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Fecal microbiota transplantation and emerging applications

Abstract

Fecal microbiota transplantation (FMT) has been utilized sporadically for over 50 years. In the past few years, Clostridium difficile infection (CDI) epidemics in the USA and Europe have resulted in the increased use of FMT, given its high efficacy in eradicating CDI and associated symptoms. As more patients request treatment and more clinics incorporate FMT into their treatment repertoire, reports of applications outside of CDI are emerging, paving the way for the use of FMT in several idiopathic conditions. Interest in this therapy has largely been driven by new research into the gut microbiota, which is now beginning to be appreciated as a microbial human organ with important roles in immunity and energy metabolism. This new paradigm raises the possibility that many diseases result, at least partially, from microbiota-related dysfunction. This understanding invites the investigation of FMT for several disorders, including IBD, IBS, the metabolic syndrome, neurodevelopmental disorders, autoimmune diseases and allergic diseases, among others. The field of microbiota-related disorders is currently in its infancy; it certainly is an exciting time in the burgeoning science of FMT and we expect to see new and previously unexpected applications in the near future. Well-designed and well-executed randomized trials are now needed to further define these microbiota-related conditions.

Key Points

  • Fecal microbiota transplantation (FMT) is arguably the most effective method in treating recalcitrant Clostridium difficile infection (CDI)

  • FMT is the engraftment of microbiota from a healthy donor into a recipient, which results in restoration of the normal gut microbial community structure

  • Standardization of FMT protocols should overcome the major practical barriers to its wider clinical implementation

  • As multiple major diseases might be linked to dysfunction of gut microbiota, FMT could have potential applications beyond CDI

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Figure 1: FMT for patients with recalcitrant CDI.

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Acknowledgements

This work was in part supported by NIH grant R21AI091907 (A. Khoruts). The authors would like to acknowledge J. Campbell, Centre for Digestive Diseases, Sydney, Australia, for her skilled assistance in various technical aspects of manuscript preparation and editorial support.

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Both authors contributed equally to researching data for the article, discussion of content, writing, reviewing and editing the manuscript.

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Correspondence to Thomas J. Borody.

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Thomas J. Borody has a pecuniary interest in the Centre for Digestive Diseases, where fecal microbiota transplantion is a treatment option, and has filed patents in this approach. Alexander Khoruts has filed patents in the field of fecal microbiota transplantation for the University of Minnesota, USA.

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Borody, T., Khoruts, A. Fecal microbiota transplantation and emerging applications. Nat Rev Gastroenterol Hepatol 9, 88–96 (2012). https://doi.org/10.1038/nrgastro.2011.244

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