Fecal microbiota transplantation in gastrointestinal disorders: time for precision medicine

Genome Medicine 12, Article number: 58 (2020) Cite this article

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Abstract

Fecal microbiota transplantation (FMT) has demonstrated efficacy in treating inflammatory bowel diseases and irritable bowel syndrome in an increasing number of randomized controlled trials. Recently published data gives striking insights into the factors associated with FMT success paving the road for the use of precision medicine in gastrointestinal disorders.

The gut microbiota is now known to be an essential co-factor in the pathophysiology of many diseases. In particular, inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS) are associated with alteration of the gut microbiota, which contributes to disease onset and maintenance. Therefore, reshaping the gut microbiome using fecal microbiota transplantation (FMT) is an attractive strategy to restore appropriate host-microbiota crosstalk.

Fecal microbiota transplantation consists of the transfer of the fecal microbial ecosystem of a healthy donor to a recipient to induce therapeutic effects. Stool preparations are usually administrated through frozen capsule, enema, colonoscopy, or duodenal infusion. As crude as it might appear, this is, nowadays, the only microbe-based therapy that allows the engraftment of a complex ecosystem into the gut.

Although FMT has been used in clinical practice for many years, many unknowns remain on its precise mode of action and long-term safety. Moreover, the role of the gut microbiota is not the same in different diseases, indicating the need for disease-specific approaches for donor selection and FMT procedure. Recently published data has given insights into the factors associated with FMT efficacy, paving the road for precision medicine in its use in gastrointestinal disorders.