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Recipient factors in faecal microbiota transplantation: one stool does not fit all

Abstract

Faecal microbiota transplantation (FMT) is a promising therapy for chronic diseases associated with gut microbiota alterations. FMT cures 90% of recurrent Clostridioides difficile infections. However, in complex diseases, such as inflammatory bowel disease, irritable bowel syndrome and metabolic syndrome, its efficacy remains variable. It is accepted that donor selection and sample administration are key determinants of FMT success, yet little is known about the recipient factors that affect it. In this Perspective, we discuss the effects of recipient parameters, such as genetics, immunity, microbiota and lifestyle, on donor microbiota engraftment and clinical efficacy. Emerging evidence supports the possibility that controlling inflammation in the recipient intestine might facilitate engraftment by reducing host immune system pressure on the newly transferred microbiota. Deciphering FMT engraftment rules and developing novel therapeutic strategies are priorities to alleviate the burden of chronic diseases associated with an altered gut microbiota such as inflammatory bowel disease.

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Fig. 1: Effects of the host immune system on intestinal microbiota composition and functions.
Fig. 2: Potential targets and strategies on the recipient side to improve FMT efficacy.

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Acknowledgements

H.S. received funding from Agence National de Recherche (ANR-17-CE15–0019–01). N.R. and H.S. received support from the AFA (Association François Aupetit).

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C.D. researched data for the article, made a substantial contribution to the discussion of content, wrote the article and reviewed/edited the manuscript before submission. H.S. and N.R. researched data for the article, made a substantial contribution to the discussion of content and reviewed/edited the manuscript before submission.

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Correspondence to Harry Sokol.

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H.S. received unrestricted study grants from Danone, Biocodex, and Enterome, board membership, consultancy or lecture fees from Carenity, Abbvie, Astellas, Danone, Ferring, Mayoly Spindler, MSD, Novartis, Roche, Tillots, Enterome, Maat, BiomX, Biose, Novartis and Takeda, and is a co-founder of Exeliom bioscience. The other authors declare no competing interests.

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Nature Reviews Gastroenterology & Hepatology thanks G. Cammarota, B. Mullish and K. Madsen for their contribution to the peer review of this work.

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Danne, C., Rolhion, N. & Sokol, H. Recipient factors in faecal microbiota transplantation: one stool does not fit all. Nat Rev Gastroenterol Hepatol (2021). https://doi.org/10.1038/s41575-021-00441-5

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