Current and future microbiome-based therapies in inflammatory bowel disease

Area of Science:

• Gastroenterology and Microbiome Research
• Immunology and Inflammatory Diseases

Background:

• Dysbiosis, an imbalance in gut microbiota, is increasingly implicated in inflammatory bowel disease (IBD) pathogenesis.
• Intestinal microbiota transplant (IMT), formerly fecal microbiota transplant, effectively restores gut health in recurrent Clostridioides difficile infection.

Purpose of the Study:

• To review the current understanding of IBD-associated dysbiosis.
• To analyze recent randomized trials on IMT for IBD treatment.
• To identify knowledge gaps hindering IMT's widespread clinical use.

Main Methods:

• Systematic review of existing literature and randomized controlled trials (RCTs).
• Analysis of mechanisms by which IMT impacts the gut microbiome.
• Evaluation of IMT's efficacy in inducing and maintaining remission in IBD.

Main Results:

• Significant differences exist in the gut microbiota composition between IBD patients and healthy individuals.
• RCTs demonstrate IMT's potential in treating ulcerative colitis, with smaller studies showing promise for Crohn's disease and pouchitis.
• Evidence supporting IMT for IBD is accumulating, but its application is limited by a lack of standardized protocols.

Conclusions:

• Standardized protocols are crucial for advancing IMT beyond clinical trials.
• Further research should focus on identifying optimal patient profiles, disease phenotypes, donor characteristics, and delivery methods for IMT.
• Optimizing dosage and frequency are key areas for future investigation to enhance IMT efficacy in IBD management.