Vassallo Gabriele Angelo, Dionisi Tommaso, De Vita Vittorio, Augello Giuseppe, Gasbarrini Antonio, Pitocco Dario, Addolorato Giovanni
Department of Internal Medicine, Barone Lombardo Hospital, Canicattì, Italy.
Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Acta Diabetol. 2025 Apr 19. doi: 10.1007/s00592-025-02508-0.
Fecal microbiota transplantation (FMT) has emerged as a potential therapeutic strategy for modulating gut dysbiosis in diabetes mellitus. This review critically evaluates preclinical and clinical evidence on FMT in type 1 (T1D) and type 2 diabetes (T2D). Studies suggest that FMT can restore microbial diversity, improve glycemic control, and modulate immune responses, with varying effects across diabetes subtypes. In T1D, preclinical models demonstrate that FMT influences regulatory T-cell expansion and β-cell preservation, though clinical translation remains limited. In T2D, FMT has shown transient improvements in insulin sensitivity, with sustained effects observed only in patients with specific microbiome signatures. However, heterogeneity in patient responses, donor variability, and methodological limitations complicate its clinical application. This review highlights the interplay between FMT, immune modulation, and microbial metabolism, advocating for phenotype-stratified trials and multi-omics integration to enhance therapeutic precision.
粪便微生物群移植（FMT）已成为调节糖尿病患者肠道菌群失调的一种潜在治疗策略。这篇综述批判性地评估了1型糖尿病（T1D）和2型糖尿病（T2D）中FMT的临床前和临床证据。研究表明，FMT可以恢复微生物多样性、改善血糖控制并调节免疫反应，对不同糖尿病亚型有不同影响。在T1D中，临床前模型表明FMT会影响调节性T细胞扩增和β细胞保存，不过临床转化仍然有限。在T2D中，FMT已显示出胰岛素敏感性的短暂改善，仅在具有特定微生物组特征的患者中观察到持续效果。然而，患者反应的异质性、供体变异性和方法学局限性使其临床应用变得复杂。这篇综述强调了FMT、免疫调节和微生物代谢之间的相互作用，主张进行表型分层试验和多组学整合以提高治疗精准度。
