Fecal Transplant Improves Cognitive Malfunction Caused by Liver Disease, Study Finds

Joana Fernandes, PhD avatar

by Joana Fernandes, PhD |

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Gut fungi and liver disease

Transplanting fecal bacteria from a healthy person to someone who has a liver-connected brain impairment may be an effective way to treat the condition, known as hepatic encephalopathy, a Norwegian study reports.

A single injection of fecal bacteria from a healthy donor, combined with an antibiotic, prevented all but two of the 20 patients in the study from having to be hospitalized because the disease failed to respond or because it recurred. Antibiotics alone led to 11 hospitalizations.

In addition, the transplant-antibiotic combo treatment restored the bacterial composition that had been effective in clearing toxins from patients’ bodies. It was also safe and well-tolerated.

Researchers presented the findings at the International Liver Congress in Amsterdam, April 19-23. The abstract was titled “Fecal Microbiota Transplant Using A Precision Medicine Approach Is Safe, Associated With Lower Hospitalization Risk And Improved Cognitive Function In Recurrent Hepatic Encephalopathy.”

Patients with liver disease are susceptible to developing hepatic encephalopathy because their liver can no longer eliminate certain toxins and other products formed during normal body activity. The molecules can accumulate in the blood and reach the brain, where they can cause harm.

Symptoms of hepatic encephalopathy include mild confusion, forgetfulness, and poor concentration. Patients can develop a severe form of the disease that produces high levels of confusion and anxiety, impaired movement, speech problems and seizures.

Episodes of hepatic encephalopathy are typically treated with the antibiotics lactulose and rifaximin. The disease often recurs with antibiotics, meaning there are a lot of hospitalizations associated with the treatment.

“Hepatic encephalopathy is a serious condition and a leading cause of re-admission to hospital due to recurrence, despite standard of care treatment,” Jasmohan Bajaj, the study’s lead author, said in a news release. “The results from this study demonstrate that in patients with hepatic encephalopathy, a fecal transplant improves brain function more than standard of care as well as reducing the number of hospital admissions, including those for recurrent hepatic encephalopathy. Fecal transplantation is an innovative and promising approach to treat this condition, and we look forward to more studies being conducted to confirm our results.”

The study investigated the effects of fecal transplantation plus an antibiotic in 20 men who had liver damage and experienced frequent hepatic encephalopathy episodes.

Patients received either a single injection of fecal bacteria from a healthy donor plus five days of antibiotic treatment, or an antibiotic alone. Researchers followed the patients for up to 150 days.

Measures of cognitive function were significantly higher in patients who received the fecal transplant, compared with the other group. Liver disease measurements increased significantly after antibiotic treatment, but returned to normal after the fecal transplant. The transplants also led to an increase in beneficial strains of bacteria, such as Bifidobacteriaceae and Lactobacillaceae.

Patients who received an antibiotic alone showed little change in cognitive function, liver disease or beneficial bacteria.

“This is the first randomised trial to show that fecal transplantation may be of benefit to patients with hepatic encephalopathy,” said Tom Karlsen of the Oslo University Hospital Rikshospitalet in Norway. “The encouraging findings open new avenues of research to determine how to best manipulate the gut microbiota in patients with hepatic encephalopathy.

“They also show proof-of-concept for the likely beneficial impact of such interventions, adding to what is already known for non-absorbable antibiotics like rifaximin,” he added.