粪便微生物群移植:关于应用、疗效和风险的新临床数据综述(2015 - 2020年)

Fecal microbiota transplants: A review of emerging clinical data on applications, efficacy, and risks (2015-2020).

作者信息

Al-Ali Dana, Ahmed Aamena, Shafiq Ameena, McVeigh Clare, Chaari Ali, Zakaria Dalia, Bendriss Ghizlane

机构信息

Premedical Division Weill Cornell Medicine-Qatar, Premedical Division, PO Box 24144 Doha, Qatar E-mail:

Northwestern University Qatar, Doha, Qatar.

出版信息

Qatar Med J. 2021 Feb 22;2021(1):5. doi: 10.5339/qmj.2021.5. eCollection 2021.

Abstract

As the importance of the gut microbiota in health and disease is a subject of growing interest, fecal microbiota transplantation (FMT) was suggested as an attractive therapeutic strategy to restore homeostasis of the gut microbiota, thereby treating diseases that were associated with alteration of the gut microbiota. FMT involves the administration of fresh, frozen, or dried fecal microorganisms from the gut of a healthy donor into the intestinal tract of a patient. This rediscovery of the potential benefits of an ancient practice was accompanied by a rapid progression of our understanding of the roles and mechanisms of gut microbes in the pathogenesis of disease. With a growing number of diseases being associated with dysbiosis or the alteration of gut microbiota, FMT was suggested as an attractive therapeutic strategy to "reset the gut" and initiate clinical resolutions or remissions. The number of FMT clinical trials is increasing worldwide, but no trials are registered in the Gulf region; this suggested the need for raising awareness of the latest studies on FMT. This review presented the emergent preclinical and clinical data to give an overview of the potential clinical applications, the benefits, and inconveniences that were worth considering for eventual future testing of fecal transplants in Qatar and the Middle East. This study highlighted the diversity of methods tested and commented on the variables that can affect the assessment of the effectiveness of FMT in specific diseases. The risks associated with FMT and the threat of antimicrobial resistance for this therapeutic approach were reviewed. From gastrointestinal diseases to neurodevelopmental disorders, understanding the roles of the gut microbiota in health and disease should be at the heart of developing novel, standardized, yet personalized, methods for this ancient therapeutic approach.

摘要

由于肠道微生物群在健康和疾病中的重要性日益受到关注,粪便微生物群移植(FMT)被认为是一种有吸引力的治疗策略,可恢复肠道微生物群的稳态,从而治疗与肠道微生物群改变相关的疾病。FMT包括将来自健康供体肠道的新鲜、冷冻或干燥的粪便微生物接种到患者的肠道中。这种对一种古老疗法潜在益处的重新发现,伴随着我们对肠道微生物在疾病发病机制中的作用和机制的理解迅速发展。随着越来越多的疾病与肠道微生物群失调或改变相关,FMT被认为是一种有吸引力的治疗策略,以“重置肠道”并启动临床缓解或病情改善。全球范围内FMT临床试验的数量在增加,但海湾地区没有注册的试验;这表明需要提高对FMT最新研究的认识。本综述展示了新出现的临床前和临床数据,以概述潜在的临床应用、益处以及在卡塔尔和中东地区最终对粪便移植进行未来测试时值得考虑的不便之处。这项研究强调了所测试方法的多样性,并对可能影响FMT在特定疾病中有效性评估的变量进行了评论。对与FMT相关的风险以及这种治疗方法对抗菌药物耐药性的威胁进行了综述。从胃肠道疾病到神经发育障碍,了解肠道微生物群在健康和疾病中的作用应该是为这种古老治疗方法开发新颖、标准化且个性化方法的核心。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c05c/8475724/acf0d2316f10/qmj-2021-005-g001.jpg

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