The use of fecal microbiota transplantation in the treatment of intestinal diseases
DOI:
https://doi.org/10.12775/JEHS.2020.10.09.082Keywords
fecal microbiota transplantation, gastrointestinal microbiome, intestinal diseasesAbstract
Introduction and purpose
Fecal microbiota transplantation (FMT) is a process of transferring gut microflora from a healthy donor to a recipient. It is indicated that the human distal gastrointestinal tract consists of more than 1000 species of bacteria, which have an impact on local and systemic processes related to immunity, nutrition and the gut-brain axis. The growth of new bacterial species, reduction of microbial variety or big changes in the ratio between them can lead to a dysbiosis. The relationship between intestinal microbiota and some systemic diseases is seen.
The study aimed to present the state of knowledge on FMT in the treatment of intestinal diseases. Publications from the last 5 years from the Pubmed database were included.
A brief description of the state of knowledge
Intestinal diseases constitute the main group of indications for FMT. FMT can be delivered via upper or lower gastrointestinal routes. The review presents different studies concerning the usage of FMT. Among them, recurrent Clostridium difficile infection, colitis ulcerosa, Crohn’s disease and irritable bowel syndrome are mainly indicated in the literature. FMT might find its application also in a treatment of multidrug-resistant organisms colonization, antibiotic-associated diarrhea, gut acute graft-versus-host disease and radiation enteritis. There is a possibility of the occurrence of adverse events from the digestive tract after FMT. However, the studies evaluate them as mostly mild and transient. In some cases it was necessary to repeat FMT to achieve a satisfactory final result.
Conclusions
Fecal microbiota transplantation gives hope for a safe and effective method of treatment of certain intestinal diseases. There is a need for conducting further analysis of the method.
References
Hsu WH, Wang JY, Kuo CH. Current applications of fecal microbiota transplantation in intestinal disorders. Kaohsiung J Med Sci. 2019;35(6):327-331. doi: 10.1002/kjm2.12069.
Kelly CR, Kahn S, Kashyap P, Laine L, Rubin D, Atreja A, Moore T, Wu G. Update on Fecal Microbiota Transplantation 2015: Indications, Methodologies, Mechanisms, and Outlook. Gastroenterology. 2015;149(1):223-237. doi:10.1053/j.gastro.2015.05.008.
GWeiss GA, Hennet T. Mechanisms and consequences of intestinal dysbiosis. Cell Mol Life Sci. 2017;74(16):2959-2977. doi: 10.1007/s00018-017-2509-x.
GKim KO, Gluck M. Fecal microbiota transplantation: an update on clinical practice. Clin Endosc. 2019;52(2):137–143. doi: 10.5946/ce.2019.009.
Zhang F, Cui B, He X, Nie Y, Wu K, Fan D, FMT-standardization Study Group. Microbiota transplantation: concept, methodology and strategy for its modernization. Protein Cell. 2018;9(5):462-473. doi: 10.1007/s13238-018-0541-8.
Liubakka A, Vaughn BP. Clostridium difficile infection and fecal microbiota transplant. AACN Adv Crit Care. 2016;27(3):324-337. doi: 10.4037/aacnacc2016703.
Hagel S, Fischer A, Ehlermann P, Frank T, Tueffers K, Sturm A, Link A, Demir M, Siebenhaar A, Storr M, Glueck T, Siegel E, Solbach P, Goeser F, Koelbel CB, Lohse A, Luebbert C, Kandzi U, Maier M, Schuerle S, Lerch MM, Tacke D, Cornely OA, Stallmach A, Vehreschild M. Fecal Microbiota Transplant in Patients With Recurrent Clostridium Difficile Infection. Dtsch Arztebl Int. 2016;113(35-36):583-9. doi: 10.3238/arztebl.2016.0583.
Kelly CR, Khoruts A, Staley C, Sadowsky MJ, Abd M, Alani M, Bakow B, Curran P, McKenney J, Tisch A, Reinert SE, Machan JT, Brandt LJ. Effect of Fecal Microbiota Transplantation on Recurrence in Multiply Recurrent Clostridium difficile Infection: A Randomized Trial. Ann Intern Med. 2016;165(9):609-616. doi: 10.7326/M16-0271.
Hvas CL, Dahl Jørgensen SM, Jørgensen SP, Storgaard M, Lemming L, Hansen MM, Erikstrup C, Dahlerup JF. Fecal Microbiota Transplantation Is Superior to Fidaxomicin for Treatment of Recurrent Clostridium difficile Infection. Gastroenterology. 2019;156(5):1324-1332.e3. doi: 10.1053/j.gastro.2018.12.019.
Hota SS, Sales V, Tomlinson G, Salpeter MJ, McGeer A, Coburn B, Guttman DS, Low DE, Poutanen SM. Oral Vancomycin Followed by Fecal Transplantation Versus Tapering Oral Vancomycin Treatment for Recurrent Clostridium difficile Infection: An Open-Label, Randomized Controlled Trial. Clin Infect Dis. 2017;64(3):265-271. doi: 10.1093/cid/ciw731.
Ianiro G,Masucci L, Quaranta G, Simonelli C, Lopetuso LR, Sanguinetti, Gasbarrini A, Cammarota G. Randomised clinical trial: faecal microbiota transplantation by colonoscopy plus vancomycin for the treatment of severe refractory Clostridium difficile infection-single versus multiple infusions. Aliment Pharmacol Ther. 2018;48(2):152-159. doi: 10.1111/apt.14816.
Lee CH,Steiner T, Petrof EO, Smieja M, Roscoe D, Nematallah A, Weese JS, Collins S, Moayyedi P, Crowther M, Ropeleski MJ, Jayaratne P, Higgins D, Li Y, Rau NV, Kim PT. Frozen vs Fresh Fecal Microbiota Transplantation and Clinical Resolution of Diarrhea in Patients With Recurrent Clostridium difficile Infection: A Randomized Clinical Trial. JAMA.2016;315(2):142-9. doi: 10.1001/jama.2015.18098.
Kao D, Roach B, Silva M, Beck P, Rioux K, Kaplan GG, Chang HJ5, Coward S, Goodman KJ, Xu H, Madsen K, Mason A, Wong GK, Jovel J, Patterson J, Louie T. Effect of Oral Capsule- vs Colonoscopy-Delivered Fecal Microbiota Transplantation on Recurrent Clostridium difficile Infection: A Randomized Clinical Trial. JAMA. 2017;318(20):1985-1993. doi: 10.1001/jama.2017.17077.
Jiang ZD, Jenq RR, Ajami NJ, Petrosino JF, Alexander AA, Ke S, Iqbal T, DuPont AW, Muldrew K, Shi Y, Peterson C, Do KA, DuPont HL. Safety and preliminary efficacy of orally administered lyophilized fecal microbiota product compared with frozen product given by enema for recurrent Clostridium difficile infection: A randomized clinical trial. PLoS One. 2018;13(11):e0205064. doi: 10.1371/journal.pone.0205064.
Kim KO, Schwartz MA, Lin OST, Chiorean MV, Gluck M. Reducing Cost and Complexity of Fecal Microbiota Transplantation Using Universal Donors for Recurrent Clostridium difficile Infection. Adv Ther. 2019;36(8):2052-2061. doi: 10.1007/s12325-019-00974-x.
Yamamoto-Furusho JK, Gutiérrez-Grobe Y, López-Gómez JG, Bosques-Padilla F, Rocha-Ramírez JL. The Mexican consensus on the diagnosis and treatment of ulcerative colitis. Consenso mexicano para el diagnóstico y tratamiento de la colitis ulcerosa crónica idiopática. Rev Gastroenterol Mex. 2018;83(2):144-167.
Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF. Ulcerative colitis. Lancet. 2017;389(10080):1756-1770.
Eisenstein M. Ulcerative colitis: towards remission. Nature. 2018;563(7730):S33. doi:10.1038/d41586-018-07276-2.
Adler E, Tabaa A, Kassam Z, Zydek M, Terdiman J, El-Nachef N. Capsule-Delivered Fecal Microbiota Transplant Is Safe and Well Tolerated in Patients with Ulcerative Colitis. Dig Dis Sci. 2019;64(9):2452-2454. doi:10.1007/s10620-019-05596-5.
Narula N, Kassam Z, Yuan Y, Colombel JF, Ponsioen C, Reinisch W, Moayyedi P. Systematic Review and Meta-analysis: Fecal Microbiota Transplantation for Treatment of Active Ulcerative Colitis. Inflamm Bowel Dis. 2017;23(10):1702-1709. doi:10.1097/MIB.0000000000001228.
Paramsothy S, Nielsen S, Kamm MA, Deshpande NP, Faith JJ, Clemente JC, Paramsothy R, Walsh AJ, van den Bogaerde J, Samuel D, Leong RWL, Connor S, Ng W, Lin E, Borody TJ, Wilkins MR, Colombel JF, Mitchell HM, Kaakoush NO. Specific Bacteria and Metabolites Associated With Response to Fecal Microbiota Transplantation in Patients With Ulcerative Colitis. Gastroenterology. 2019;156(5):1440-1454.e2. doi:10.1053/j.gastro.2018.12.001.
Paramsothy S, Kamm MA, Kaakoush NO, Walsh AJ, van den Bogaerde J, Samuel D, Leong RWL, Connor S, Ng W, Paramsothy R, Xuan W, Lin E, Mitchell HM, Borody TJ. Multidonor intensive faecal microbiota transplantation for active ulcerative colitis: a randomised placebo-controlled trial. Lancet. 2017;389(10075):1218-1228. doi:10.1016/S0140-6736(17)30182-4.
Mahajan R, Midha V, Singh A, Mehta V, Gupta Y, Kaur K, Sudhakar R, Singh Pannu A, Singh D, Sood A. Incidental benefits after fecal microbiota transplant for ulcerative colitis. Intest Res. 2020;18(3):337-340. doi: 10.5217/ir.2019.00108.
Tian Y, Zhou Y, Huang S, Li J, Zhao K, Li X, Wen X, Li XA. Fecal microbiota transplantation for ulcerative colitis: a prospective clinical study. BMC Gastroenterol. 2019;19(1):116. doi:10.1186/s12876-019-1010-4.
Uygun A, Ozturk K, Demirci H, Oger C, Avci IY, Turker T, Gulsen M. Fecal microbiota transplantation is a rescue treatment modality for refractory ulcerative colitis. Medicine (Baltimore). 2017;96(16):e6479. doi:10.1097/MD.0000000000006479.
Ballester Ferré MP, Boscá-Watts MM, Mínguez Pérez M. Crohn's disease. Enfermedad de Crohn. Med Clin (Barc). 2018;151(1):26-33. doi:10.1016/j.medcli.2017.10.036.
Veauthier B, Hornecker JR. Crohn's Disease: Diagnosis and Management. Am Fam Physician. 2018;98(11):661-669.
Ibraheim H, Giacomini C, Kassam Z, Dazzi F, Powell N. Advances in mesenchymal stromal cell therapy in the management of Crohn's disease. Expert Rev Gastroenterol Hepatol. 2018;12(2):141-153. doi:10.1080/17474124.2018.1393332.
Gajendran M, Loganathan P, Catinella AP, Hashash JG. A comprehensive review and update on Crohn's disease. Dis Mon. 2018;64(2):20-57 doi:10.1016/j.disamonth.2017.07.001.
Wang H, Cui B, Li Q, Ding X, Li P, Zhang T, Yang X, Ji G, Zhang F. The Safety of Fecal Microbiota Transplantation for Crohn's Disease: Findings from A Long-Term Study. Adv Ther. 2018;35(11):1935-1944. doi:10.1007/s12325-018-0800-3.
Vaughn BP, Vatanen T, Allegretti JR, Bai A, Xavier RJ, Korzenik J, Gevers D, Ting A, Robson SC, Moss AC. Increased Intestinal Microbial Diversity Following Fecal Microbiota Transplant for Active Crohn's Disease. Inflamm Bowel Dis. 2016;22(9):2182-2190. doi:10.1097/MIB.0000000000000893.
Gutin L, Piceno Y, Fadrosh D, Lynch K, Zydek M, Kassam Z, LaMere B, Terdiman J, Ma A, Somsouk M, Lynch S, El-Nachef N. Fecal microbiota transplant for Crohn disease: A study evaluating safety, efficacy, and microbiome profile. United European Gastroenterol J. 2019;7(6):807-814. doi:10.1177/2050640619845986.
Li P, Zhang T, Xiao Y, Tian L, Cui B, Ji G, Liu YY, Zhang F. Timing for the second fecal microbiota transplantation to maintain the long-term benefit from the first treatment for Crohn's disease. Appl Microbiol Biotechnol. 2019;103(1):349-360. doi:10.1007/s00253-018-9447-x.
Sokol H, Landman C, Seksik P, Berard L, Montil M, Nion-Larmurier I, Bourrier A, Le Gall G, Lalande V, De Rougemont A, Kirchgesner J, Daguenel A, Cachanado M, Rousseau A, Drouet É, Rosenzwajg M, Hagege H, Dray X, Klatzman D, Marteau P; Saint-Antoine IBD Network, Beaugerie L, Simon T. Fecal microbiota transplantation to maintain remission in Crohn's disease: a pilot randomized controlled study. Microbiome. 2020;8(1):12. doi:10.1186/s40168-020-0792-5.
Herndon CC, Wang YP, Lu CL. Targeting the gut microbiota for the treatment of irritable bowel syndrome. Kaohsiung J Med Sci. 2020;36(3):160-170. doi:10.1002/kjm2.12154.
Enck P, Aziz Q, Barbara G, Farmer AD, Fukudo S, Mayer EA, Niesler B, Quigley EM, Rajilić-Stojanović M, Schemann M, Schwille-Kiuntke J, Simren M, Zipfel S, Spiller RC. Irritable bowel syndrome. Nat Rev Dis Primers. 2016;2:16014. doi:10.1038/nrdp.2016.14.
Camilleri M. Management Options for Irritable Bowel Syndrome. Mayo Clin Proc. 2018;93(12):1858-1872. doi:10.1016/j.mayocp.2018.04.032.
Mazzawi T, Lied GA, Sangnes DA, El-Salhy M, Hov JR, Gilja OH, Hatlebakk JG, Hausken T. The kinetics of gut microbial community composition in patients with irritable bowel syndrome following fecal microbiota transplantation. PLoS One. 2018;13(11):e0194904. doi:10.1371/journal.pone.0194904.
Mazzawi T, Hausken T, Hov JR, Valeur J, Sangnes DA, El-Salhy M, Gilja OH, Hatlebakk JG, Lied GA. Clinical response to fecal microbiota transplantation in patients with diarrhea-predominant irritable bowel syndrome is associated with normalization of fecal microbiota composition and short-chain fatty acid levels. Scand J Gastroenterol. 2019;54(6):690-699. doi:10.1080/00365521.2019.1624815.
Halkjær SI, Christensen AH, Lo BZS, Browne PD, Günther S, Hansen LH, Petersen AM. Faecal microbiota transplantation alters gut microbiota in patients with irritable bowel syndrome: results from a randomised, double-blind placebo-controlled study. Gut. 2018;67(12):2107-2115. doi:10.1136/gutjnl-2018-316434.
El-Salhy M, Hatlebakk JG, Gilja OH, Bråthen Kristoffersen A, Hausken T. Efficacy of faecal microbiota transplantation for patients with irritable bowel syndrome in a randomised, double-blind, placebo-controlled study. Gut. 2020;69(5):859-867. doi:10.1136/gutjnl-2019-319630.
Dai M, Liu Y, Chen W, Buch H, Shan Y, Chang L, Bai Y, Shen C, Zhang X, Huo Y, Huang D, Yang Z, Hu Z, He X, Pan J, Hu L, Pan X, Wu X, Deng B, Li Z, Cui B, Zhang F. Rescue fecal microbiota transplantation for antibiotic-associated diarrhea in critically ill patients. Crit Care. 2019;23:324. doi:10.1186/s13054-019-2604-5.
Singh R , de Groot PF, Geerlings SE, Hodiamont CJ, Belzer C, Berge IJMT, de Vos WM, Bemelman FJ, Nieuwdorp M. Fecal microbiota transplantation against intestinal colonization by extended spectrum beta-lactamase producing Enterobacteriaceae: a proof of principle study. BMC Res Notes. 2018 Mar 22;11(1):190. doi: 10.1186/s13104-018-3293-x.
Kakihana K, Fujioka Y, Suda W, Najima Y, Kuwata G, Sasajima S, Mimura I, Morita H, Sugiyama D, Nishikawa H, Hattori M, Hino Y, Ikegawa S, Yamamoto, Toya T, Doki N, Koizumi K, Honda K, Ohashi K. Fecal microbiota transplantation for patients with steroid-resistant acute graft-versus-host disease of the gut. Blood. 2016;128(16):2083-2088. doi: 10.1182/blood-2016-05-717652.
Ding X, Li Q, Li P, Chen X, Xiang L, Bi L, Zhu J, Huang X, Cui B, Zhang F. Fecal microbiota transplantation: A promising treatment for radiation enteritis? Radiother Oncol. 2020;143:12-18. doi:10.1016/j.radonc.2020.01.011.
Downloads
Published
How to Cite
Issue
Section
License
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 479
Number of citations: 0