Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter February 11, 2021

Inappropriate extrapolations abound in fecal microbiota research

Sok-Ja Janket, Harry A. Conte and Eleftherios P. Diamandis ORCID logo

Corresponding author: Eleftherios P. Diamandis, Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.


1. Wargo, JA. Modulating gut microbes. Science (New York, NY) 2020;369:1302–3. in Google Scholar PubMed

2. Gopalakrishnan, V, Spencer, CN, Nezi, L, Reuben, A, Andrews, MC, Karpinets, TV, et al.. Gut microbiome modulates response to anti-PD-1 immunotherapy in melanoma patients. Science (New York, NY) 2018;359:97–103. in Google Scholar PubMed PubMed Central

3. Doki, N, Suyama, M, Sasajima, S, Ota, J, Igarashi, A, Mimura, I, et al.. Clinical impact of pre-transplant gut microbial diversity on outcomes of allogeneic hematopoietic stem cell transplantation. Ann Hematol 2017;96:1517–23. in Google Scholar PubMed

4. Hanage, WP. Microbiology: microbiome science needs a healthy dose of scepticism. Nature 2014;512:247–8. in Google Scholar PubMed

5. Donaldson, GP, Lee, SM, Mazmanian, SK. Gut biogeography of the bacterial microbiota. Nat Rev Microbiol 2016;14:20–32. in Google Scholar PubMed PubMed Central

6. Janket, SJ, Ackerson, LK, Diamandis, EP. Gut microbiotas and immune checkpoint inhibitor therapy response: a causal or coincidental relationship? Clin Chem Lab Med 2019;58:18–24. in Google Scholar PubMed

7. Janket, SJ, Ackerson, LK, Diamandis, E. Simpson’s paradox in proof-of-concept studies. Nat Med 2019;25:1640. in Google Scholar PubMed

8. Spencer, CN, Gopalakrishnan, V, McQuade, J, Andrews, MC, Helmink, B, Khan, MAW, et al.. Abstract 2838: the gut microbiome (GM) and immunotherapy response are influenced by host lifestyle factors. Canc Res 2019;79:2838.10.1158/1538-7445.AM2019-2838Search in Google Scholar

9. Wang, W, Lin, L, Du, Y, Song, Y, Peng, X, Chen, X, et al.. Assessing the viability of transplanted gut microbiota by sequential tagging with D-amino acid-based metabolic probes. Nat Commun 2019;10:1317. in Google Scholar PubMed PubMed Central

10. Curtis, MM, Hu, Z, Klimko, C, Narayanan, S, Deberardinis, R, Sperandio, V. The gut commensal Bacteroides thetaiotaomicron exacerbates enteric infection through modification of the metabolic landscape. Cell Host Microbe 2014;16:759–69. in Google Scholar PubMed PubMed Central

11. Quera, R, Espinoza, R, Estay, C, Rivera, D. Bacteremia as an adverse event of fecal microbiota transplantation in a patient with Crohn’s disease and recurrent Clostridium difficile infection. J Crohns Colitis 2014;8:252–3. in Google Scholar PubMed

12. Hefazi, M, Patnaik, MM, Hogan, WJ, Litzow, MR, Pardi, DS, Khanna, S. Safety and efficacy of fecal microbiota transplant for recurrent Clostridium difficile infection in patients with cancer treated with cytotoxic chemotherapy: a single-institution retrospective case series. Mayo Clin Proc 2017;92:1617–24. in Google Scholar PubMed

13. Friedman-Moraco, RJ, Mehta, AK, Lyon, GM, Kraft, CS. Fecal microbiota transplantation for refractory Clostridium difficile colitis in solid organ transplant recipients. Am J Transplant 2014;14:477–80. in Google Scholar PubMed PubMed Central

14. Kelly, CR, Ihunnah, C, Fischer, M, Khoruts, A, Surawicz, C, Afzali, A, et al.. Fecal microbiota transplant for treatment of Clostridium difficile infection in immunocompromised patients. Am J Gastroenterol 2014;109:1065–71. in Google Scholar PubMed PubMed Central

15. Kao, D, Roach, B, Silva, M, Beck, P, Rioux, K, Kaplan, GG, et al.. Effect of oral capsule- vs colonoscopy-delivered fecal microbiota transplantation on recurrent Clostridium difficile infection: a randomized clinical trial. J Am Med Assoc 2017;318:1985–93. in Google Scholar PubMed PubMed Central

16. Janket, SJ, Ackerson, LK, Diamandis, EP. Drug-resistant bacteremia after fecal microbiota transplant. N Engl J Med 2020;382:1960.10.1056/NEJMc2002496Search in Google Scholar PubMed

17. Abu-Ali, GS, Mehta, RS, Lloyd-Price, J, Mallick, H, Branck, T, Ivey, KL, et al.. Metatranscriptome of human faecal microbial communities in a cohort of adult men. Nat Microbiol 2018;3:356–66. in Google Scholar PubMed PubMed Central

18. Panelli, S, Capelli, E, Lupo, GFD, Schiepatti, A, Betti, E, Sauta, E, et al.. Comparative study of salivary, duodenal, and fecal microbiota composition across adult celiac disease. J Clin Med 2020;9:1109. in Google Scholar PubMed PubMed Central

19. Hennekens, CH, Buring, JE. Epidemiology in medicine. Hagerstown, MD: Lippincott Williams & Wilkins; 1987.Search in Google Scholar

Received: 2020-12-24
Accepted: 2021-01-29
Published Online: 2021-02-11
Published in Print: 2021-06-25

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Scroll Up Arrow