5 Questions About the Role of FMT in Weight Loss

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The Centers for Disease Control and Prevention estimates that approximately 93.3 million US adults had obesity from 2015 to 2016.1 And according to the researchers of a pilot study, these people may have another option for weight loss treatment.2

The study, which was coauthored by Jessica R. Allegretti, MD, MPH, director of the Fecal Microbiota Transplant Program at Brigham and Women’s Hospital, investigated the impact that fecal microbiota transplant (FMT) from a lean donor has on a person with obesity who is metabolically normal. The results showed that it is safe for people with obesity to receive FMT from a person who is lean. In fact, such a transplant may lead to engraftment of donor-specific taxa.

Gastroenterology Consultant spoke with Dr Allegretti about the research and its implications for clinical practice.

Gastroenterology Consultant: In discovering that FMT from lean donors is safe, were there any surprises in your findings?

Jessica Allegretti: Unfortunately, it was ultimately a negative study for our primary outcome, which was a change in glucagon-like-peptide-1 (GLP-1). What I take away from it all is that perhaps GLP-1 was not the correct pathway on which to focus. We did ultimately assess many other variables, and we certainly learned quite a bit from the study. We noted significant changes in the bile acid profiles, so we are doing follow-up work on analyzing various metabolites. In turn, the obvious next steps would be analyzing the dosage—maybe the reason it was a negative trial was because we did not dose correctly. There are still many questions, but at least we come away with knowing that FMT was safe and well tolerated, and that we were able to achieve engraftment of that lean donor bacteria. Those are all very promising first steps, but a lot of work still needs to be done.

GASTRO CON: Do you have a timeline on when we can expect those next steps in research?

JA: That is the $1 million question—figuratively and legitimately, because it takes $1 million to fund the research. We are currently in the funding acquisition phase, but I do expect within the next year or so to at least be in the beginning steps. For some context, this placebo-controlled pilot trial took us about 4.5 years to do.

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