Virome may be just as important as microbiome for FMT success

Restoration of the gut virome may be as important as restoration of the bacterial microbiome in the management of Clostridium difficle infections (CDI) via faecal microbiota transplants (FMT).

According to a preliminary Chinese study of 24 patients with CDI and 20 healthy controls, CDI is characterised by enteric virome dysbiosis.

Amongst other changes, faecal samples from patients with CDI had significantly more Caudovirales overall but a lower diversity, richness and evenness of the bacteriophages than in control samples.

The study also found the abundance of Caudovirales decreased following FMT.

All patients who received FMT from donors with a higher richness of Caudvirales were cured of CDI whereas the treatment response was inconsistent in people receiving FMT from donors with lower richness of the bacteriophages.

The researchers said the findings highlight the therapeutic potential of components in donor samples other than bacteria.

It also suggested that future FMT therapy should take into consideration a detailed characterisation of the faecal virome in donors and recipients.

“Bacteriophages have the potential to alter the composition and function of host microbiota and influence treatment outcomes. In particular, correlations between specific bacteriophages and bacteria shown in this study appeared to be associated with the outcome of FMT in CDI,” the researchers said.

Commenting on the study, Professor Tom Borody told the limbic the findings opened the door to new mechanisms for managing CDI, especially when considered together with other recent work.

Professor Borody, director of the Centre for Digestive Diseases in Sydney, said German research had shown that administration of sterile fecal filtrates to patients with CDI could also eliminate symptoms and restore normal stool habits.

“We think that we need to add some Bacteroides or Firmicutes and then CDI goes away but actually it could be the products of the bacteria or bacteriophages doing the work in FMT.”

“There is more interest now in finding which component has the greatest effect in CDI or whether there is a synergistic effect. It may be that different FMT treatments may be useful for different conditions,” he added.

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