Review Article

Fecal Microbiota Transplantation: A New Therapeutic Attempt from the Gut to the Brain

Table 2

Clinical application for FMT based on the gut-brain axis.

Disease typeStudiesStudy typeLocationAgeSexComplicationAdministration routeFMT frequencyDonorClinical outcome

Neurological diseases
 Parkinson’s diseaseHuang et al. [49]Case report1China71MPD, constipationTET tube (colon)3 timesHealthy volunteerConstipation cured, PD symptoms relieved for 2 months
 Alzheimer’s diseaseHazan [50]Case report1USA82MAD, rCDIColonoscopyOnceHis wifeMMSE score increased from 20 to 29
 Multiple sclerosisBorody et al. [51]Case series3Australia30/29/80M/M/FMS, constipation, vertigo, impaired concentration/MS, constipation/MS, constipation, proctalgia fugax, difficulty in walkingNA5 FMTs/10 FMTs/5 FMTsNAConstipation resoluted, MS improved, 15 years post-FMT without relapse/constipation resolved, neurological symptoms improved, 3 years maintained normal motor/bowel symptoms resoluted, neurological improved
Makkawi et al. [52]Case report1Canada61FMS, rCDIEnemaOnceHer partnerrCDI resolved, prevented MS progression for over 10 years
 EpilepsyHe et al. [53]Case report1China22FEpilepsy, CDTET tube (colon)3 timesHealthy volunteerSeizure-free without antiepileptic drugs, decreasing CDAI to 104 points after 12 months and maintained until the end of 20-month follow-up
 Tourette SyndromeZhao et al. [54]Case report1China9MTSGastroscope & colonoscopyOnceHealthy volunteerYGTSS-total tic score decreased from 31 to 5, motor severity score fell from 16 to 5, vocal severity score fell from 15 to 0, shifting from severe to mild
Ding et al. [55]Open-label clinical trial11ChinaMTSTET tube (nasojejunal)3 timesHealthy volunteer45.5% (5/11), 45.5% (5/11) and 36.4% (4/11) of patients achieved improvement (≥30% reduction in YGTSS-total tic score) at week 1, week 4, and week 8 post-FMT, respectively. GTS-QoL score decreased at week 8 post-FMT
 Myalgic encephalomyelitis/chronic fatigue syndromeBorody et al. [56]Larger cohort study60Australia36 F, 24 MCFS (52 with IBS, 4 with constipation)Single TC infusion (), two-day infusion (TC and enema, ), three-day infusion (TC, 2-day enema, )Once/twice/3 times13 nonpathogenic enteric bacteria from healthy individual35/60 patients responded after single FMT while7 patients responded after secondary FMT, giving a total of 42/60 improved patients
Psychiatric diseases
 Autism spectrum disorderWard et al. [57]Case series9CanadaNAASDCapsules & enemaTwiceHealthy volunteerASD symptoms were not changed in the 21-year-old subject, while markedly improving in 1 of two 8-year-old subjects
Zhao et al. [58]Open-label, randomized waitlist-controlled trial48ChinaNANAASDGastroscope & colonoscopyTwiceHealthy volunteerCARS score in the FMT group showed a statistically 10.8% decrease compared to a 0.8% decrease in the waitlist group after the first FMT and remained marginally reduced after the second FMT
Kang et al. [32]Open-label clinical trial18USA7 to 16 yearsNAASDOral vs. enemaFor 7–8 weeksHealthy volunteer80% reduction of GI symptoms post-FMT, ASD symptoms improved significantly and remained improved 8 weeks post-FMT
Kang et al. [32]Follow-up of a clinical trial18USA7 to 16 yearsNAASDOral vs. enemaFor 7–8 weeksHealthy volunteerTwo years post-FMT, most GI symptom improvements continued, and autism-related symptoms improved even more
 Bipolar disorderHinton [59]Case report1Australia33FBDNA9 FMTs over a period of 2 monthsHer husbandSymptom-free from depression
 DepressionCai et al. [60]Case report1China79FMDDGastroscopeOnceHer grandsonPHQ-9 scores improved
Other system-related neurological diseases
 Hepatic encephalopathyKao et al. [61]Case report1Canada57MLiver cirrhosis, HEColonoscopy & enema5 FMTsHealthy volunteerStoop test, serum ammonia, and quality of life all significantly improved; appetite, alertness and overall well-being improved
Bajaj et al. [62]Open-label, randomized clinical trial20USA (FMT) vs. (SOC)MLiver cirrhosis, HEEnemaOnceHealthy volunteerSignificantly improved in PHES total score and EncephalApp Stroop in the FMT group
Bajaj et al. [63]A phase 1, randomized, placebo-controlled trial20USA (FMT) vs. (SOC)16 M, 4 FLiver cirrhosis, HECapsules15 capsules of FMT/placeboHealthy volunteerEncephalApp improved
 Neuropathic painCai et al. [64]Case report1China46FDiabetic neuropathyColonoscopyTwiceHealthy volunteerThe glycemic control improved, with a remarkable relief of the symptoms of painful DN
 SepsisLi et al. [65]Case report1China29FBacteremia, shockNasoduodenal tubeOnceHealthy volunteerFever went down, and the stool output had a marked reduction
Li et al. [66]Case report1China44FShock, respiratory failure, AKINasoduodenal tubeOnceHealthy volunteerPatient’s septic symptoms and severe diarrhea were successfully controlled
Wei et al. [67]Case report2China65/84MShock, respiratory failure, bacteremia, AKINasoduodenal tubeOnceHealthy volunteerMODS and severe diarrhea were alleviated in both patients
Gopalsamy et al. [68]Case report1Georgia57MMDRO infection, respiratory failurePEG tubeOnceNADeath (not due to FMT)

FMT: fecal microbiota transplantation; M: male; F: female; PD: Parkinson’s disease; TET: transendoscopic enteral tubing; MMSE score: minimental state examination score; AD: Alzheimer’s disease; rCDI: recurrent clostridium difficile infection; CDAI: Crohn’s disease activity index; MS: multiple sclerosis; CD: Crohn’s disease; YGTSS-total tic score: Yale Global Tic Severity Scale-total tic score; TS: Tourette Syndrome; GTS-QoL score: Gilles de la Tourette Syndrome-quality of life score; CFS: chronic fatigue syndrome; IBS: Irritable bowel syndrome; TC: transcolonoscopic; ASD: autism spectrum disorder; CARS score: childhood autism rating scale score; BD: bipolar disorder; MDD: major depressive disorder; PHQ-9 scores: Patient Health Questionnaire-9 scores; HE: hepatic encephalopathy; PHES total score: psychometric hepatic encephalopathy score total score; DN: diabetic neuropathy; AKI: acute kidney injury; MODS: multiple organ dysfunction syndrome; MDRO infection: multidrug-resistant organism infection; PEG tube: polyethylene glycol tube.