmail.com.
⁴ Department of Clinical and Toxicology Analysis, School of Pharmaceutical Sciences, University of São Paulo, São Paulo 05403-010, SP, Brazil.
⁵ School of Arts, Science and Humanities, University of São Paulo, São Paulo 05403-010, SP, Brazil.

Abstract

Background: Metabolic syndrome is a multifactorial disease, and the gut microbiota may play a role in its pathogenesis. Obesity, especially abdominal obesity, is associated with insulin resistance, often increasing the risk of type two diabetes mellitus, vascular endothelial dysfunction, an abnormal lipid profile, hypertension, and vascular inflammation, all of which promote the development of atherosclerotic cardiovascular disease.

Aim: To evaluate the outcomes of fecal microbiota transplantation (FMT) in patients with metabolic syndrome.

Methods: This was a randomized, single-blind placebo-controlled trial comparing FMT and a sham procedure in patients with metabolic syndrome. We selected 32 female patients, who were divided into eight groups of four patients each. All of the patients were submitted to upper gastrointestinal endoscopy. In each group, two patients were randomly allocated to undergo FMT, and the other two patients received saline infusion. The patients were followed for one year after the procedures, during which time anthropometric, bioimpedance, and biochemical data were collected. The patients also had periodic consultations with a nutritionist and an endocrinologist. The primary end point was a change in the gut microbiota.

Results: There was evidence of a postprocedural change in microbiota composition in the patients who underwent FMT in relation to that observed in those who underwent the sham procedure. However, we found no difference between the two groups in terms of the clinical parameters evaluated.

Conclusion: There were no significant differences in biochemical or anthropometric parameters, between the two groups evaluated. Nevertheless, there were significant postprocedural differences in the microbiota composition between the placebo group. To date, clinical outcomes related to FMT remain uncertain.

Keywords: Diabetes mellitus; Endocrinology; Endoscopy; Fecal microbiota transplantation; Metabolic syndrome; Obesity.