Bénard Mèlanie V, de Goffau Marcus C, Blonk Justine, Hugenholtz Floor, van Buuren Joep, Paramsothy Sudarshan, Kaakoush Nadeem O, D'Haens Geert R A M, Borody Thomas J, Kamm Michael A, Ponsioen Cyriel Y
Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Inflammatory Bowel Disease Centre, Amsterdam UMC, Amsterdam, the Netherlands.
Wellcome Sanger Institute, Hinxton, United Kingdom.
Clin Gastroenterol Hepatol. 2024 Oct 21. doi: 10.1016/j.cgh.2024.10.001.
BACKGROUND & AIMS: Fecal microbiota transplantation (FMT) can induce remission in patients with ulcerative colitis, yet its efficacy needs improvement. We conducted a comprehensive evaluation of the current literature on microbial factors affecting outcome, as well as a meta-analysis on some of the largest datasets regarding composition.
MEDLINE, Embase, and Cochrane were systematically searched through August 2024 for relevant studies. The quality of studies was analyzed with JBI tools and a composite critical appraisal score. Additionally, species-level data from 2 landmark FMT trials (the Transplantation of Feces in Ulcerative Colitis; Returning Nature's Homeostasis [TURN] and Fecal Microbiota Transplantation for Chronic Active Ulcerative Colitis [FOCUS] trials) were reanalyzed from a compositional perspective.
Out of 3755 citations identified, 56 met the inclusion criteria, of which 29 fulfilled quality standards. Higher microbial α-diversity, either in donors or recipients (at baseline or following FMT treatment), was associated with better clinical response rates. Engraftment of the donors' microbiota could not be clearly linked with clinical response, possibly because not every donor has an ideal microbiome. Butyrate-producing species from the Lachnospiraceae and Oscillospiraceae families were often related with response, whereas the reverse was true for Fusobacteria, many Proteobacteria, and Ruminococcus gnavus. Compositional analyses showed that clinical response is associated with a shift from a low-diversity, often Bacteroides-dominant composition to one with higher diversity, either dominated by various butyrate producers, the Christensenellaceae-Methanobrevibacter trophic network, or a moderate/high-diversity composition with abundant but not excessive levels of Prevotella copri.
This systematic review/meta-analysis yielded a coherent picture from a compositional perspective, which may help identify beneficial donor profiles and guide personalized FMT approaches.
粪菌移植（FMT）可诱导溃疡性结肠炎患者缓解，但其疗效仍需提高。我们对影响治疗结果的微生物因素的现有文献进行了全面评估，并对一些关于菌群组成的最大数据集进行了荟萃分析。
通过系统检索MEDLINE、Embase和Cochrane数据库，截至2024年8月查找相关研究。使用JBI工具和综合批判性评价分数分析研究质量。此外，从菌群组成角度重新分析了两项具有里程碑意义的FMT试验（溃疡性结肠炎粪便移植试验；恢复自然内环境平衡试验[TURN]和慢性活动性溃疡性结肠炎粪菌移植试验[FOCUS]）中的物种水平数据。
在识别出的3755篇文献中，56篇符合纳入标准，其中29篇达到质量标准。供体或受体中（基线时或FMT治疗后）较高的微生物α多样性与更好的临床缓解率相关。供体菌群的植入与临床缓解之间没有明确关联，可能是因为并非每个供体都有理想的微生物组。来自毛螺菌科和颤螺菌科的产丁酸菌通常与缓解相关，而梭杆菌属、许多变形菌门细菌和迟缓瘤胃球菌则相反。组成分析表明，临床缓解与从低多样性、通常以拟杆菌属为主的组成向高多样性组成的转变有关，后者要么由各种产丁酸菌、克里斯滕森菌科-甲烷短杆菌营养网络主导，要么是具有丰富但不过量的普氏粪杆菌的中度/高度多样性组成。
这项系统评价/荟萃分析从菌群组成角度得出了连贯的结果，这可能有助于识别有益的供体特征并指导个性化FMT方法。
