Department of Gastroenterology, Shaanxi Hospital of Traditional Chinese Medicine, Xi'an 710003, Shaanxi Province, China.
Department of Neurology, Xi'an Hospital of Traditional Chinese Medicine, Xi'an 710021, Shaanxi Province, China.
World J Gastroenterol. 2022 Jun 21;28(23):2546-2560. doi: 10.3748/wjg.v28.i23.2546.
With the development of microbiology and metabolomics, the relationship between the intestinal microbiome and intestinal diseases has been revealed. Fecal microbiota transplantation (FMT), as a new treatment method, can affect the course of many chronic diseases such as metabolic syndrome, malignant tumor, autoimmune disease and nervous system disease. Although the mechanism of action of FMT is now well understood, there is some controversy in metabolic diseases, so its clinical application may be limited. Microflora transplantation is recommended by clinical medical guidelines and consensus for the treatment of recurrent or refractory infection, and has been gradually promoted for the treatment of other intestinal and extraintestinal diseases. However, the initial results are varied, suggesting that the heterogeneity of the donor stools may affect the efficacy of FMT. The success of FMT depends on the microbial diversity and composition of donor feces. Therefore, clinical trials may fail due to the selection of ineffective donors, and not to faulty indication selection for FMT. A new understanding is that FMT not only improves insulin sensitivity, but may also alter the natural course of type 1 diabetes by modulating autoimmunity. In this review, we focus on the main mechanisms and deficiencies of FMT, and explore the optimal design of FMT research, especially in the field of cardiometabolic diseases.
随着微生物学和代谢组学的发展，肠道微生物群与肠道疾病之间的关系已经被揭示出来。粪便微生物移植（FMT）作为一种新的治疗方法，可以影响代谢综合征、恶性肿瘤、自身免疫性疾病和神经系统疾病等许多慢性疾病的进程。虽然 FMT 的作用机制现在已经得到很好的理解，但在代谢疾病中存在一些争议，因此其临床应用可能受到限制。微生物群移植被临床医疗指南和共识推荐用于治疗复发性或难治性感染，并已逐渐推广用于治疗其他肠道和肠外疾病。然而，最初的结果是多样的，这表明供体粪便的异质性可能会影响 FMT 的疗效。FMT 的成功取决于供体粪便的微生物多样性和组成。因此，临床试验可能会因选择无效的供体而失败，而不是因为 FMT 的适应症选择不当。新的认识是，FMT 不仅可以提高胰岛素敏感性，而且可以通过调节自身免疫来改变 1 型糖尿病的自然病程。在这篇综述中，我们重点讨论了 FMT 的主要机制和缺陷，并探讨了 FMT 研究的最佳设计，特别是在心血管代谢疾病领域。
