Fecal microbiota transplantation alleviates experimental colitis through the Toll-like receptor 4 signaling pathway

World J Gastroenterol. 2023 Aug 14;29(30):4657-4670. doi: 10.3748/wjg.v29.i30.4657.


Background: Fecal microbiota transplantation (FMT) has shown promising therapeutic effects on mice with experimental colitis and patients with ulcerative colitis (UC). FMT modulates the Toll-like receptor 4 (TLR4) signaling pathway to treat some other diseases. However, it remains unknown whether this modulation is also involved in the treatment of UC.

Aim: To clarify the necessity of TLR4 signaling pathway in FMT on dextran sodium sulphate (DSS)-induced mice and explain the mechanism of FMT on UC, through association analysis of gut microbiota with colon transcriptome in mice.

Methods: A mouse colitis model was constructed with wild-type (WT) and TLR4-knockout (KO) mice. Fecal microbiota was transplanted by gavage. Colon inflammation severity was measured by disease activity index (DAI) scoring and hematoxylin and eosin staining. Gut microbiota structure was analyzed through 16S ribosomal RNA sequencing. Gene expression in the mouse colon was obtained by transcriptome sequencing.

Results: The KO (DSS + Water) and KO (DSS + FMT) groups displayed indistinguishable body weight loss, colon length, DAI score, and histology score, which showed that FMT could not inhibit the disease in KO mice. In mice treated with FMT, the relative abundance of Akkermansia decreased, and Lactobacillus became dominant. In particular, compared with those in WT mice, the scores of DAI and colon histology were clearly decreased in the KO-DSS group. Microbiota structure showed a significant difference between KO and WT mice. Akkermansia were the dominant genus in healthy KO mice. The ineffectiveness of FMT in KO mice was related to the decreased abundance of Akkermansia. Gene Ontology enrichment analysis showed that differentially expressed genes between each group were mainly involved in cytoplasmic translation and cellular response to DNA damage stimulus. The top nine genes correlating with Akkermansia included Aqp4, Clca4a, Dpm3, Fau, Mcrip1, Meis3, Nupr1 L, Pank3, and Rps13 (|R| > 0.9, P < 0.01).

Conclusion: FMT may ameliorate DSS-induced colitis by regulating the TLR4 signaling pathway. TLR4 modulates the composition of gut microbiota and the expression of related genes to ameliorate colitis and maintain the stability of the intestinal environment. Akkermansia bear great therapeutic potential for colitis.

Keywords: Akkermansia; Aquaporin 4; Colitis; Fecal microbiota transplantation; Lactobacillus; Toll-like receptor 4; Transcriptome sequencing.

MeSH terms

  • Animals
  • Colitis* / chemically induced
  • Colitis* / therapy
  • Colitis, Ulcerative* / chemically induced
  • Colitis, Ulcerative* / genetics
  • Colitis, Ulcerative* / therapy
  • Disease Models, Animal
  • Fecal Microbiota Transplantation
  • Mice
  • Signal Transduction
  • Toll-Like Receptor 4* / genetics


  • Toll-Like Receptor 4
  • Tlr4 protein, mouse