"Changing the gut to change Parkinson's: Faecal Microbiota Transplantation (FMT)" with Dr Arnout Bruggeman

Could changing the gut microbiome help change the course of Parkinson's disease?

In this session, Dr Arnout Bruggeman, neurologist and researcher at Ghent University in Belgium, explores the increasingly important relationship between the gut and Parkinson's disease, with a particular focus on fecal microbiota transplantation (FMT). FMT involves transferring gut microbiota from a carefully screened healthy donor to a person with Parkinson's, with the aim of changing the composition of the gut microbiome.

Arnout explains why the gut-brain axis is attracting so much attention in Parkinson's research, including the role of the vagus nerve, the immune system, inflammation and gut barrier integrity. He discusses the evidence suggesting that changes in the gut microbiome may be associated with Parkinson's, as well as the "body-first" and "brain-first" hypotheses of how the disease may develop.

The session looks at the evidence from animal studies, where changing the gut microbiota has been shown to influence Parkinson's-like symptoms and pathology, before turning to human clinical trials. Arnout presents results from his own double-blind, placebo-controlled clinical trial involving 46 people with Parkinson's, including findings on motor symptoms and constipation, and explains why the results are encouraging but still need to be confirmed in larger, multicentre studies.

The discussion also explores how FMT is performed, how healthy donors are selected, the different methods of administering FMT, potential side effects, and the challenges involved in identifying the ideal donor and the people most likely to respond. Arnout also discusses the possible relationship between the gut microbiome and levodopa absorption, the role of short-chain fatty acids, probiotics, diet, exercise and fasting, and whether FMT could eventually become a disease-modifying treatment used alongside existing Parkinson's therapies.

Throughout the session, Arnout emphasises that the research is still at an early stage. Although some clinical trials have produced promising results, studies have used very different methodologies, and there are still many unanswered questions about how FMT should be performed, who should receive it and how long any benefits might last.