Fecal transplant leads to sudden obesity
02/23/15 01:24 PM
Loc: Seattle, WA
Reuters Health Information
Case Report: Fecal Transplants May up Risk of Obesity Onset
By Will Boggs MD
February 17, 2015
NEW YORK (Reuters Health) - Fecal microbiota transplantation can be effective for recurrent Clostridium difficile infection, but new-onset obesity could follow transplant of stool from an overweight donor, say the authors of a case report.
"Fecal transplant has helped a lot of people who have run out of other options," Dr. Colleen R. Kelly, from Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, told Reuters Health by email. "However, there is a lot we don't know in terms of side effects/risks and long-term safety."
Dr. Kelly and Dr. Neha Alang, from Newport Hospital, Rhode Island, report the case of a 32-year-old woman with recurrent C. difficile infection who received a fecal microbiota transplant from her 16-year-old daughter.
She had no further recurrence of her C. difficile infection after the transplant, according to the February 1 Open Forum Infectious Diseases online report.
Prior to her illness, she had always been of normal weight. In the 16 months after her fecal microbiota transplant, the patient reported an unintentional weight gain of 34 pounds. By 36 months post-transplant, she had gained another seven pounds despite efforts to diet and exercise.
"This patient's weight gain was dramatic and disturbing," Dr. Kelly said. "She told me she felt like a 'switch flipped' in her body after the fecal transplant, and she has been unable to get back to a healthy weight despite great efforts."
In the meantime, her daughter's weight increased from about 140 pounds (BMI=26.4) to 170 pounds.
Animal models support the notion that fecal microbiota transplantation can trigger or contribute to obesity. Unfortunately, the researchers note, they did not have microbiome sequencing to compare the patient and the donor.
Dr. Kelly also said that other factors could have contributed to her weight gain: "She was ill for a while; perhaps weight gain related to increased intake, which she kept up after getting better. . . . Perhaps genetics . . . her daughter was heavy before she was. Patient remembers going on oral contraceptives shortly after; another possible factor."
"(We) need much more research and probably a national registry to follow these patients for a period of time after fecal transplant," Dr. Kelly said. "There is a lot of excitement around fecal transplantation right now for other things; we must remember it's experimental and unproven therapy."
In the meantime, the authors recommend selecting non-overweight donors for fecal microbiota transplantation.
Dr. Ana A. Weil and Dr. Elizabeth L. Hohmann, from Massachusetts General Hospital and Harvard Medical School, Boston, wrote an editorial related to this report. They told Reuters Health in a jointly authored email, "Groups using family members or intimate partners as donors have proposed and used less rigorous lab testing and phenotyping of donors for numerous practical reasons."
"We don't yet know the entire spectrum of risks and benefits, for the short and the long term," they added. "For that reason, we should use caution in choosing donors, and more importantly in choosing patients who are deemed in need of fecal microbiota transplant (FMT). Yet, (we) would emphasize that for some patients FMT can be life-changing and even life-saving, such as patients with recurrent severe C. difficile infection."
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