Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.
College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA.
Clin Infect Dis. 2023 Dec 5;77(Suppl 6):S447-S454. doi: 10.1093/cid/ciad639.
The profound impact of the human microbiome on health and disease has captivated the interest of clinical and scientific communities. The human body hosts a vast array of microorganisms collectively forming the human microbiome, which significantly influences various physiological processes and profoundly shapes overall well-being. Notably, the gut stands out as an exceptional reservoir, harboring the most significant concentration of microorganisms, akin to an organ in itself. The gut microbiome's composition and function are influenced by genetics, environment, age, underlying conditions, and antibiotic usage, leading to dysbiosis and pathogenesis, such as Clostridioides difficile infection (CDI). Conventional CDI treatment, involving antibiotics like oral vancomycin and fidaxomicin, fails to address dysbiosis and may further disrupt gut microbial communities. Consequently, emerging therapeutic strategies are focused on targeting dysbiosis and restoring gut microbiota to advance CDI therapeutics. Fecal microbiota transplantation (FMT) has demonstrated remarkable efficacy in treating recurrent CDI by transferring processed stool from a healthy donor to a recipient, restoring gut dysbiosis and enhancing bacterial diversity. Moreover, 2 newer Food and Drug Administration (FDA)-approved live biotherapeutic products (LBP), namely, Fecal Microbiota Live-JSLM and Fecal Microbiota Spores Live-BRPK, have shown promise in preventing CDI recurrence. This review explores the role of the gut microbiota in preventing and treating CDI, with an emphasis on gut-based interventions like FMT and fecal microbiota-based products that hold potential for gut restoration and prevention of CDI recurrence. Understanding the microbiome's impact on CDI prevention and treatment offers valuable insights for advancing future CDI therapeutics.
人体微生物组对健康和疾病的深远影响引起了临床和科学界的关注。人体携带着大量的微生物,共同构成了人体微生物组,这些微生物对各种生理过程有重要影响,并深刻影响整体健康。特别是肠道是一个特殊的储存库,拥有最大浓度的微生物,就像一个器官一样。肠道微生物组的组成和功能受到遗传、环境、年龄、潜在条件和抗生素使用的影响,导致微生态失调和发病机制,如艰难梭菌感染(CDI)。传统的 CDI 治疗,包括口服万古霉素和非达霉素等抗生素,无法解决微生态失调问题,并且可能进一步破坏肠道微生物群落。因此,新兴的治疗策略集中在针对微生态失调和恢复肠道微生物群,以推进 CDI 治疗。粪便微生物群移植(FMT)通过将来自健康供体的加工粪便转移给受体,来治疗复发性 CDI,已证明其具有显著疗效,可恢复肠道微生态失调并增强细菌多样性。此外,2 种新的获得美国食品和药物管理局(FDA)批准的活体生物治疗产品(LBP),即 Fecal Microbiota Live-JSLM 和 Fecal Microbiota Spores Live-BRPK,在预防 CDI 复发方面显示出潜力。本综述探讨了肠道微生物组在预防和治疗 CDI 中的作用,重点介绍了 FMT 和基于粪便微生物组的产品等基于肠道的干预措施,这些措施有可能恢复肠道并预防 CDI 复发。了解微生物组对 CDI 预防和治疗的影响,为推进未来 CDI 治疗提供了有价值的见解。
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