A reproducible enteric phage community improves blood glucose regulation in an obesity mouse model

Metabolic syndrome encompasses amongst other conditions like obesity, type-2 diabetes, and metabolic dysfunction associated fatty liver disease (MAFLD), which are all associated with gut microbiome (GM) dysbiosis. Fecal microbiota transplantation (FMT) has been explored to treat metabolic syndrome by restoring the GM. FMT is generally safe, but motivated by case reports, accidental transfer of pathogenic bacteria remains a concern. As a safer alternative, fecal virome transplantation (FVT, sterile-filtrated feces) has the advantage over FMT in that mainly bacteriophages are transferred and FVT from lean male donors has shown promise in alleviating the metabolic effects of a high-fat diet in a preclinical mouse study. However, FVT still carries the risk of eukaryotic viral infections. To address this, we here apply recently developed modification methodologies to inactivate or remove the eukaryotic viral component of FVT while maintaining an active enteric bacteriophage community. Modified FVTs were compared with unmodified FVT and saline in an animal model of diet-induced obesity using male C57BL/6N mice. In contrast to the obese control group, mice administered a modified FVT, nearly depleted from eukaryotic viruses (0.1%), exhibited enhanced blood glucose clearance, although without a concurrent reduction in weight gain. The unmodified FVT improved liver pathology and reduced the proportions of immune cells in the adipose tissue with a non-uniform response. GM analysis suggested that bacteriophage-mediated GM modulation had influenced these outcomes. When optimized, this may pave the way for developing safe bacteriophage-based therapies targeting metabolic syndrome through GM restoration.