D Goldenberg Simon, Merrick Blair
Centre for Clinical Infection & Diagnostics Research, King's College London and Guy's & St. Thomas' NHS Foundation Trust, 5th floor, North Wing, St Thomas' hospital, Westminster Bridge Road, London, SE1 7EH, UK.
Centre for Clinical Infection & Diagnostics Research, King's College London and Guy's & St. Thomas' NHS Foundation Trust, London, UK.
Ther Adv Infect Dis. 2021 Jan 25;8:2049936120981526. doi: 10.1177/2049936120981526. eCollection 2021 Jan-Dec.
Faecal microbiota transplantation (FMT) is the transfer of screened and minimally processed faecal material from a 'healthy' donor to 'diseased' recipient. It has an established role, and is recommended as a therapeutic strategy, in the management of recurrent infection (CDI). Recognition that gut dysbiosis is associated with, and may contribute to, numerous disease states has led to interest in exploiting FMT to 'correct' this microbial imbalance. Conditions for which it is proposed to be beneficial include inflammatory bowel disease, irritable bowel syndrome, liver disease and hepatic encephalopathy, neuropsychiatric conditions such as depression and anxiety, systemic inflammatory states like sepsis, and even coronavirus disease 2019. To understand what role, if any, FMT may play in the management of these conditions, it is important to consider the potential risks and benefits of the therapy. Regardless, there are several barriers to its more widespread adoption, which include incompletely understood mechanism of action (especially outside of CDI), inability to standardise treatment, disagreement on its active ingredients and how it should be regulated, and lack of long-term outcome and safety data. Whilst the transfer of faecal material from one individual to another to treat ailments or improve health has a history dating back thousands of years, there are fewer than 10 randomised controlled trials supporting its use. Moving forward, it will be imperative to gather as much data from FMT donors and recipients over as long a timeframe as possible, and for trials to be conducted with rigorous methodology, including appropriate control groups, in order to best understand the utility of FMT for indications beyond CDI. This review discusses the history of FMT, its appreciable mechanisms of action with reference to CDI, indications for FMT with an emerging evidence base above and beyond CDI, and future perspectives on the field.
粪便微生物群移植(FMT)是将经过筛选和最低限度处理的粪便物质从“健康”供体转移到“患病”受体。在复发性感染(CDI)的管理中,它已确立了作用,并被推荐为一种治疗策略。认识到肠道生态失调与多种疾病状态相关且可能促成这些疾病状态,引发了人们利用FMT来“纠正”这种微生物失衡的兴趣。有人提出它可能有益的病症包括炎症性肠病、肠易激综合征、肝病和肝性脑病、诸如抑郁和焦虑等神经精神病症、像脓毒症这样的全身炎症状态,甚至还有2019冠状病毒病。为了了解FMT在这些病症的管理中可能发挥何种作用(如果有作用的话),重要的是要考虑该疗法的潜在风险和益处。无论如何,其更广泛应用存在若干障碍,包括作用机制尚未完全理解(尤其是在CDI之外)、无法使治疗标准化、对其活性成分以及应如何进行监管存在分歧,以及缺乏长期结果和安全性数据。虽然将粪便物质从一个人转移到另一个人以治疗疾病或改善健康的做法已有数千年历史,但支持其使用的随机对照试验不到10项。展望未来,必须在尽可能长的时间范围内收集来自FMT供体和受体的尽可能多的数据,并采用严格的方法进行试验,包括设置适当的对照组,以便最好地了解FMT在CDI之外的适应症方面的效用。本综述讨论了FMT的历史、其针对CDI的明显作用机制、除CDI之外有新证据基础的FMT适应症以及该领域的未来展望。
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