School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
PLoS One. 2024 Oct 21;19(10):e0311731. doi: 10.1371/journal.pone.0311731. eCollection 2024.
Gut microbiota play important roles in several diseases like viral infections. In this systematic review, our objective was to assess the efficacy and safety of fecal microbiota transplantation (FMT) in treating various viral diseases.
We conducted searches on databases including PubMed, Web of Science, Scopus, and Google Scholar until November 2023. Clinical trials reported outcomes related to safety of FMT or its efficacy in patients with viral diseases were included. We excluded other types of studies that enrolled healthy individuals or patients with other disorders and did not use FMT. The assessment of bias risk was conducted using the National Institutes of Health (NIH) study quality evaluation tool.
Eight studies with total 196 participants were included. Viral diseases were human immunodeficiency virus (HIV), hepatitis B, COVID-19 and Clostridioides difficile coinfection, and cytomegalovirus colitis. In hepatitis B cases, HBeAg clearance was significant in those received FMT (p<0.01), while it was not significant in another one (p = 0.19). A clinical response was noted in 37.5% of patients with cytomegalovirus colitis, with an equal percentage achieving clinical remission post-FMT. There was a significant reduction in Clostridioides difficile relapse rate in FMT group than controls in coinfection of Clostridioides difficile and COVID-19 (2.17% vs. 42.5%, p<0.05). In patients with HIV, partial engraftment of the donor microbiome and increases in alpha diversity were observed after FMT. No severe adverse events were reported. Most studies had fair or good qualities.
Our findings revealed FMT as a promising, safe treatment for some viral diseases. It improved viral clearance, clinical outcomes, and inflammation. However, the varying responses and small sample sizes call for more trials on FMT in viral diseases.
肠道微生物群在多种疾病中发挥着重要作用，如病毒感染。在这项系统评价中，我们的目的是评估粪便微生物群移植（FMT）治疗各种病毒性疾病的疗效和安全性。
我们在数据库中进行了检索，包括 PubMed、Web of Science、Scopus 和 Google Scholar，检索时间截至 2023 年 11 月。纳入的临床试验报告了与 FMT 的安全性或其在病毒性疾病患者中的疗效相关的结局。我们排除了其他类型的研究，这些研究纳入了健康个体或患有其他疾病且未使用 FMT 的患者。偏倚风险的评估使用美国国立卫生研究院（NIH）的研究质量评估工具进行。
纳入了 8 项研究，共 196 名参与者。病毒性疾病包括人类免疫缺陷病毒（HIV）、乙型肝炎、COVID-19 和艰难梭菌感染以及巨细胞病毒结肠炎。在乙型肝炎病例中，接受 FMT 的患者 HBeAg 清除率显著（p<0.01），而另一项研究则不显著（p=0.19）。巨细胞病毒结肠炎患者中有 37.5%出现临床反应，FMT 后有相同比例的患者达到临床缓解。在艰难梭菌和 COVID-19 感染的艰难梭菌感染中，FMT 组的艰难梭菌复发率显著低于对照组（2.17%比 42.5%，p<0.05）。在 HIV 患者中，FMT 后观察到供体微生物组的部分定植和 alpha 多样性增加。未报告严重不良事件。大多数研究的质量为良好或中等。
我们的研究结果表明，FMT 是治疗某些病毒性疾病的一种有前途、安全的治疗方法。它改善了病毒清除率、临床结局和炎症。然而，不同的反应和小样本量呼吁在病毒性疾病中进行更多的 FMT 试验。
