Fecal Transplants Relieve Constipation and Motor, Non-Motor Symptoms

Fecal transplants — when patients receive a transplant of healthy gut microbiota into their intestines — were found to alleviate gastrointestinal problems, including constipation, and lessen both motor and non-motor symptoms in people with Parkinson’s disease, a small study showed.

The results of the study suggest that the use of fecal transplants to target the gut-brain axis, which regulates gastrointestinal function and has been linked to several neurological disorders, may have potential as a Parkinson’s disease therapy.

“This tentative study may open a new avenue to study the mechanism of the microbe-gut-brain axis and the biological treatment of Parkinson’s,” the researchers wrote.

The study, “Evaluation of fecal microbiota transplantation in Parkinson’s disease patients with constipation,” was published in Microbial Cell Factories.

Gastrointestinal problems such as constipation are one of the most common non-motor symptoms of Parkinson’s, affecting around 70–80% of patients. Both constipation and motor impairments have been linked to abnormal gut microbiome — the bacteria that live inside the intestines — which is one of the earliest markers of Parkinson’s disease.

In fecal microbiota transplants, patients receive a transplant from a healthy person’s gut microbiota into their intestines. Although research in the area is limited, one study suggested that fecal transplants may help alleviate some motor and non-motor Parkinson’s symptoms.

Now, a team of researchers from The Affiliated Suzhou Hospital of Nanjing Medical University, in China, assessed the effectiveness and safety of fecal microbiota transplants as a treatment for gastrointestinal dysfunction and other clinical features of Parkinson’s patients. 

A total of 11 individuals — seven men and four women — with the neurodegenerative disorder and constipation were included in the study. The patients had a mean age of 62.45 and a median disease duration of 7.18 years.

Motor and non-motor symptoms were evaluated at six and 12 weeks post-transplant using the Hoehn and Yahr (H-Y) Grade, the Unified Parkinson’s Disease Rating Scale (UPDRS), and the Non-Motion Symptom Questionnaire (NMSS).

Constipation symptoms were assessed using the Patient Assessment of Constipation Quality of Life (PAC-QOL) score and the Wexner constipation score. For all assessments, lower scores represent reduced symptoms.

At six and 12 weeks (about three months) post-transplant, there was a lessening in motor and non-motor symptoms as evidence by drops in the scores of all scales assessed. Specifically, at 12 weeks post-surgery, 10 patients (90.1%, all but one individual) had significantly lower scores in the H-Y Grade.

These results indicate that among this small patient group, fecal microbiota transplant appears to have reduced both motor and non-motor Parkinson’s symptoms.

Constipation symptoms also were alleviated at six and 12 weeks post-transplant.

The median expression of homocysteine — a marker for neuronal damage in Parkinson’s disease — was significantly lower 12 weeks after the procedure.

In the week before the transplant, an overgrowth of small intestinal bacteria was observed in all 11 patients. At 12 weeks post-transplant, this overgrowth was had resolved. 

Additionally, the diversity and richness of gut bacteria in these Parkinson’s patients were significantly different before and after the fecal microbiota transplants. Specifically, species diversity and the pattern of the richness of patients’ gut before transplant were significantly decreased at the beginning of the study when compared with 12 weeks after transplant and with that of healthy controls. However, at 12 weeks following the procedure, the diversity and richness were not significantly different from those of the healthy controls.

The most frequently reported adverse events during the fecal microbiota transplants were flatulence (45.5%), abdominal pain (27.3%), nausea (27.3%), venting (18.2%), throat irritation (18.2%), and diarrhea (9.1%), with all cases being mild. Abdominal pain (18.2%) and flatulence (18.2%) were reported during follow-up.

“Based on our results, FMT [fecal microbiota transplant] is a good choice for PD [Parkinson’s disease] treatment with gastrointestinal symptoms; however, its effectiveness and safety requires further evaluation,” the researchers wrote. “In order to evaluate the effectiveness and safety of FMT in the treatment of PD accurately, a larger sample study is required in the future.”