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Considerations of the relationship between intestinal flora and psychological tendencies and the improvement of physical symptoms and psychological changes by fecal microbiota transplantation

Research Topic
Considerations of the relationship between intestinal flora and psychological tendencies and the improvement of physical symptoms and psychological changes by fecal microbiota transplantation

Lead Researcher
Hitomi Shirotani, Clinical Psychologist, Luke’s Ashiya Clinic

Center Co-Researcher
Toshio Kawai, Professor, Kokoro Research Center, Kyoto University

Collaborating Researcher
Masahiko Shirotani, Director, Luke’s Ashiya Clinic

With recent advances in metagenomic analysis of intestinal bacteria, the relationship between intestinal flora and various diseases has been attracting more and more attention. In particular, from the viewpoint of the brain-gut correlation, various studies have suggested that the type and balance of intestinal bacteria can significantly affect the host’s psychological state and development. At our clinic, nearly 80 patients have undergone meta-genomic analysis of intestinal flora since 2017. In this study, we will attempt to analyze and examine the features of metagenomic analysis of intestinal flora and psychological tests with the aim of evaluating the association between features and symptoms of the intestinal flora and its relationship to psychological characteristics.

In addition, we are conducting fecal microbiota transplantation (FMT) for patients with intractable diseases such as ulcerative colitis, connective tissue disease (CTD) and atopic dermatitis (AD), by receiving bacterial solution generated from donor feces from the clinical research group for intestinal flora transplantation. FMT is a treatment in which dissolved microorganisms (bacterial fluid) taken from the feces of healthy donors are transplanted into the patient’s gastrointestinal tract to try and treat the disease. A Dutch medical team reported in 2013 that a combination treatment group of FMT produced a significantly higher cure rate for refractory/recurrent Clostridium difficile infection (CDI) compared with a conventional treatment group that received oral vancomycin. This finding has attracted a lot of attention, and the current guidelines by Infectious Diseases Society of America strongly recommend FMT treatment for recurrent CDI. Because of its high therapeutic effect on CDI, FMT is currently being also studied in Japan for various diseases including intractable refractory inflammatory bowel disease such as ulcerative colitis, as well as autoimmune disease and autism.

On the other hand, few studies have been conducted in Japan to examine the psychological effects of FMT. To date, only one study has been reported; emotions, such as depression and anxiety were compared in patients with gastrointestinal symptoms at a university hospital, using a questionnaire before and after transplantation. Results of this study showed that emotions were significantly improved after transplantation, and the diversity of the patient’s intestinal flora may have contributed to their emotional stability.

At our clinic, we have interviewed patients undergoing FMT before and after the procedure, not only to know their physical indicators such as an improvement of symptoms and changes in the balance of intestinal flora, but also to perform psychological drawing tests and dream analysis. As in previous studies, patients who underwent transplantation reported psychological changes as well as improvements in physical illness. This study, however, will examine the effects of FMT on structural changes in the mind, which may be related not only to emotional changes but also longer-term psychological changes.

2021/07/30

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