Evaluation of fecal microbiota transplantation in Parkinson’s disease patients with constipation Original paper

What was studied?

This study investigated the efficacy and safety of fecal microbiota transplantation in treating Parkinson’s disease (PD) patients suffering from constipation, with a particular focus on changes in gut microbiota composition. The research aimed to determine whether FMT could alleviate both motor and non-motor symptoms of PD, improve constipation, and alter the gut microbial profile. Eleven PD patients received a single FMT, and fecal samples were analyzed via 16S rDNA gene sequencing before and at multiple intervals after treatment. Clinical outcomes were assessed using validated scales, while small intestinal bacterial overgrowth was monitored using lactulose H₂ breath tests. The study’s central question was whether FMT could correct gut microbial dysbiosis and thereby improve PD-related symptoms and gastrointestinal dysfunction.

Who was studied?

The study cohort comprised eleven individuals diagnosed with Parkinson’s disease and chronic constipation, recruited from The Affiliated Suzhou Hospital of Nanjing Medical University. Inclusion criteria required a PD diagnosis with significant constipation; exclusion criteria included severe immunodeficiency, major organ dysfunction, inability to consent, or concurrent intestinal infections. The group was mixed in age (mean 62.45 ± 13.08 years), gender (predominantly male), and disease duration (mean 7.18 ± 3.25 years), all following a traditional Chinese diet. All participants maintained their standard PD medications throughout the study. FMT material was sourced from healthy donors via a centralized fecal bank, and the transplantation was administered via a nasoduodenal tube.

Most important findings

FMT led to significant clinical and microbiological changes in PD patients with constipation. After FMT, there were marked improvements in both motor and non-motor symptoms, as evidenced by reduced Hoehn-Yahr grades, UPDRS, and NMSS scores. Constipation scores (PAC-QOL and Wexner) also decreased substantially. Importantly, SIBO, detected before FMT in all patients, resolved after treatment, indicating improved gut function.

Microbiome analysis revealed that before FMT, PD patients exhibited reduced gut microbial diversity and richness compared to healthy controls, with a dominance of Bacteroidetes (notably Bacteroides genus), Enterobacteriaceae (notably Escherichia-Shigella), and decreased levels of health-associated genera like Blautia and Faecalibacterium. Following FMT, there was a significant increase in community richness and restoration of diversity to levels comparable with healthy controls. Notably, the abundance of Blautia, Prevotella, and Faecalibacterium (butyrate producers with anti-inflammatory properties) increased, while Bacteroides and Escherichia-Shigella abundances decreased. These shifts suggest a correction of dysbiosis towards a more “eubiotic” profile. Correlation analyses linked these microbial changes with clinical parameters such as BMI and age. Adverse events were mild and self-limited, with no serious complications observed.

Key implications

This study provides compelling preliminary evidence that FMT can positively modulate the gut microbiome and improve gastrointestinal and neurological symptoms in PD patients with constipation. The observed increase in beneficial bacteria (Blautia, Faecalibacterium, Prevotella) and decrease in potential pathobionts (Bacteroides, Escherichia-Shigella) are clinically relevant microbiome signatures, suggesting FMT’s potential as a disease-modifying intervention via the gut-brain axis. The resolution of SIBO and improvements in motility further support the therapeutic role of restoring microbial balance. Despite the small sample size, these findings pave the way for larger, controlled studies and suggest that personalized microbiome-targeting therapies may become integral to managing PD-associated gastrointestinal dysfunction and perhaps modifying disease progression.

Citation

Kuai X, Yao X, Xu L, Zhou Y, Zhang L, Liu Y, Pei S, Zhou C. Evaluation of fecal microbiota transplantation in Parkinson’s disease patients with constipation. Microb Cell Fact. 2021;20:98. doi:10.1186/s12934-021-01589-0