Fecal microbiota transplantation: current challenges and future landscapes

Area of Science:

• Gastroenterology and Microbiology
• Immunology
• Oncology

Background:

• Gut microbial homeostasis is crucial for health, driving interest in microbiome restoration therapies.
• Fecal microbiota transplantation (FMT) is an established treatment for recurrent Clostridioides difficile infection (rCDI).
• FMT's potential extends to inflammatory bowel disease (IBD), metabolic syndrome, and cancer immunotherapy, though its complex nature poses challenges.

Purpose of the Study:

• To review the clinical applications, efficacy, durability, and safety of FMT.
• To delineate FMT's mechanisms in IBD, contrasting with rCDI.
• To discuss omics technologies, regulatory issues, and future microbiome-based therapeutics.

Main Methods:

• Comprehensive review of human studies on FMT in rCDI and IBD.
• Analysis of data on FMT's procedural and administration aspects.
• Examination of omics technologies (metagenomics) and bioinformatics for microbial community characterization.

Main Results:

• FMT is effective for rCDI and shows promise in IBD, with ongoing research into its mechanisms.
• Mechanisms include colonization resistance, functional restoration, microbiome modulation (virome/phageome, metabolome), and immunomodulation.
• FMT's application in pediatric populations and cancer immunotherapy is also described.

Conclusions:

• FMT is a significant therapeutic strategy for gut dysbiosis, particularly rCDI, with expanding applications.
• Understanding FMT's complex mechanisms is key to optimizing its use in IBD and other diseases.
• Future directions involve addressing regulatory challenges, ethical considerations, and developing tailored microbiome therapeutics through pharmacomicrobiomics.