An update on fecal microbiota transplantation for the treatment of gastrointestinal diseases

Abstract

Our understanding of the microbiome and its implications for human health and disease continues to develop. Fecal microbiota transplantation (FMT) is now an established treatment for recurrent Clostridioides difficile infection. There is also increasing evidence for the efficacy of FMT in inducing remission for mild-moderate ulcerative colitis. However, for other indications, data for FMT are limited, with randomized controlled trials rare, typically small and often conflicting. Studies are continuing to explore the role of FMT for many other conditions, including Crohn's disease, functional gut disorders, metabolic syndrome, modulating responses to chemotherapy, eradication of multidrug resistant organisms, and the gut-brain axis. In light of safety, logistical, and regulatory challenges, there is a move to standardized products including narrow spectrum consortia. However, the mechanisms underpinning FMT remain incompletely understood, including the role of non-bacterial components, which may limit success of novel microbial approaches.

Preservation by lyophilization of a human intestinal microbiota: influence of the cultivation pH on the drying outcome and re‐establishment ability

“…Further, the transferred metabolic products of the microbiota, short‐chain‐fatty acids (SCFAs), contribute by their anti‐inflammatory properties (Tedelind et al ., 2007 ). In addition to the treatment of CDI, successful FMT applications including diseases like ulcerative colitis (Angelberger et al ., 2013 ; Waller et al ., 2021 ), Parkinson’s disease (Ananthaswamy, 2011 ; Xue et al ., 2020 ) or multiple sclerosis (Borody et al ., 2011 ; Li et al ., 2020 ) have been reported. Nevertheless, the method has some limitations: ethical and safety concerns, a work and cost intensive donor screening prior to FMT and mainly the availability of suitable faecal material (Terveer et al ., 2017 ; Zhang et al ., 2018 ).…”

Role of Dietary Supplements and Probiotics in Modulating Microbiota and Bone Health: The Gut-Bone Axis

“…A more recent therapeutic strategy for the modulation of the gut microbiota is the transfer of donor stools to a recipient’s GIT—the so-called fecal microbiota transplants (FMTs), which have gained much recognition recently [ 160 ]. Considered to be an established treatment for recurrent Clostridium difficile infection, FMT is a potential therapy for inducing remission of mild–moderate ulcerative colitis [ 161 ]. Furthermore, its use has been debated in the literature for improving several extraintestinal conditions, including metabolic syndrome, modulation of responses to chemotherapy, eradication of multidrug-resistant organisms, and osteomuscular disorders [ 161 ].…”

“…Considered to be an established treatment for recurrent Clostridium difficile infection, FMT is a potential therapy for inducing remission of mild–moderate ulcerative colitis [ 161 ]. Furthermore, its use has been debated in the literature for improving several extraintestinal conditions, including metabolic syndrome, modulation of responses to chemotherapy, eradication of multidrug-resistant organisms, and osteomuscular disorders [ 161 ]. In the context of bone disorders, FMT from young to aged rats improved senile osteoporosis in terms of bone volume, trabecular bone volume fraction, trabecular number, and trabecular thickness by restoring gut dysbiosis at the phylum and family levels [ 162 ].…”

Efficacy and safety of fecal microbiota transplantation for the induction of remission in active ulcerative colitis: a systematic review and meta-analysis of randomized controlled trials

“…It has shown potential in treating hepatic encephalopathy, autism, and metabolic syndrome. Other potential areas in which FMT has been shown beneficial effects include modulating the response to chemotherapy, overcoming multidrug resistance, and treating conditions involving the gut-brain axis (4,7). For many other indications, the data on FMT are limited, as randomized controlled trials (RCTs) are scarce and typically constrained by small populations, and often have conflicting results (7).…”