pubmed.ncbi.nlm.nih.gov

Update on Fecal Microbiota Transplantation 2015: Indications, Methodologies, Mechanisms, and Outlook - PubMed

Review

Update on Fecal Microbiota Transplantation 2015: Indications, Methodologies, Mechanisms, and Outlook

Colleen R Kelly et al. Gastroenterology. 2015 Jul.

Abstract

The community of microorganisms within the human gut (or microbiota) is critical to health and functions with a level of complexity comparable to that of an organ system. Alterations of this ecology (or dysbiosis) have been implicated in a number of disease states, and the prototypical example is Clostridium difficile infection (CDI). Fecal microbiota transplantation (FMT) has been demonstrated to durably alter the gut microbiota of the recipient and has shown efficacy in the treatment of patients with recurrent CDI. There is hope that FMT may eventually prove beneficial for the treatment of other diseases associated with alterations in gut microbiota, such as inflammatory bowel disease, irritable bowel syndrome, and metabolic syndrome, to name a few. Although the basic principles that underlie the mechanisms by which FMT shows therapeutic efficacy in CDI are becoming apparent, further research is needed to understand the possible role of FMT in these other conditions. Although relatively simple to perform, questions regarding both short-term and long-term safety as well as the complex and rapidly evolving regulatory landscape has limited widespread use. Future work will focus on establishing best practices and more robust safety data than exist currently, as well as refining FMT beyond current "whole-stool" transplants to increase safety and tolerability. Encapsulated formulations, full-spectrum stool-based products, and defined microbial consortia are all in the immediate future.

Keywords: FMT; Fecal Transplant; Gut Microbial Therapeutics.

Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

PubMed Disclaimer

Figures

Figure 1
Figure 1

Mechanisms underlying successful treatment of recurrent CDI with FMT Improvement in symptoms following fecal microbiota transplant has been associated with change in microbial community structure such as a decrease in Proteobacteria as well as restoration of microbial diversity, increase in secondary bile acid production and niche exclusion by other bacteria.

Similar articles

Cited by

References

    1. Backhed F, Ley RE, Sonnenburg JL, et al. Host-bacterial mutualism in the human intestine. Science. 2005;307:1915–20. - PubMed
    1. Ley RE, Peterson DA, Gordon JI. Ecological and evolutionary forces shaping microbial diversity in the human intestine. Cell. 2006;124:837–48. - PubMed
    1. Cammarota G, Ianiro G, Gasbarrini A. Fecal microbiota transplantation for the treatment of Clostridium difficile infection: a systematic review. J Clin Gastroenterol. 2014;48:693–702. - PubMed
    1. Van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013;368:407–15. - PubMed
    1. Kassam Z, Lee CH, Yuan Y, et al. Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol. 2013;108:500–8. - PubMed

Publication types

MeSH terms