PMC9996308_01
PMC9996308_02
Therapeutic evaluation of fecal microbiota transplantation. (A) Clinical assessments of ankylosing spondylitis (AS) and ulcerative colitis (UC). (B) Laboratory findings. ASDAS, AS Disease Activity Score; BASDAI, Bath AS Disease Activity Index; BAS-G, Bath AS Patient Global Score; BASFI, Bath AS Functional Index; BASMI, Bath AS Metrology Index; pMS, partial Mayo score; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; IL-6, interleukin-6; Hb, hemoglobin.
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Ankylosing Spondylitis Disease Activity Index (BASDAI) was 4.81 and 5.1, respectively ( Figure 1A ). Severe back pain with a limitation of axial mobility led the patient to be wheelchair-ridden. Besides this, a moderate disease activity of UC was exhibited (Mayo score = 6), in which bloody diarrhea occurred accompanied with a low level of hemoglobin (85 g/L). At 3 days after FMT1, the patient reported relief from low back pain. Hemoglobin rose from a baseline value of 85 to 108 g/L ( Figure 1B ). During the follow-up period (week 16 and week 36), the AS disease status was maintained ( Figure 1 ).
Colonoscopy photographs. FMT1 showing mucosal erythema, friability, erosions with white fur-like substance, and an obscure vascular pattern (Mayo endoscopic score = 2). FMT2 showing a milder degree of the above-mentioned characteristics (Mayo endoscopic score = 1). FMT3 showing an almost normal colonic mucosal appearance with faint inflammatory evidence (Mayo endoscopic score = 1).
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Besides these, colonoscopy at FMT2 revealed slighter colitis (Mayo endoscopic sub-score from baseline 2 to 1) ( Figure 2 ).
Microbial profiles. (A) Principal coordinate analysis of the taxonomy profile. (B) Shannon index of the gut microbiota. (C) Taxonomy at the genus level. D1-D3 represent the microbial profiles of donors for FMT1-3.
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The results of the principal coordinate analysis demonstrated that the microbial profile of the patient improved toward those of donors following FMTs and remained roughly stable ( Figure 3A ). The Shannon index of the patient's fecal microbiota was increased after FMT1 and decreased after FMT3 ( Figure 3B ). Marked changes at the genus level, such as decreased relative abundance of Escherichia-Shigella and Intestinibacter and increased relative abundance of Faecalibacterium and Parasutterella, were detected after FMT ( Figure 3C ). Moreover, a microbial disturbance at 8 weeks post-FMT2 (week 12), which might have been influenced by external factors such as staying up late, was also observed ( Figure 3 ).