Update on Fecal Microbiota Transplantation 2015: Indications, Methodologies, Mechanisms, and Outlook.
Update on Fecal Microbiota Transplantation 2015: Indications, Methodologies, Mechanisms, and Outlook.
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DOI：
10.1053/j.gastro.2015.05.008
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发表时间：
2015-07
期刊：
影响因子：
29.4
通讯作者：
Wu G
中科院分区：
文献类型：
--
作者：
Kelly CR;Kahn S;Kashyap P;Laine L;Rubin D;Atreja A;Moore T;Wu G
人体肠道内的微生物群落（或微生物群）对健康和功能至关重要，其复杂性可与器官系统相媲美。这种生态改变（或生态失调）与许多疾病状态有关，典型的例子是艰难梭菌感染（CDI）。粪便微生物群移植（FMT）已被证明可以持久地改变受体的肠道微生物群，并在治疗复发性CDI方面显示出疗效。FMT有望最终被证明对治疗其他与肠道微生物群改变相关的疾病有益，如炎症性肠病、肠易激综合征和代谢综合征，仅举几例。尽管FMT在CDI中表现出治疗效果的机制的基本原理越来越明显，但还需要进一步的研究来了解FMT在这些其他疾病中的可能作用。尽管操作相对简单，但关于短期和长期安全性的问题，以及复杂和快速发展的监管环境，限制了该技术的广泛应用。未来的工作将侧重于建立最佳实践和比目前存在的更可靠的安全性数据，以及改进FMT，以超越目前的“全粪便”移植，以提高安全性和耐受性。封装配方，全光谱基于粪便的产品和定义的微生物联盟都在不久的将来。
The community of microorganisms within the human gut (or microbiota) is critical to health and functions with a level of complexity comparable to an organ system. Alterations of this ecology (or dysbiosis) has been implicated in a number of disease states, the prototypical example being Clostridium difficile infection (CDI). Fecal microbiota transplantation (FMT) has been demonstrated to durably alter the gut microbiota of the recipient and has shown efficacy in the treatment of recurrent CDI. There is hope that FMT may eventually prove beneficial for treatment of other disease associated with alterations in gut microbiota, such as inflammatory bowel disease, irritable bowel syndrome and the metabolic syndrome, to name a few. Although the basic principles that underlie the mechanisms by which FMT demonstrates therapeutic efficacy in CDI are becoming apparent, further research is needed to understand the possible role of FMT in these other conditions. Though relatively simple to perform, questions regarding both short- and long-term safety, as well as the complex and rapidly evolving regulatory landscape has limited widespread utilization. Future work will focus on establishing best practices and more robust safety data than exist currently, as well as refining FMT beyond current “whole stool” transplants to increase safety and tolerability. Encapsulated formulations, full spectrum stool-based products and defined microbial consortia are all in the immediate future.