Objective: 1. Assess the efficacy of FMT in PD by evaluating its impact on motor and non-motor symptoms.

2. Determine the safety profile of FMT in PD patients, focusing on adverse events and tolerability.

3. Analyze variations in FMT administration methods (colonic, nasoduodenal, oral) and their potential influence on treatment outcomes.

4. Compare findings across different RCTs to identify trends, inconsistencies, and limitations in current evidence.

5. Highlight gaps in research and suggest future directions for optimizing FMT as a potential therapeutic intervention in PD.

Background: Parkinson’s disease (PD) involves progressive neurodegeneration with motor and non-motor symptoms. Gut microbiota alterations are implicated in PD pathogenesis, leading to interest in fecal microbiota transplantation (FMT) as a therapeutic option. This systematic review assesses the efficacy and safety of FMT in managing PD symptoms.

Method: We conducted a comprehensive search across PubMed, Scopus, Web of Science, and Cochrane Central Controlled trials databases. Studies were screened based on predetermined inclusion criteria, focusing on randomized controlled trials (RCTs) involving FMT in PD patients. Two reviewers independently performed the data extraction and quality assessment. Key outcomes included improvements in motor and non-motor symptoms, quality of life, and adverse effects.

Results: Five RCTs involving 157 patients met the inclusion criteria. Some studies reported improvements in motor and non-motor symptoms, particularly with colonic FMT, while others found no significant benefit. One trial observed motor function worsening. FMT was generally well-tolerated, with mild and transient gastrointestinal side effects.

Conclusion: FMT may relieve PD symptoms, but findings are inconsistent. Larger trials with standardized protocols are needed to determine its long-term efficacy and safety.

References: Aho, V.T.E. et al. (2019) ‘Gut microbiota in Parkinson’s disease: Temporal stability and relations to disease progression’, EBioMedicine, 44, pp. 691–707. Available at: https://doi.org/10.1016/j.ebiom.2019.05.064.

Aho, V.T.E. et al. (2021) ‘Relationships of gut microbiota, short-chain fatty acids, inflammation, and the gut barrier in Parkinson’s disease’, Molecular Neurodegeneration, 16(1), pp. 1–14. Available at: https://doi.org/10.1186/S13024-021-00427-6/FIGURES/7.

Belizário, J.E., Faintuch, J. and Garay-Malpartida, M. (2018) ‘Gut Microbiome Dysbiosis and Immunometabolism: New Frontiers for Treatment of Metabolic Diseases’, Mediators of Inflammation, 2018, p. 2037838. Available at: https://doi.org/10.1155/2018/2037838.

Boertien, J.M. et al. (2022) ‘Fecal microbiome alterations in treatment-naive de novo Parkinson’s disease’, npj Parkinson’s Disease 2022 8:1, 8(1), pp. 1–12. Available at: https://doi.org/10.1038/s41531-022-00395-8.

Bove, C. and Travagli, R.A. (2019) ‘Neurophysiology of the brain stem in Parkinson’s disease’, Journal of neurophysiology, 121(5), pp. 1856–1864. Available at: https://doi.org/10.1152/JN.00056.2019.

Braak, H. et al. (2003) ‘Idiopathic Parkinson’s disease: possible routes by which vulnerable neuronal types may be subject to neuroinvasion by an unknown pathogen’, Journal of neural transmission (Vienna, Austria : 1996), 110(5), pp. 517–536. Available at: https://doi.org/10.1007/S00702-002-0808-2.

Bruggeman, A. et al. (2024) ‘Safety and efficacy of faecal microbiota transplantation in patients with mild to moderate Parkinson’s disease (GUT-PARFECT): a double-blind, placebo-controlled, randomised, phase 2 trial’, EClinicalMedicine, 71. Available at: https://doi.org/10.1016/J.ECLINM.2024.102563.

Burke, R.E., Dauer, W.T. and Vonsattel, J.P.G. (2008) ‘A critical evaluation of the Braak staging scheme for Parkinson’s disease’, Annals of neurology, 64(5), pp. 485–491. Available at: https://doi.org/10.1002/ANA.21541.

Camacho, M. et al. (2021) ‘Early constipation predicts faster dementia onset in Parkinson’s disease’, npj Parkinson’s Disease 2021 7:1, 7(1), pp. 1–7. Available at: https://doi.org/10.1038/s41531-021-00191-w.

Cheng, Y. et al. (2023) ‘Efficacy of fecal microbiota transplantation in patients with Parkinson’s disease: clinical trial results from a randomized, placebo-controlled design’, Gut microbes, 15(2). Available at: https://doi.org/10.1080/19490976.2023.2284247.

Cherbut, C. et al. (1997) ‘Effects of short-chain fatty acids on gastrointestinal motility’, Scandinavian journal of gastroenterology. Supplement, 222(222), pp. 58–61. Available at: https://doi.org/10.1080/00365521.1997.11720720.

Cilia, R. et al. (2021) ‘Does Gut Microbiota Influence the Course of Parkinson’s Disease? A 3-Year Prospective Exploratory Study in de novo Patients’, Journal of Parkinson’s Disease, 11(1), pp. 159–170. Available at: https://doi.org/10.3233/JPD-202297.

Dempsey, E. and Corr, S.C. (2022) ‘Lactobacillus spp. for Gastrointestinal Health: Current and Future Perspectives’, Frontiers in Immunology, 13. Available at: https://doi.org/10.3389/FIMMU.2022.840245/PDF.

Devos, D. et al. (2013) ‘Colonic inflammation in Parkinson’s disease’, Neurobiology of disease, 50(1), pp. 42–48. Available at: https://doi.org/10.1016/J.NBD.2012.09.007.

Ding, X. et al. (2019) ‘Long-Term Safety and Efficacy of Fecal Microbiota Transplant in Active Ulcerative Colitis’, Drug safety, 42(7), pp. 869–880. Available at: https://doi.org/10.1007/S40264-019-00809-2.

Drossman, D.A. (2016) ‘Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV’, Gastroenterology, 150(6), pp. 1262-1279.e2. Available at: https://doi.org/10.1053/J.GASTRO.2016.02.032.

DuPont, H.L. et al. (2023) ‘Fecal microbiota transplantation in Parkinson’s disease—A randomized repeat-dose, placebo-controlled clinical pilot study’, Frontiers in Neurology, 14. Available at: https://doi.org/10.3389/FNEUR.2023.1104759/PDF.

Erny, D. et al. (2015) ‘Host microbiota constantly control maturation and function of microglia in the CNS’, Nature neuroscience, 18(7), pp. 965–977. Available at: https://doi.org/10.1038/NN.4030.

Goetz, C.C. (2003) ‘The Unified Parkinson’s Disease Rating Scale (UPDRS): status and recommendations’, Movement disorders : official journal of the Movement Disorder Society, 18(7), pp. 738–750. Available at: https://doi.org/10.1002/MDS.10473.

Goetz, C.G. et al. (2008) ‘Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results’, Movement disorders : official journal of the Movement Disorder Society, 23(15), pp. 2129–2170. Available at: https://doi.org/10.1002/MDS.22340.

Jiang, Z.D. et al. (2018) ‘Safety and preliminary efficacy of orally administered lyophilized fecal microbiota product compared with frozen product given by enema for recurrent Clostridium difficile infection: A randomized clinical trial’, PloS one, 13(11). Available at: https://doi.org/10.1371/JOURNAL.PONE.0205064.

Kim, N. et al. (2021) ‘Transplantation of gut microbiota derived from Alzheimer’s disease mouse model impairs memory function and neurogenesis in C57BL/6 mice’, Brain, behavior, and immunity, 98, pp. 357–365. Available at: https://doi.org/10.1016/J.BBI.2021.09.002.

Kuai, X. yi et al. (2021) ‘Evaluation of fecal microbiota transplantation in Parkinson’s disease patients with constipation’, Microbial Cell Factories, 20(1), pp. 1–9. Available at: https://doi.org/10.1186/S12934-021-01589-0/FIGURES/3.

Lach, G. et al. (2018) ‘Anxiety, Depression, and the Microbiome: A Role for Gut Peptides’, Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 15(1), pp. 36–59. Available at: https://doi.org/10.1007/S13311-017-0585-0.

Leite Silva, A.B.R. et al. (2023) ‘Premotor, nonmotor and motor symptoms of Parkinson’s Disease: A new clinical state of the art’, Ageing Research Reviews, 84, p. 101834. Available at: https://doi.org/10.1016/J.ARR.2022.101834.

Ley, R.E., Peterson, D.A. and Gordon, J.I. (2006) ‘Ecological and evolutionary forces shaping microbial diversity in the human intestine’, Cell, 124(4), pp. 837–848. Available at: https://doi.org/10.1016/J.CELL.2006.02.017.

Li, C. et al. (2019) ‘Gut microbiota differs between parkinson’s disease patients and healthy controls in northeast China’, Frontiers in Molecular Neuroscience, 12. Available at: https://doi.org/10.3389/FNMOL.2019.00171/PDF.

Li, N. et al. (2019) ‘Fecal microbiota transplantation from chronic unpredictable mild stress mice donors affects anxiety-like and depression-like behavior in recipient mice via the gut microbiota-inflammation-brain axis’, Stress (Amsterdam, Netherlands), 22(5), pp. 592–602. Available at: https://doi.org/10.1080/10253890.2019.1617267.

Margolis, K.G., Cryan, J.F. and Mayer, E.A. (2021a) ‘The Microbiota-Gut-Brain Axis: From Motility to Mood’, Gastroenterology, 160(5), p. 1486. Available at: https://doi.org/10.1053/J.GASTRO.2020.10.066.

Margolis, K.G., Cryan, J.F. and Mayer, E.A. (2021b) ‘The Microbiota-Gut-Brain Axis: From Motility to Mood’, Gastroenterology, 160(5), pp. 1486–1501. Available at: https://doi.org/10.1053/J.GASTRO.2020.10.066.

Matcovitch-Natan, O. et al. (2016) ‘Microglia development follows a stepwise program to regulate brain homeostasis’, Science (New York, N.Y.), 353(6301). Available at: https://doi.org/10.1126/SCIENCE.AAD8670.

Matheson, J.A.T. and Holsinger, R.M.D. (2023) ‘The Role of Fecal Microbiota Transplantation in the Treatment of Neurodegenerative Diseases: A Review’, International Journal of Molecular Sciences 2023, Vol. 24, Page 1001, 24(2), p. 1001. Available at: https://doi.org/10.3390/IJMS24021001.

Mirzaei, H. et al. (2022) ‘Probiotics and the Treatment of Parkinson’s Disease: An Update’, Cellular and Molecular Neurobiology, 42(8), pp. 2449–2457. Available at: https://doi.org/10.1007/S10571-021-01128-W/METRICS.

Morais, L.H., Schreiber, H.L. and Mazmanian, S.K. (2021) ‘The gut microbiota-brain axis in behaviour and brain disorders’, Nature reviews. Microbiology, 19(4), pp. 241–255. Available at: https://doi.org/10.1038/S41579-020-00460-0.

Nishiwaki, H. et al. (2022) ‘Short chain fatty acids-producing and mucin-degrading intestinal bacteria predict the progression of early Parkinson’s disease’, npj Parkinson’s Disease 2022 8:1, 8(1), pp. 1–12. Available at: https://doi.org/10.1038/s41531-022-00328-5.

Ouzzani, M. et al. (2016) ‘Rayyan-a web and mobile app for systematic reviews’, Systematic Reviews, 5(1), pp. 1–10. Available at: https://doi.org/10.1186/S13643-016-0384-4/FIGURES/6.

Page, M.J. et al. (2021) ‘The PRISMA 2020 statement: an updated guideline for reporting systematic reviews’, BMJ, 372. Available at: https://doi.org/10.1136/BMJ.N71.

Rekdal, V.M. et al. (2019) ‘Discovery and inhibition of an interspecies gut bacterial pathway for Levodopa metabolism’, Science (New York, N.Y.), 364(6445). Available at: https://doi.org/10.1126/SCIENCE.AAU6323.

Romano, S. et al. (2021) ‘Meta-analysis of the Parkinson’s disease gut microbiome suggests alterations linked to intestinal inflammation’, NPJ Parkinson’s Disease, 7(1), p. 27. Available at: https://doi.org/10.1038/S41531-021-00156-Z.

Rooks, M.G. and Garrett, W.S. (2016) ‘Gut microbiota, metabolites and host immunity’, Nature reviews. Immunology, 16(6), pp. 341–352. Available at: https://doi.org/10.1038/NRI.2016.42.

Rostagno, A.A. et al. (2023) ‘The Role of Fecal Microbiota Transplantation in the Treatment of Neurodegenerative Diseases: A Review’, International Journal of Molecular Sciences 2023, Vol. 24, Page 1001, 24(2), p. 1001. Available at: https://doi.org/10.3390/IJMS24021001.

Scheperjans, F. et al. (2015) ‘Gut microbiota are related to Parkinson’s disease and clinical phenotype’, Movement Disorders, 30(3), pp. 350–358. Available at: https://doi.org/10.1002/MDS.26069.

Scheperjans, F. et al. (2024a) ‘Fecal Microbiota Transplantation for Treatment of Parkinson Disease: A Randomized Clinical Trial’, JAMA Neurology, 81(9), pp. 925–938. Available at: https://doi.org/10.1001/jamaneurol.2024.2305.

Scheperjans, F. et al. (2024b) ‘Fecal Microbiota Transplantation for Treatment of Parkinson Disease: A Randomized Clinical Trial’, JAMA neurology, 81(9), pp. 925–938. Available at: https://doi.org/10.1001/JAMANEUROL.2024.2305.

Segal, A. et al. (2021) ‘Fecal microbiota transplant as a potential treatment for Parkinson’s disease – A case series’, Clinical Neurology and Neurosurgery, 207, p. 106791. Available at: https://doi.org/10.1016/J.CLINEURO.2021.106791.

Sharon, G. et al. (2016) ‘The Central Nervous System and the Gut Microbiome’, Cell, 167(4), pp. 915–932. Available at: https://doi.org/10.1016/J.CELL.2016.10.027.

Sterne, J.A.C. et al. (2019) ‘RoB 2: a revised tool for assessing risk of bias in randomised trials’, BMJ, 366. Available at: https://doi.org/10.1136/BMJ.L4898.

Tan, A.H., Lim, S.Y. and Lang, A.E. (2022) ‘The microbiome–gut–brain axis in Parkinson disease — from basic research to the clinic’, Nature Reviews Neurology 2022 18:8, 18(8), pp. 476–495. Available at: https://doi.org/10.1038/s41582-022-00681-2.

Toh, T.S. et al. (2022) ‘Gut microbiome in Parkinson’s disease: New insights from meta-analysis’, Parkinsonism and Related Disorders, 94, pp. 1–9. Available at: https://doi.org/10.1016/j.parkreldis.2021.11.017.

Del Tredici, K. and Braak, H. (2008) ‘A not entirely benign procedure: progression of Parkinson’s disease’, Acta neuropathologica, 115(4), pp. 379–384. Available at: https://doi.org/10.1007/S00401-008-0355-5.

Verbaan, D. et al. (2007) ‘Patient-reported autonomic symptoms in Parkinson disease’, Neurology, 69(4), pp. 333–341. Available at: https://doi.org/10.1212/01.WNL.0000266593.50534.E8.

Weingarden, A.R. et al. (2016) ‘Changes in Colonic Bile Acid Composition following Fecal Microbiota Transplantation Are Sufficient to Control Clostridium difficile Germination and Growth’, PloS one, 11(1). Available at: https://doi.org/10.1371/JOURNAL.PONE.0147210.

Xie, A. et al. (2022) ‘Bacterial Butyrate in Parkinson’s Disease Is Linked to Epigenetic Changes and Depressive Symptoms’, Movement Disorders, 37(8), pp. 1644–1653. Available at: https://doi.org/10.1002/MDS.29128.

Xue, L.J. et al. (2020) ‘Fecal microbiota transplantation therapy for Parkinson’s disease: A preliminary study’, Medicine, 99(35), p. E22035. Available at: https://doi.org/10.1097/MD.0000000000022035.

Zhao, Y. and Yu, Y.B. (2016) ‘Intestinal microbiota and chronic constipation’, SpringerPlus, 5(1). Available at: https://doi.org/10.1186/S40064-016-2821-1.

Zhao, Z. et al. (2021) ‘Fecal microbiota transplantation protects rotenone-induced Parkinson’s disease mice via suppressing inflammation mediated by the lipopolysaccharide-TLR4 signaling pathway through the microbiota-gut-brain axis’, Microbiome, 9(1), p. 226. Available at: https://doi.org/10.1186/S40168-021-01107-9.

Zhu, M. et al. (2022) ‘Gut Microbiota: A Novel Therapeutic Target for Parkinson’s Disease’, Frontiers in Immunology, 13, p. 937555. Available at: https://doi.org/10.3389/FIMMU.2022.937555.
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