Fecal transplant: A safe and sustainable clinical therapy for restoring intestinal microbial balance in human disease?

Vrieze, Anne; Groot, Pieter F. de; Kootte, Ruud S.; Knaapen, Max; Nood, Els van; Nieuwdorp, Max

doi:10.1016/j.bpg.2013.03.003

Cited by 96 publications

(82 citation statements)

References 68 publications

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“…Donor signature bacterial groups were identified including bacteria often associated with health (for example, the potentially anti-inflammatory F. prausnitzii) (Sokol et al, 2008) as well as microbes associated with different steps of the complex carbohydrate fermentation scheme, such as primary complex carbohydrate degradation or secondary fermenters, like butyrate producers. Assessing a resilient and stable colonization of the gastrointestinal tract by a healthy microbiota and its networks is the key to identify an optimal ' healthy' microbiota composition, ideal for a successful FMT Vrieze et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…However, currently, the only effective treatment option for longstanding recurrent CDI is faecal microbiota transplantation (FMT) or donor faeces infusion, with a cure rate of 94% in patients with antibiotic refractory disease Vrieze et al, 2013). FMT is defined as the transfer of intestinal microbiota from a healthy donor that leads to the restoration of a stable microbial community in the gut (Borody and Khoruts, 2011;Lo Vecchio and Zacur, 2012).…”

Section: Introductionmentioning

confidence: 99%

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Reset of a critically disturbed microbial ecosystem: faecal transplant in recurrent Clostridium difficile infection

et al. 2014

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Recurrent Clostridium difficile infection (CDI) can be effectively treated by infusion of a healthy donor faeces suspension. However, it is unclear what factors determine treatment efficacy. By using a phylogenetic microarray platform, we assessed composition, diversity and dynamics of faecal microbiota before, after and during follow-up of the transplantation from a healthy donor to different patients, to elucidate the mechanism of action of faecal infusion. Global composition and network analysis of the microbiota was performed in faecal samples from nine patients with recurrent CDI. Analyses were performed before and after duodenal donor faeces infusion, and during a follow-up of 10 weeks. The microbiota data were compared with that of the healthy donors. All patients successfully recovered. Their intestinal microbiota changed from a low-diversity diseased state, dominated by Proteobacteria and Bacilli, to a more diverse ecosystem resembling that of healthy donors, dominated by Bacteroidetes and Clostridium groups, including butyrate-producing bacteria. We identified specific multi-species networks and signature microbial groups that were either depleted or restored as a result of the treatment. The changes persisted over time.Comprehensive and deep analyses of the microbiota of patients before and after treatment exposed a therapeutic reset from a diseased state towards a healthy profile. The identification of microbial groups that constitute a niche for C. difficile overgrowth, as well as those driving the reinstallation of a healthy intestinal microbiota, could contribute to the development of biomarkers predicting recurrence and treatment outcome, identifying an optimal microbiota composition that could lead to targeted treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reset of a critically disturbed microbial ecosystem: faecal transplant in recurrent Clostridium difficile infection

et al. 2014

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“…Table 4 shows the protocol for screening of fecal donors as used in the two RCT's [10,18] . In 2013, already an optimized screening protocol for fecal donors was published by the same authors [59] , which concerns not only the risk for transmission of infectious diseases, but also to the risk of transmitting other (autoimmune) diseases with regard to several conditions that may be transferred through feces.…”

Section: Records Identified Through Cochrane N = 172mentioning

confidence: 99%

Fecal microbiota transplantation as novel therapy in gastroenterology: A systematic review

Rossen

MacDonald

Vries

et al. 2015

WJG

207

131

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AIM:To study the clinical efficacy and safety of Fecal microbiota transplantation (FMT). We systematically reviewed FMT used as clinical therapy. METHODS:We searched MEDLINE, EMBASE, the Cochrane Library and Conference proceedings from inception to July, 2013. Treatment effect of FMT was calculated as the percentage of patients who achieved clinical improvement per patient category, on an intention-to-treat basis. RESULTS:We included 45 studies; 34 on Clostridium difficile -infection (CDI), 7 on inflammatory bowel disease, 1 on metabolic syndrome, 1 on constipation, 1 on pouchitis and 1 on irritable bowel syndrome (IBS). In CDI 90% resolution of diarrhea in 33 case series (n = 867) was reported, and 94% resolution of diarrhea after repeated FMT in a randomized controlled trial (RCT) (n = 16). In ulcerative colitis (UC) remission rates of 0% to 68% were found (n = 106). In Crohn's disease (CD) (n = 6), no benefit was observed. In IBS, 70% improvement of symptoms was found (n = 13). 100% Reversal of symptoms was observed in constipation (n = 3). In pouchitis, none of the patients (n = 8) achieved remission. One RCT showed significant improvement of insulin sensitivity in metabolic syndrome (n = 10). Serious adverse events were rare. SYSTEMATIC REVIEWS CONCLUSION:FMT is highly effective in CDI, and holds promise in UC. As for CD, chronic constipation, pouchitis and IBS data are too limited to draw conclusions. FMT increases insulin sensitivity in metabolic syndrome.

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“…However, experience with this technique is limited and requires careful consideration [91,92]. In addition, the development of genetically modified probiotics may be beneficial; for example, clinical benefit was observed with genetically modified L. lactis treatment to deliver IL-10 from intestinal mucosa in Crohn's disease patients.…”

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confidence: 99%

Role of Altered Intestinal Microbiota in Systemic Inflammation and Cardiovascular Disease in Chronic Kidney Disease

et al. 2014

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The normal intestinal microbiota plays a major role in the maintenance of health and disease prevention. In fact, the alteration of the intestinal microbiota has been shown to contribute to the pathogenesis of several pathological conditions, including obesity and insulin resistance, among others. Recent studies have revealed profound alterations of the gut microbial flora in patients and animals with chronic kidney disease (CKD). Alterations in the composition of the microbiome in CKD may contribute to the systemic inflammation and accumulation of gut-derived uremic toxins, which play a central role in the pathogenesis of accelerated cardiovascular disease and numerous other CKD-associated complications. This review is intended to provide a concise description of the potential role of the CKD-associated changes in the gut microbiome and its potential role the pathogenesis of inflammation and uremic toxicity. In addition, the potential efficacy of pre- and pro-biotics in the restoration of the microbiome is briefly described.

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Fecal transplant: A safe and sustainable clinical therapy for restoring intestinal microbial balance in human disease?

Cited by 96 publications

References 68 publications

Reset of a critically disturbed microbial ecosystem: faecal transplant in recurrent Clostridium difficile infection

Reset of a critically disturbed microbial ecosystem: faecal transplant in recurrent Clostridium difficile infection

Fecal microbiota transplantation as novel therapy in gastroenterology: A systematic review

Role of Altered Intestinal Microbiota in Systemic Inflammation and Cardiovascular Disease in Chronic Kidney Disease

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