FECAL MICROBIOTA TRANSPLANTATION FOR THE TREATMENT OF GASTROINTESTINAL DISEASE : PRESENT AND FUTURE PROSPECTS

Abstract

Fecal microbiota transplantation (FMT), which is a therapeutic approach for restoring normal functions of the intestinal microbiota by transplanting bacterial flora among feces derived from a healthy donor, has recently been evaluated in the context of treating patients with ulcerative colitis (UC). The therapeutic potential of FMT for treating various diseases has been extensively investigated in recent years. The high efficacy of FMT for the treatment of therapy-refractory, recurrent Clostridium difficile infection (CDI), an intestinal disease also linked to dysbiosis, was demonstrated by Von Nood et al. Two randomized placebo-controlled trials of FMT in patients with UC were reported in 2015 ; however, the efficacy of FMT treatment in patients with UC remains controversial. In 2017, a third randomized controlled trial in UC patients was reported in Australia. In this trial, multidonor intensive FMT was performed five times a week for eight weeks, resulting in remissions and positive responses. The multidonor intensive FMT was proven to be effective ; however, this treatment takes a large amount of time and is associated with complications. Thus, we have created a more effective and simple strategy for performing FMT in UC patients. We previously reported that FMT following triple antibiotic therapy (AFM : amoxicillin, fosfomycin and metronidazole) synergistically contributed to the recovery of the phylum Bacteroidetes composition, which was associated with the endoscopic severity of UC and a high clinical improvement rate. We named this combination therapy as A-FMT therapy, which stands for AFM plus FMT therapy. Standardization of donor screening and FMT techniques is needed to improve the efficacy and safety of FMT. Currently, no standard procedure for administering FMT therapy to UC patients has been established. More effective, simple, and personalized strategies for performing FMT in UC patients need to be developed.