Effect of fecal microbiota transplantation in children with autism spectrum disorder: A systematic review

Jing Zhang; Gang Zhu; Lin Wan; Yan Liang; Xinting Liu; Huimin Yan; Bo Zhang; Guang Yang

doi:10.3389/fpsyt.2023.1123658

Effect of fecal microbiota transplantation in children with autism spectrum disorder: A systematic review

Front Psychiatry. 2023 Mar 2:14:1123658. doi: 10.3389/fpsyt.2023.1123658. eCollection 2023.

Authors

Jing Zhang^{1

2

3}, Gang Zhu^{1

2

3}, Lin Wan^{1

2

3}, Yan Liang^{1

2

3}, Xinting Liu^{1

2

3}, Huimin Yan^{1

2

3}, Bo Zhang^{4

5}, Guang Yang^{1

2

3

6}

Affiliations

¹ Senior Department of Pediatrics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China.
² Department of Pediatrics, The First Medical Center of Chinese PLA General Hospital, Beijing, China.
³ Medical School of Chinese PLA, Beijing, China.
⁴ Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
⁵ Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
⁶ Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.

Abstract

Background: Fecal microbiota transplantation (FMT) may be helpful in the treatment of autism spectrum disorder (ASD) as rebalancing the gut microbiome has been shown to potentially improve behavioral symptoms in children with ASD.

Methods: This systematic review was conducted to assess the effect of FMT for children with ASD. The Embase, PubMed, Web of Science, and Cochrane Library databases were searched for articles published from inception to October 6, 2022. Two reviewers independently screened the identified records and undertook data extraction.

Results: The search identified a total of five studies: two prospective open-label studies, two retrospective observational studies, and a case report; however, no randomized controlled trial was identified. All five studies reported a significant post-FMT-treatment improvement in neuropsychological assessment of ASD. The two prospective open-label studies suggested that the Autism Behavior Checklist (ABC) score, and the Social Responsiveness Scale (SRS) score at the posttreatment assessment decreased from the baseline (Wilcoxon signed-rank test; all p < 0.01]). The two retrospective observational studies suggested that FMT helped to improve the ASD symptoms. One observational study reported that the Childhood Autism Rating Scale (CARS) score and ABC score of the constipation group decreased from the baseline after the second course assessment (CARS [baseline: mean 35.25 ± standard deviation 4.36, second course: 32.5 ± 3.1, p = 0.015]; ABC [baseline: 56.21 ± 16.08, second course: 46.54 ± 16.54, p = 0.046]). Another observational study found that both ABC and CARS scores decreased as the number of FMT courses increased, and significant differences were found at the end of each course as compared with the baseline.

Conclusion: Compared with the baseline, FMT significantly improved symptoms of autism in children with ASD in observational studies. However, rigorously designed randomized controlled clinical trials are needed to establish the safety and efficacy of FMT as a treatment for ASD.

Keywords: autism; autism spectrum disorder; fecal microbiota transplantation (FMT); meta-analysis; microbiota-gut-brain axis; systematic review.

Publication types

Systematic Review

Grants and funding

This research was in part supported by the General Project of Beijing Natural Science Foundation (Grant No. 7222187), the Nutrition and Care of Maternal and Child Research Fund Project of Biostime Institute of Nutrition and Care (Grant No. 2021BINCMCF030), the Epilepsy Research Foundation of Chinese Association Against Epilepsy (Grant No. CU-B-2021-11), and the Special Scientific Research Project of Military Family Planning (Grant No. 22JSZ20).