Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection Associates With Functional Alterations in Circulating microRNAs

Tanya M. Monaghan*, Anna M. Seekatz, Nicholas O. Markham, Tung On Yau, Maria Hatziapostolou, Tahseen Jilani, Niki Christodoulou, Brandi Roach, Eleni Birli, Odette Pomenya, Thomas Louie, D. Borden Lacy, Peter Kim, Christine Lee, Dina Kao, Christos Polytarchou

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)


Background and aims: The molecular mechanisms underlying successful fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (rCDI) remain poorly understood. The primary objective of this study was to characterize alterations in microRNAs (miRs) following FMT for rCDI. Methods: Sera from 2 prospective multicenter randomized controlled trials were analyzed for miRNA levels with the use of the Nanostring nCounter platform and quantitative reverse-transcription (RT) polymerase chain reaction (PCR). In addition, rCDI-FMT and toxin-treated animals and ex vivo human colonoids were used to compare intestinal tissue and circulating miRs. miR inflammatory gene targets in colonic epithelial and peripheral blood mononuclear cells were evaluated by quantitative PCR (qPCR) and 3′UTR reporter assays. Colonic epithelial cells were used for mechanistic, cytoskeleton, cell growth, and apoptosis studies. Results: miRNA profiling revealed up-regulation of 64 circulating miRs 4 and 12 weeks after FMT compared with screening, of which the top 6 were validated in the discovery cohort by means of RT-qPCR. In a murine model of relapsing-CDI, RT-qPCR analyses of sera and cecal RNA extracts demonstrated suppression of these miRs, an effect reversed by FMT. In mouse colon and human colonoids, C difficile toxin B (TcdB) mediated the suppressive effects of CDI on miRs. CDI dysregulated DROSHA, an effect reversed by FMT. Correlation analyses, qPCR, and 3′UTR reporter assays revealed that miR-23a, miR-150, miR-26b, and miR-28 target directly the 3′UTRs of IL12B, IL18, FGF21, and TNFRSF9, respectively. miR-23a and miR-150 demonstrated cytoprotective effects against TcdB. Conclusions: These results provide novel and provocative evidence that modulation of the gut microbiome via FMT induces alterations in circulating and intestinal tissue miRs. These findings contribute to a greater understanding of the molecular mechanisms underlying FMT and identify new potential targets for therapeutic intervention in rCDI.

Original languageEnglish
Pages (from-to)255-270.e4
Issue number1
Early online date9 Apr 2021
Publication statusPrint publication - 1 Jul 2021
Externally publishedYes


  • C difficile
  • Fecal Transplantation
  • microRNA
  • Circulating MicroRNA/blood
  • Tissue Culture Techniques
  • Humans
  • Middle Aged
  • Gastrointestinal Microbiome
  • Transcriptome
  • Male
  • Treatment Outcome
  • Intestines/microbiology
  • Clostridium Infections/blood
  • Reinfection
  • Fecal Microbiota Transplantation
  • Randomized Controlled Trials as Topic
  • Animals
  • Aged, 80 and over
  • Adult
  • Female
  • Aged
  • Disease Models, Animal


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