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粪便微生物群移植:历史、程序和监管考虑因素。

Fecal microbiota transplantation: History, procedure and regulatory considerations.

机构信息

Research Student - Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education Research, Mysuru, Karnataka, India.

Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education Research, S.S. Nagar, Mysuru, 570015 Karnataka, India; Faculty of Pharmaceutical Sciences, UCSI University, Malaysia.

出版信息

Presse Med. 2023 Dec;52(4):104204. doi: 10.1016/j.lpm.2023.104204. Epub 2023 Nov 7.

Abstract

Fecal microbiota transplantation (FMT) is a medical treatment which involves the transfer of feces from a healthy donor to a recipient to restore the balance of gut microbiota and improve clinical outcomes. FMT has gained recognition in recent years due to its effectiveness in treating recurrent Clostridioides difficile infections (rCDI) and other gastrointestinal disorders. Additionally, it has been studied as an intervention for some other conditions, like inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). This review covers regulatory considerations related to FMT, including the current state of FMT regulation and the need for further research to fully understand the safety and efficacy of this treatment. For transplantation of fecal microbiota, the Food and Drug Administration (FDA) classifies the treatment as an investigational new drug (IND), which typically requires physicians and scientists to submit an IND application. Ethical issues surrounding FMT, including the necessity of informed consent from donors and recipients and the potential transmission of infectious agents, are also discussed. Overall, FMT has the potential to offer significant therapeutic benefits, but it also raises regulatory and ethical considerations that require careful consideration. Further research is necessary to fully comprehend risks and benefits of FMT and to develop guidelines for its use in clinical practice.

摘要

粪便微生物群移植(FMT)是一种医疗治疗方法,涉及将粪便从健康供体转移到受者体内,以恢复肠道微生物群的平衡并改善临床结果。由于 FMT 在治疗复发性艰难梭菌感染(rCDI)和其他胃肠道疾病方面的有效性,近年来它已得到认可。此外,它还被研究作为一些其他疾病的干预措施,如炎症性肠病(IBD)和肠易激综合征(IBS)。本综述涵盖了与 FMT 相关的监管考虑因素,包括 FMT 监管的现状以及进一步研究以充分了解这种治疗方法的安全性和有效性的必要性。对于粪便微生物群的移植,食品和药物管理局(FDA)将该治疗方法归类为研究性新药(IND),通常要求医生和科学家提交 IND 申请。还讨论了围绕 FMT 的伦理问题,包括供体和受者知情同意的必要性以及潜在的传染病原体传播的问题。总的来说,FMT 有可能提供显著的治疗益处,但也提出了监管和伦理方面的考虑因素,需要仔细考虑。需要进一步研究以充分了解 FMT 的风险和益处,并制定其在临床实践中的使用指南。

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