Objective: To assess Fecal Microbiota Transplantation (FMT) efficacy in improving Parkinson’s disease (PD) symptoms.

Background: Dysregulation of the microbiome–gut–brain axis is a key pathophysiological mechanism preceding the onset of motor symptoms in PD. FMT has been evaluated in several randomized controlled trials (RCTs) as a novel intervention for PD. However, it remains inconclusive whether FMT significantly improves PD symptoms.

Method: MEDLINE, Web of Science, Scopus, and the Cochrane Library databases were systematically searched for RCTs comparing FMT with placebo in PD patients. We assessed efficacy using the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), the PD Questionnaire (PDQ-39), the Irritable Bowel Syndrome Scale (IBSS), and the Wexner Constipation score. We used random-effect models and mean differences with 95% confidence intervals (CI). R Studio, version 4.4.2, was used for all statistical analyses.

Results: 3 RCTs and 145 patients were included, of whom 79 (54,48%) underwent FMT. The baseline MDS-UPDRS III scores were 21.64 ± 8.85 (on medication) and 34.34 ± 8.78 (off medication) for the FMT group, and 25.12 ± 11.69 (on) and 32.43 ± 7.36 (off) for the placebo group. MDS-UPDRS-III showed no difference between groups (mean difference [MD] -0.76; 95% CI -4.46 to 2.93; p=0.68; I²=35.1%). There was no difference in the other MDS-UPDRS subscales. The PDQ-39 showed a statistically significant difference favoring the FMT group [MD -7.57; 95% CI -13.34 to -1.81; p=0.01; I²=70.2%), while the Wexner score favored the placebo group (MD -1.22; 95% CI -1.68 to -0.76; p<0.0000001; I²=0.0%). The IBSS also showed no differences between groups (MD -23.08; 95% CI -144.30 to 98.15; p=0.70; I²=54.6%).

Conclusion: Our findings indicate improvement quality of life of PD patients receiving FMT as measured by PDQ-39. However, we did not observe any impact on motor, experiences of daily living, and constipation scores. Further trials that control for baseline differences between groups are needed to clarify the effects of FMT on PD.

PDQ-39 change from baseline

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MDS Abstracts - https://www.mdsabstracts.org/abstract/fecal-microbiota-transplantation-for-parkinsons-disease-a-systematic-review-and-meta-analysis/