Advances and challenges in microbiome transplantation.

Area of Science:

• Microbiology
• Gastroenterology
• Immunology

Background:

• The microbiome significantly influences host health and disease.
• Fecal microbiome transplantation (FMT) is an established therapy for recurrent Clostridioides difficile infection (rCDI).
• FMT is being investigated for various other conditions, including metabolic, neurological, oncological, and autoimmune disorders.

Purpose of the Study:

• To review current fecal microbiome transplantation (FMT) designs, mechanisms, indications, and obstacles.
• To discuss emerging strategies and the need for a deeper mechanistic understanding of FMT.
• To highlight how improved understanding can lead to safer and more effective microbiome-based therapies.

Main Methods:

• This review synthesizes existing literature on fecal microbiome transplantation (FMT).
• It examines current FMT protocols, underlying mechanisms, and clinical applications.
• The review also considers novel approaches and challenges in the field.

Main Results:

• FMT is a proven therapy for rCDI and shows potential in other diseases.
• Challenges include donor selection, risk of pathogen transmission, and unclear mechanisms of action.
• Emerging strategies involve microbial consortia and extra-intestinal FMT.

Conclusions:

• A comprehensive understanding of FMT's functions, limitations, and off-target effects is crucial.
• This knowledge will enable the development of safer and more generalizable microbiome modulation strategies.
• Future directions include refined donor screening, standardized protocols, outcome tracking, and identification of key microbial and metabolic drivers.