The Underlying Changes in Serum Metabolic Profiles and Efficacy Prediction in Patients with Extensive Ulcerative Colitis Undergoing Fecal Microbiota Transplantation

(1) Background: Fecal microbiota transplantation (FMT) is an effective treatment for ulcerative colitis (UC). Metabolomic techniques would assist physicians in clinical decision-making. (2) Methods: Patients with active UC undergoing FMT were enrolled the study and monitored 3 months. We explored short-term changes serum metabolic signatures of groups association between baseline metabolomic profiles patient outcomes. (3) Results: Forty-four eligible patients included analysis. Of them, 50.0% 29.5% achieved response remission, respectively, months post-FMT. The top two significantly altered pathways group vitamin B6 metabolism aminoacyl-tRNA biosynthesis. Both remission exhibited enriched pathway biosynthesis primary bile acid. found a clear separation non-remission at baseline, characterized by higher levels glycerophosphocholines, glycerophospholipids, glycerophosphoethanolamines group. A random forest (RF) classifier was constructed 20 markers selected Boruta method to predict post-FMT, area under curve 0.963. (4) Conclusions: effectively induced UC, metabolites partially improving post-FMT responsive promising role non-invasive prediction efficacy demonstrated value metabolome-informed managing UC.