Oral lyophilized donor FMT in ulcerative colitis

Oral lyophilized donor fecal microbiota transplantation (FMT) involves encapsulated, freeze-dried fecal microbiota from a healthy donor, designed for oral administration. This innovative approach simplifies the logistics of FMT compared to traditional frozen formulations, providing a practical, non-invasive treatment option. The goal of FMT is to restore microbial diversity and balance in the gut, which is often disrupted in ulcerative colitis (UC). UC is a chronic inflammatory bowel disease characterized by dysbiosis—reduced microbial diversity and loss of beneficial short-chain fatty acid-producing bacteria, such as Faecalibacterium prausnitzii and Akkermansia muciniphila. Dysbiosis contributes to intestinal inflammation, impaired barrier function, and disease progression.

The study investigated oral lyophilized FMT in mild-to-moderate UC patients, showing promising results. FMT significantly increased gut microbial diversity, shifting the microbiome toward the donor’s composition. Key beneficial taxa, such as Clostridium SGB6179, Faecalibacterium prausnitzii, and Alistipes finegoldii, engrafted efficiently into patients' microbiomes, promoting anti-inflammatory effects and epithelial repair. Functional changes included enhanced microbial pathways for L-citrulline biosynthesis and the urea cycle, vital for intestinal repair and immune modulation.

Clinically, 53% of FMT-treated patients achieved corticosteroid-free remission with endoscopic response by week 8, compared to 15% in the placebo group. Long-term low-dose FMT maintained remission for up to 56 weeks. Furthermore, FMT reduced antibiotic resistance gene abundance, restoring a healthier resistome profile. This study highlights oral lyophilized FMT as an effective, accessible therapy for UC, paving the way for targeted microbial therapeutics in chronic inflammatory bowel diseases.