P2399 - Effect of Fecal Microbiota Transplantation on Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

Tarun Kumar Suvvari, MBBS¹, Sumanth Gundraju, MBBS², Nischitha Vallurupalli, MBBS³, Sindhuja Karangula, MBBS⁴, Nayanika Tummala, MD⁵, Divya Durga, MBBS⁶, Srija Yadav Kadari, MBBS⁷, Sri Kruthi Alaka Nandha Godavari, MBBS², Tetta Venkata SARMA. Jayant, ⁸
1Squad Medicine and Research (SMR), Amadalavalasa, Andhra Pradesh, India; 2Rangaraya medical college, Kakinada, Andhra Pradesh, India; 3All India Institute of Medical Sciences Bhubaneswar, Hyderabad, Telangana, India; 4MRIMS, Downingtown, PA; 5St. Mary's General Hospital, New York Medical College, Poughkeepsie, NY; 6NRI MEDICAL COLLEGE,GUNTUR, Vizag, Andhra Pradesh, India; 7Mallareddy institute of medical sciences, Khammam, Telangana, India; 8Government Medical College Srikakulam, Visakhapatnam, Andhra Pradesh, India

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as NAFLD, is a prevalent liver condition closely linked to obesity, insulin resistance, and gut microbiota dysbiosis. Fecal microbiota transplantation (FMT) has emerged as a potential therapeutic strategy to modulate the gut-liver axis. This systematic review evaluated clinical trial evidence on the efficacy of FMT in improving hepatic and metabolic outcomes in MASLD.

Methods: A systematic search of PubMed, Scopus, and Web of Science from 2010 to April 2025 identified randomized controlled trials (RCTs) assessing FMT in adult MASLD patients. Eligible studies included those with clinical, biochemical, histologic, or imaging-based liver outcomes. One preclinical mouse study was also summarized narratively for biological insight. Data extraction and risk-of-bias assessment were performed independently by two reviewers using the Cochrane RoB 2.0 tool.

Results: Three RCTs (n=82) were included. One study (n=36) demonstrated significant hepatic fat reduction in lean MASLD patients receiving FMT (CAP: −42.1 dB/m, p< 0.05) and ALT improvement (−12.6 U/L), alongside improved microbial diversity. Another trial (n=21) showed downregulation of hepatic inflammatory gene expression (e.g., IL-1β, p< 0.05) and beneficial metabolomic shifts post-allogenic FMT. A third RCT (n=25) reported no change in HOMA-IR or MRI-PDFF overall, but improved intestinal permeability in a subset (lactulose:mannitol ratio: 0.038 to 0.021, p=0.03). An animal study supported these findings with reduced NAS scores (5.3 to 2.1, p< 0.01) and enhanced gut barrier integrity. Overall, FMT showed modest but promising effects, particularly in metabolically distinct NAFLD phenotypes.

Discussion: FMT appears to beneficially modulate gut microbiota and improve selected hepatic and metabolic parameters in MASLD, particularly in metabolically distinct subgroups. However, findings remain preliminary due to limited sample sizes and outcome heterogeneity. Larger, standardized trials are needed to clarify therapeutic efficacy and identify optimal donor characteristics and patient phenotypes.

Disclosures:
Tarun Kumar Suvvari indicated no relevant financial relationships.
Sumanth Gundraju indicated no relevant financial relationships.
Nischitha Vallurupalli indicated no relevant financial relationships.
Sindhuja Karangula indicated no relevant financial relationships.
Nayanika Tummala indicated no relevant financial relationships.
Divya Durga indicated no relevant financial relationships.
Srija Yadav Kadari indicated no relevant financial relationships.
Sri Kruthi Alaka Nandha Godavari indicated no relevant financial relationships.
Tetta Venkata Jayant indicated no relevant financial relationships.

Tarun Kumar Suvvari, MBBS¹, Sumanth Gundraju, MBBS², Nischitha Vallurupalli, MBBS³, Sindhuja Karangula, MBBS⁴, Nayanika Tummala, MD⁵, Divya Durga, MBBS⁶, Srija Yadav Kadari, MBBS⁷, Sri Kruthi Alaka Nandha Godavari, MBBS², Tetta Venkata SARMA. Jayant, ⁸. P2399 - Effect of Fecal Microbiota Transplantation on Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.