PDF(Pubmed)
Abstract：
In patients with ulcerative colitis (UC), the development of an antidrug antibody (ADA) to anti-tumor necrosis factor (TNF)α agent is a crucial problem which aggravates the clinical course of the disease, being cited as one of the most common causes for discontinuing anti-TNFα treatment. This is due to ADA eventually causing secondary LOR, leading to discontinuation of anti-TNFα treatment. Recently, research on the microbiome and relationship between worsening UC and dysbiosis has been conducted. Further, investigations on the association between the microbiome and secondary LOR are increasing. Here, we present the therapeutic effect of fecal microbiota transplantation (FMT) on a 42-year-old man with secondary LOR and high ADA levels. FMT has recently been used for the treatment of, and for overcoming, drug resistance through microbiome modification. Stool samples were collected from the patient before and 4 weeks after FMT. Symptoms, including hematochezia and Mayo endoscopy sub-scores, improved after FMT, while ADA levels decreased by one-third to less than half the value (29 ng/mL) compared to before FMT (79 ng/mL). Additionally, the trough level of infliximab became measurable, which reflects the improvement in the area under the concentration (AUC). Butyricicoccus, Faecalibacterium, Bifidobacterium, Ligilactobacillus, Alistipes, and Odoribacter, which regulate immune responses and alleviate inflammation, also increased after FMT. We report a case in which microbiome modification by FMT increased the AUC of anti-TNFα in a patient who developed secondary LOR during anti-TNFα treatment, thereby improving symptoms and mucosal inflammation.
摘要：
在溃疡性结肠炎（UC）患者中，抗肿瘤坏死因子(TNF)α药物的抗药抗体(ADA)的开发是加重该疾病临床进程的关键问题,被认为是停止抗TNFα治疗的最常见原因之一。这是由于ADA最终导致二次LOR，导致停止抗TNFα治疗。最近,对微生物组以及UC恶化与菌群失调之间的关系进行了研究。Further,关于微生物组和次级LOR之间关联的研究正在增加.这里,我们介绍了粪便微生物移植(FMT)对一名42岁的继发性LOR和高ADA水平男性的治疗效果.FMT最近被用于治疗，为了克服，通过微生物组修饰产生耐药性。在FMT之前和之后4周从患者收集粪便样品。症状,包括便血和Mayo内窥镜检查子评分，FMT后改进，而与FMT前（79ng/mL）相比，ADA水平下降了三分之一至不到一半（29ng/mL）。此外,英夫利昔单抗的谷值水平变得可测量，这反映了浓度下面积(AUC)的改善。Butyricicocus,粪杆菌,双歧杆菌,小杆菌,Alistipes,和Odoribacter,调节免疫反应和减轻炎症，FMT后也有所增加。我们报告了一个病例，在抗TNFα治疗期间发生继发性LOR的患者中，FMT对微生物组的修饰增加了抗TNFα的AUC，从而改善症状和粘膜炎症。
