Fecal microbiota transplantation – past, present, and future

Česká verze

Authors: Stebel R.; Vojtilová L.; Husa P.
Authors place of work: Klinika infekčních chorob LF MU a FN Brno
Published in the journal: Gastroent Hepatol 2020; 74(1): 54-61
Category: Klinická a experimentální gastroenterologie: přehledová práce
doi: https://doi.org/10.14735/amgh201954

Summary

Distortions in intestinal microbial ecosystems are important pathogenetic factors of numerous diseases. The role of alterations in intestinal microbiota in the pathogenesis of recurrent clostridium colitis is well known. A fecal transfer from a healthy donor can restore natural homeostasis in intestinal microbiota and thus disrupt a „vicious circle“ of chronic relapsing clostridium infection. In the future, it should be possible to perform peroral fecal microbiota transplantations using enterosolvent tablets or commercially produced fecal derivatives. This administration route minimises the risk of adverse complications, which are rarely observed when fecal suspensions are administered via a nasoenteral probe, endoscopy, or by rectal clysma. In the past few years, intestinal microbiota transplantation has been used for the treatment of other diseases, the pathogenesis of which is probably associated with intestinal dysbiosis. In this respect, the most discussed issues are idiopathic intestinal inflammations, irritable bowel syndrome, liver encephalopathy and recently, „civilisation diseases“ such as diabetes mellitus type 2, multiple sclerosis, Parkinson’s disease, and metabolic syndrome. The fecal bacteriotherapy effect is observed also during the eradication of multi-resistant bacterial strains that colonise patients’ intestines. At present, fecal bacteriotherapy for recurrent clostridium colitis, as a proved medical method, is an accepted and world-wide recommended therapy. As for other diseases, this method is still in the experimental stage. Conclusive results of randomised control trials are expected.

Conflict of Interest: The authors declare that the article/ manuscript complies with ethical standards, patient anonymity has been respected, and they state that they have no financial, advisory or other com mercial interests in relation to the subject matter.

Publication Ethics: This article/ manuscript has not been published or is cur rently be ing submitted for another review. The authors agree to publish their name and e-mail in the published article/ manuscript.

Dedication: Supported by MZ ČR – RVO (FNBr, 65269705).

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for bio medical papers.

Keywords:

dysbiosis – Clostridioides difficile – fecal microbiota transplantation – microbial drug resistance – intestinal microbiome – pseudomembranous colitis

Zdroje

1. Rao K, Young VB. Fecal Microbiota transplantation for the management of Clostridium difficile Infection. Infect Dis Clin North Am 2015; 29 (1): 109–122. doi: 10.1016/j.idc.2014.11.009.

2. Ooijevaar RE, Terveer EM, Verspaget HW et al. Clinical application and potential of fecal microbiota transplantation. Annu Rev Med 2019; 70 (1): 335–351. doi: 10.1146/annurev-med-111717-122956.

3. Gens KD, Elshaboury RH, Holt JS. Fecal microbiota transplantation and emerging treatments for Clostridium difficile infection. J Pharm Pract 2013; 26 (5): 498–505. doi: 10.1177/089719 0013499527.

4. Wilson BC, Vatanen T, Cutfield WS et al. The super-donor phenomenon in fecal microbiota transplantation. Front Cell Infect Microbiol 2019; 9. doi: 10.3389/fcimb.2019.00002.

5. Ooijevaar RE, Van Beurden YH, Terveer EM et al. Update of treatment algorithms for Clostridium difficile infection. Clin Microbiol Infect 2018; 24 (5): 452–462. doi: 10.1016/j.cmi.2017.12.022.

6. Wang JW, Kuo CH, Kuo FC et al. Fecal microbiota transplantation: review and update. J Formos Med Assoc 2019; 118 (Supl 1): S23–S31. doi: 10.1016/j.jfma.2018.08.011.

7. Mills JP, Rao K, Young VB. Probiotics for prevention of Clostridium difficile infection. Curr Opin Gastroenterol 2018; 34 (1): 3–10. doi: 10.1097/MOG.0000000000000410.

8. Moutinho BD, Baima JP, Rigo FF et al. Fecal microbiota transplantation in refractory ulcerative colitis – a case report. J Int Med Res 2019; 47 (2): 1072–1079. doi: 10.1177/0300060518821790.

9. Debast SB, Bauer MP, Kuijper EJ et al. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect 2014; 20 (Supl 2): S1–S26. doi: 10.1111/1469-0691.12418.

10. Yacyshyn B. Pathophysiology of Clostridium difficile–associated diarrhea. Gastroenterol Hepatol 2016; 12 (9): 558–560.

11. Napolitano LM, Edmiston CE Jr. Clostridium difficile disease: diagnosis, pathogenesis, and treatment update. Surgery 2017; 162 (2): 325–348. doi: 10.1016/j.surg.2017.01.018.

12. Polívková S, Vojtilová L, Husa P et al. Doporučený postup fekální bakterioterapie pro léčbu rekurentní klostridiové kolitidy. Klin Mikrobiol Infekc Lek 2018; 24 (2): 57–64.

13. Cammarota G, Ianiro G, Tilg H et al. European consensus conference on faecal microbiota transplantation in clinical practice. Gut 2017; 66 (4): 569–580. doi: 10.1136/gutjnl-2016-313017.

14. Lee CH, Steiner T, Petrof EO et al. Frozen vs fresh fecal microbiota transplantation and clinical resolution of diarrhea in patients with recurrent Clostridium difficile infection. JAMA 2016; 315 (2): 142–149. doi: 10.1001/jama.2015.18098.

15. Li YT, Cai HF, Wang ZH et al. Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation for Clostridium difficile infection. Aliment Pharmacol Ther 2016; 43 (4): 445–457. doi: 10.1111/apt.13492.

16. Youngster I, Sauk J, Pindar C et al. Fecal microbiota transplant for relapsing Clostridium difficile infection using a frozen inoculum from unrelated donors. Clin Infect Dis 2014; 58 (11): 1515–1522. doi: 10.1093/cid/ciu135.

17. Li N, Tian H, Ma C et al. Efficacy analysis of fecal microbiota transplantation in the treatment of 406 cases with gastrointestinal disorders. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20 (1): 40–46.

18. Březina J, Bajer L, Špičák J et al. Fekální mikrobiální transplantace u idiopatických střevních zánětů. Gastroent Hepatol 2016; 70 (1): 51–56. doi: 10.14735/amgh201651.

19. Moayyedi P, Surette MG, Kim PT et al. Fecal microbiota transplantation induces remission in patients with active Ulcerative colitis in a randomized controlled trial. Gastroenterology 2015; 149 (1): 102–109. doi: 10.1053/j.gastro.2015.04.001.

20. Rossen NG, Fuentes S, Van Der Spek MJ et al. Findings from a randomized controlled trial of fecal transplantation for patients with Ulcerative colitis. Gastroenterology 2015; 149 (1): 110–118. doi: 10.1053/j.gastro.2015.03.045.

21. Wang T, Kraft CS, Woodworth MH et al. Fecal microbiota transplant for refractory Clostridium difficile infection interrupts 25-year history of recurrent urinary tract infections. Open Forum Infect Dis 2018; 5 (2): 016. doi: 10.1093/ofid/ofy016.

22. Dinh A, Fessi H, Duran C et al. Clearance of carbapenem-resistant Enterobacteriaceae vs vancomycin-resistant enterococci carriage after faecal microbiota transplant: a prospective comparative study. J Hosp Infect 2018; 99 (4): 481–486. doi: 10.1016/j.jhin.2018.02.018.

23. Johnsen PH, Hilpüsch F, Cavanagh JP et al. Faecal microbiota transplantation versus placebo for moderate-to-severe irritable bowel syndrome: a double-blind, randomised, placebo-controlled, parallel-group, single-centre trial. Lancet Gastroenterol Hepatol 2018; 3 (1): 17–24. doi: 10.1016/S2468-1253 (17) 30338-2.

24. Mullish BH, Mc Donald JA, Thursz MR et al. Fecal microbiota transplant from a rational stool donor improves hepatic encephalopathy: a randomized clinical trial. Hepatology 2017; 66 (4): 1354–1355. doi: 10.1002/hep.29369.

25. Bajaj JS, Kassam Z, Fagan A et al. Fecal microbiota transplant from a rational stool donor improves hepatic encephalopathy: a randomized clinical trial. Hepatology 2017; 66 (6): 1727–1738. doi: 10.1002/hep.29306.

26. Marotz CA, Zarrinpar A. Treating obesity and metabolic syndrome with fecal microbiota transplantation. Yale J Biol Med 2016; 89 (3): 383–388.

27. Vrieze A, Van Nood E, Holleman F et al. Transfer of intestinal microbiota from lean donors increases insulin sensitivity in individuals with metabolic syndrome. Gastroenterology 2012; 143 (4): 913–916. doi: 10.1053/j.gastro.2012.06.031.

28. Alang N, Kelly CR. Weight gain after fecal microbiota transplantation. Open Forum Infect Dis 2015; 2 (1): ofv004. doi: 10.1093/ofid/ofv004.

29. Yang Y, Tian J, Yang B. Targeting gut microbiome: a novel and potential therapy for autism. Life Sci 2018; 194: 111–119. doi: 10.1016/j.lfs.2017.12.027.

30. Kang DW, Adams JB, Gregory AC et al. Microbiota transfer therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study. Microbiome 2017; 5 (1): 10. doi: 10.1186/s40168-016-0225-7.