Fecal microbiota transplantation Patients were randomly allocated to receive Before FMT, the phylum Proteobacteria was At T0, high levels of CD4+ and CD8+ via enema for recurrent frozen or fresh FMT via enema. Fecal highly prevalent in all patients, in particular the HLADR+CD38+ T lymphocytes were found. The microbiota composition was evaluated by gamma Proteobacteria class and the levels of immuneactivation of T lymphocytes Clostridium difficile infection 16S rDNA sequencing (MiSeq) before and Enterobacteriaceae family. After the FMT, a were decreased after FMT but this variation was modulates the inflammatory after the FMT in patients and healthy donors. rapid decrease of the Proteobacteria was not statistically significant. (Fig.4) host response and restore The real Time PCR was employed for a quick observed, with a parallel increase of the phyla evaluation of the fecal ecosystem by Firmicutes and Bacteroitedes, which reached intestinal dysbiosis. analyzing the presence of the bacterial 80% of the total microbiota (Fig.2,3) D’Abramo A1., Oliva A1, Zingaropoli MA1, phylum Bacteroitedes and Firmicutes, and of Cicerone C.,2 Bruno G.2 M., Corazziari E S 2. the bacterial species Escherichia coli and PT.I Pre-FMT DONOR I PT.I Post-FMT Schippa S1 Trancassini1, Vullo V1 Fecalibacterium prausntizii, whose ratio was used as a dysbiosis index. Lymphocyte Department of Public Health and Infectious surface phenotypes were evaluated in 4 Disease, Sapienza University of Rome 1 patients by flow cytometry using fresh PT.2 Pre-FMT PT.2 Post-FMT Department of Internal Medicine and Medical peripheral blood before (T0) and after (T1). DONOR 2 Specialties “Gastroenterology Unit”, Sapienza For the activation analysis of T Lymphocytes, University of Rome 2 the following fluorochrome-labeled antibodies PT.3 Pre-FMT PT. 3 Post-FMT Background: were used: CD3, HLA DR, CD8, CD38, CD4. Fecal microbiota transplantation (FMT) is able Immune activation was defined as co- + + to restore resistance to C.difficile (CD) expression of HLADR CD38 on CD 4 and colonization by re-establishing a healthy CD8 T cells. PT. 4 Pre- I FMT PT4. Post- I FMT microbial ecosystem in the gut of patients with Results high cure rates. In addition to A/B toxins effect, DONOR 3 Fig.3 recent study showed that the host immune A total of 11 FMT procedures were response and microbiota composition play a performed in 8 patients. Clinical characteristics were summarized in table1 PT. 4 Pre- II FMT PT. 4 Post- II FMT Conclusion role in the pathogenesis of CD infection. The FMT via enema aim of the study was to determine the efficacy - was effective and safe of FMT via enema in recurrent CD infection Study Population - induced a rapid recovery of the microbiota Clostridia Bacilli Bacteroidia Υ-proteobacteria Fig.1 (R-CDI) and to evaluate the FMT impact on Numbers of donors: 5 balance the host immune response and the gut Β-proteobacteria Actinobacteria Verrucomicrobia Fusobacteria M/F 3/2 - reduced of the inflammatory response with a microbiota composition. Age (years): 25± 1.3 90 decreased levels of T Lymphocyts Material/methods: BMI (kg/m2): 22.4 ± 1.2 80 immuneactivation The study recruited patients with R-CDI Numbers of patients: 8 70 - Given the high rate of success, might admitted at the Policlinico Umberto I Hospital, M/F 3/5 60 represent a useful therapeutical option for (Rome). Patients received 4-5 days oral Age (years;): 72±10.7 50 R-CDI as well as other intestinal disorder Pre-FMT vancomycin (500 mg every 6 hours) and the Total procedures: 11 40 whose pathophysiology is linked to a % Phyla Phyla % Post-FMT day prior to FMT, polyethylene glycol-based Time of infusion (minutes) 45 ± 12 30 intestinal dysbiosis status. oral lavage of the colon. Loperamide was given Resolution 7/8 20 3 h prior to the infusion in order to facilitate the Major adverse events None 10 retention. Fecal material was collected from 5 0 healthy donors. Table1. Study population Firmicutes Bacteroidetes Proteobacteria Fig.2