Fecal Microbiota Transplantation during and Post-COVID-19 Pandemic

Abstract

COVID-19 is a major pandemic facing the world today, which has implications on current microbiome-based treatments such as fecal microbiota transplantation (FMT) used for recurrent Clostridioides difficile infections. The bidirectional relationship between the inhabitants of our gut, the gut microbiota, and COVID-19 pathogenesis, as well as the underlying mechanism involved, must be elucidated in order to increase FMT safety and efficacy. In this perspective, we discuss the crucial cross-talk between the gut microbiota and the lungs, known as the gut–lung axis, during COVID-19 infection, as well as the putative effect of these microorganisms and their functional activity (i.e., short chain fatty acids and bile acids) on FMT treatment. In addition, we highlight the urgent need to investigate the possible impact of COVID-19 on FMT safety and efficacy, as well as instilling stringent screening protocols of donors and recipients during COVID-19 and post-COVID-19 pandemic to produce a cohesive and optimized FMT treatment plan across all centers and in all countries across the globe.

S1-Leitlinie Post-COVID/Long-COVID

“…Diese Hypothese wird durch die Beobachtung gestützt, dass in Autopsiestudien eine hohe Dichte von CD8 + -T-Zellen in der Lunge und anderen Organen beobachtet wurden [25]. Eine weitere Ursache für eine Hyperinflammation oder Autoimmunität können Veränderungen der Mikrobiota des Gastrointestinaltraktes sein [26]. Eine (pro-inflammatorische) Dysbiose ist typisch für COVID-19-Patienten, persistiert über den Krankenhausaufenthalt hinaus und korreliert mit dem Schweregrad der COVID-19-Erkrankungen und einer verlängerten fäkalen SARS-CoV-2-Ausscheidung [27,28].…”

The Human Virome: Viral Metagenomics, Relations with Human Diseases, and Therapeutic Applications

“…With regard to donor and recipient selection for FMT, as the bidirectional gut-lung axis during COVID-19 infection can directly (via ACE2 receptors and gut microbial metabolites) and indirectly (via the immune system) affect the gut and lung, FMT screening protocols are required during and after the COVID-19 pandemic [8]. Another review summarizing donor screening recommendations indicated that diabetes mellitus, prior cardiovascular events, and exposure in clinical healthcare settings should be considered exclusion criteria until more is known about the associations of these conditions with the human gut microbiome [133].…”

“…Moreover, virome-related therapeutic applications to overcome dysbiosis, such as fecal microbiota transplantation (FMT) and phage therapy, have been applied in several clinical trials. Potential adverse effects related to each treatment type should be taken into consideration, and clinical protocols are also required for such applications during the COVID-19 pandemic and post-COVID-19 period [8].…”

Leitlinie S1: Long COVID: Differenzialdiagnostik und Behandlungsstrategien

“…Diskutiert wird, dass das SARS-CoV‑2 in Antigen-präsentierenden Zellen eine „bystander-Aktivierung“ von T‑Zellen gegen Autoantigene auslösen könnte [ 28 ]. Mögliche alternative oder weitere Ursache für eine Hyperinflammation könnten Veränderungen der Mikrobiota des Gastrointestinaltraktes [ 29 ] bzw. eine Dysbiose [ 30 , 31 ] sein.…”