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Fecal transplant stops beta cell decline in newly diagnosed T1D

Reuters Health - 20/11/2020 - Fecal microbiota transplantation (FMT) stops the functional decline of islet beta cells in adults with new-onset type-1 diabetes (T1D), a new randomized controlled trial shows.

"Autoimmune diseases could be fueled by altered (small) intestinal gut microbiota composition," Dr. Max Niewdorp of Amsterdam University Medical Centres, in the Netherlands, told Reuters Health by email. "Diet and gut microbiota composition could be important in autoimmune endocrine diseases, but more research is needed."

Studies in mice suggest that T1D is associated with changes in the microbiome, and that the small-intestinal immune system may play a role, Dr. Niewdorp and his team write in Gut.

They investigated whether autologous FMTs or allogeneic FMTs from healthy donors would affect beta-cell function in 20 patients with diabetes diagnosed less than six weeks previously. Patients were randomized to receive three donor FMTs or three autologous FMTs over four months.

At 12 months, stimulated C peptide levels showed greater preservation of beta-cell function in the autologous-FMT group compared with the donor-FMT group.

There was an inverse relationship between small-intestinal Prevotella and residual beta-cell function. Preservation of beta-cell function had a linear correlation with plasma metabolites 1-arachidonoyl-GPC and 1-myristoyl-2-arachidonoyl-GPC levels.

Several baseline factors predicted whether a patient would have preserved beta-cell function with FMT, including CD4 +CXCR3+T-cell counts, small-intestinal Desulfovibrio piger, and duodenal biopsies showing CCL22 and CCL5 gene expression.

"There seems to be a specific match between specific gut microbiota strains and autoimmunological tone for some DM1 patients," Dr. Nieuwdorp said. The findings also suggest, he added, that "based on microbiota composition at baseline, we might be able to flesh out in which patients course of type 1 diabetes can be altered by microbiota and in whom this cannot be."

He and his colleagues are currently conducting larger trials of FMT in T1D patients, and plan to investigate whether gut microbiota are associated with autoimmunity in patients with longer-standing disease.

The study did not have commercial funding.

By Anne Harding

SOURCE: https://bit.ly/3eNLmYH Gut, online October 30, 2020.

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