Abnormal Intestinal Microbiome in Medical Disorders and Potential Reversibility by Fecal Microbiota Transplantation

Abstract

Reduction in diversity of the intestinal microbiome (dysbiosis) is being identified in many disease states, and studies are showing important biologic contributions of microbiome to health and disease. Fecal microbiota transplantation (FMT) is being evaluated as a way to reverse dysbiosis in diseases and disorders in an attempt to improve health. The published literature was reviewed to determine the value of FMT in the treatment of medical disorders for which clinical trials have recently been conducted. FMT is effective in treating recurrent C. difficile infection in one or two doses, with many healthy donors providing efficacious fecal-derived products. In inflammatory bowel disease (IBD), FMT may lead to remission in approximately one-third of moderate-to-severe illnesses with one study suggesting that more durable FMT responses may be seen when used once medical remissions have been achieved. Donor products differ in their efficacy in treatment of IBD. Combining donor products has been one way to increase the potential value of FMT in treating chronic disorders. FMT is being explored in a variety of clinical settings affecting different organ systems outside CDI, with positive preliminary signals, in treatment of functional constipation, immunotherapy-induced colitis, neurodegenerative disease, as well as prevention of cancer-related disorders like graft versus host disease and decolonization of patients with recurrent urinary tract infection due to antibiotic-resistant bacteria. Currently, intense research is underway to see how the microbiome products like FMT can be harnessed for health benefits.

Modulation of Anti-Tumour Immune Responses by Probiotic Bacteria

“…Fecal microbial transfer (FMT) is a strategy considered in order to populate a patient's colon with bacterial content from healthy individuals. FMT is currently used in the treatment of Clostridioides difficile infection; however, there have been reports concerning its effectiveness in other gastrointestinal disorders as well [88,89]. With regard to cancer, Sivan et al [75] initially demonstrated that the spontaneous immune-mediated control of tumours could be transferred between responsive and unresponsive animals by FMT.…”

Autologous fecal microbiota transplantation for the treatment of inflammatory bowel disease

“…8,9,30,[35][36][37][38] However, analysis of microbiome data from three completed IBD h-FMT trials [39][40][41] showed there was no association between the presence and abundance of butyrate-producers in the feces of donors and the clinical response after h-FMT, suggesting that butyrate alone is not sufficient as a predictor for FMT efficacy. 42 In addition to the microbiota, some studies have suggested that the donor virome (''phagebiota") and fungal composition 43,44 play a critical role in determining h-FMT success, [44][45][46][47] although this appears to be disease specific, with studies demonstrating that phages are more relevant to FMT efficacy in CDI (eg, Caudovirales), 43,48 compared to the presence of eukaryotic viruses in donor stool for UC. 49 In addition to the relevance of the donor microbiome, studies showed that the gut microbiome composition in the recipient also plays a role in their clinical response to h-FMT.…”

FMT for chronic intestinal obstruction caused by constrictive pericarditis: a case report

“…In recent years, FMT is mainly used for the treatment of recurrent clostridium di cile infection (CDI), as well as the exploratory researches of various ora-related diseases, like in ammatory bowel disease (IBD), irritable bowel Syndrome (IBS), metabolic syndrome (MS), liver disease, autism spectrum disorder (ASD), autoimmune disease and immunode ciency disease. 5,6,7 Intestinal obstruction is a disease characterized by symptoms of intestinal obstruction are bloating, abdominal pain, vomiting, ceasing exhaust and defecate. Acute intestinal obstruction is often encountered in the emergency department and requires surgical treatment.…”