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2016 ; 13
(9
): 508-16
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Understanding the mechanisms of faecal microbiota transplantation
#MMPMID27329806
Khoruts A
; Sadowsky MJ
Nat Rev Gastroenterol Hepatol
2016[Sep]; 13
(9
): 508-16
PMID27329806
show ga
This Review summarizes mechanistic investigations in faecal microbiota
transplantation (FMT), which has increasingly been adapted into clinical practice
as treatment for Clostridium difficile infection (CDI) that cannot be eliminated
with antibiotics alone. Administration of healthy donor faecal microbiota in this
clinical situation results in its engraftment and restoration of normal gut
microbial community structure and functionality. In this Review, we consider
several main mechanisms for FMT effectiveness in treatment of CDI, including
direct competition of C. difficile with commensal microbiota delivered by FMT,
restoration of secondary bile acid metabolism in the colon and repair of the gut
barrier by stimulation of the mucosal immune system. Some of these mechanistic
insights suggest possibilities for developing novel, next-generation CDI
therapeutics. FMT might also have potential applications for non-CDI indications.
The gut can become a reservoir of other potential antibiotic-resistant pathogens
under pressure of antibiotic treatments, and restoration of normal microbial
community structure by FMT might be a promising approach to protect against
infections with these pathogens as well. Finally, FMT could be considered for
multiple chronic diseases that are associated with some form of dysbiosis.
However, considerable research is needed to optimize the FMT protocols for such
applications before their therapeutic promise can be evaluated.