Fecal microbiota transplantation: understanding from holistic integrative view

The role of fecal microbiota transplantation (FMT) for Clostridium difficile infection (CDI) is not well-known. To assess the efficacy, comparative effectiveness, and harms of FMT for CDI. MEDLINE (1980 to January 2015), Cochrane Library, and ClinicalTrials.gov, followed by hand-searching references from systematic reviews and identified studies. Any study of FMT to treat adult patients with CDI; case reports were only used to report harms. Data were extracted by 1 author and verified by another; 2 authors independently assessed risk of bias and strength of evidence. Two randomized, controlled trials (RCTs); 28 case-series studies; and 5 case reports were included. Two RCTs and 21 case-series studies (516 patients receiving FMT) reported using FMT for patients with recurrent CDI. A high proportion of treated patients had symptom resolution; however, the role of previous antimicrobials is unclear. One RCT comparing FMT with 2 control groups (n = 43) reported resolution of symptoms in 81%, 31%, and 23% of the FMT, vancomycin, or vancomycin-plus-bowel lavage groups, respectively (P < 0.001 for both control groups vs. FMT). An RCT comparing FMT route (n = 20) reported no difference between groups (60% in the nasogastric tube group and 80% in the colonoscopy group; P = 0.63). Across all studies for recurrent CDI, symptom resolution was seen in 85% of cases. In 7 case-series studies of patients with refractory CDI, symptom resolution ranged from 0% to 100%. Among 7 patients treated with FMT for initial CDI, results were mixed. Most studies were uncontrolled case-series studies; only 2 RCTs were available for analysis. Fecal microbiota transplantation may have a substantial effect with few short-term adverse events for recurrent CDI. Evidence is insufficient on FMT for refractory or initial CDI treatment and on whether effects vary by donor, preparation, or delivery method. U.S. Department of Veterans Affairs.

Introduction: Steroid dependance develops in 15- 20% of patients of ulcerative colitis. These patients are prone to develop various side effects of long term steroid abuse. Medical treatment options in such cases, biologicals and/or immunosuppressive are expensive and associated with significant toxicity. Recently, there have been reports of FMT being effective in some of these patients. We evaluated the efficacy and safety of fecal microbiota transplantation(FMT) in patients with steroid dependant ulcerative colitis Methods: We report the data of an open label study of FMT in induction and maintainance of remission of patients with steroid dependant ulcerative colitis. Baseline demographic disease characteristics, disease severity and drug history at enrollment were recorded. FMT protocol was 2 weekly for 2 times and then 4 weekly for 5 times (a total of 7 sessions). Clinical and endoscopic response was assessed using mayo score at week 4, end of study period (6 months) and follow up of 6 months.Figure 1Figure 2Results: A total of 17 patients were enrolled. Of these, 10 were males and mean age for the whole group was 35.23 years (23-55). Seven patients (41.1%) had pancolitis and 10 (58.8%) had left sided disease. All patients (n = 17) had moderate to severe disease. Fifteen of 17 (88.23 %) patients achieved clinical remission at week 4. Ten (58.8 %) stayed in remission at the end of 6 months of treatment and 6 months follow up period, allowing stoppage of steroids. Five (29.4 %) patients who initially responded to FMT, eventually had worsening of symptoms and were given adalimumab. Of the remaining 2 patients, 1 (5.8 %) was lost to follow up after a single session of FMT, while the other (5.8 %) developed toxic megacolon after 2 sessions, then post operative sepsis and died. Conclusion: FMT is a promising therapeutic option for patients having steroid dependant ulcerative colitis. Previous exposure to immunosuppressives or biologicals does not hamper response to FMT. However, Randomized, placebo controlled trials from developing countries are needed for more robust data.

Fecal microbiota transplantation (FMT) has emerged as a potential therapeutic strategy for modulating gut dysbiosis in diabetes mellitus. This review critically evaluates preclinical and clinical evidence on FMT in type 1 (T1D) and type 2 diabetes (T2D). Studies suggest that FMT can restore microbial diversity, improve glycemic control, and modulate immune responses, with varying effects across diabetes subtypes. In T1D, preclinical models demonstrate that FMT influences regulatory T-cell expansion and β-cell preservation, though clinical translation remains limited. In T2D, FMT has shown transient improvements in insulin sensitivity, with sustained effects observed only in patients with specific microbiome signatures. However, heterogeneity in patient responses, donor variability, and methodological limitations complicate its clinical application. This review highlights the interplay between FMT, immune modulation, and microbial metabolism, advocating for phenotype-stratified trials and multi-omics integration to enhance therapeutic precision.

The vital roles that intestinal flora, now called microbiota, have in maintaining our health are being increasingly appreciated. Starting with birth, exposure to the outside world begins the life-long intimate association our microbiota will have with our diet and environment, and initiates determination of the post-natal structural and functional maturation of the gut. Moreover, vital interactions of the microbiota with our metabolic activities, as well as with the immunological apparatus that constitutes our major defense system against foreign antigens continues throughout life. A perturbed intestinal microbiome has been associated with an increasing number of gastrointestinal and non-gastrointestinal diseases including Clostridium difficile infection (CDI). It has become recognized that fecal microbiota transplantation (FMT) can correct the dysbiosis that characterizes chronic CDI, and effect a seemingly safe, relatively inexpensive, and rapidly effective cure in the vast majority of patients so treated. In addition, FMT has been used to treat an array of other gastrointestinal and non-gastrointestinal disorders, although experience in these other non-CDI diseases is in its infancy. More work needs to be done with FMT to ensure its safety and optimal route of administration. There is a conceptual sea change that is developing in our view of bacteria from their role only as pathogens to that of being critical to health maintenance in a changing world. Future studies are certain to narrow the spectrum of organisms that need to be given to patients to cure disease. FMT is but the first step in this journey.

Introduction The gut microbiota has a complex relationship with the human host and is key to maintaining health. Disruption of the healthy diverse gut microbial milieu plays an important role in the pathogenesis of several diseases including Clostridioides difficile infection (CDI), inflammatory bowel disease, irritable bowel syndrome, alcohol-related liver disease and metabolic-dysfunction associated steatotic liver disease (MASLD). Fecal microbiota transplantation (FMT) is highly effective in treating CDI, though its utility in other diseases is still being explored. Areas covered In this narrative review, we explore the role of gut microbiota in liver diseases, focusing on key changes in the microbial composition and function. We summarize current evidence on the role of FMT, identifying gaps in current research and outlining future directions for investigation. We comprehensively searched PubMed through 15 October 2024 to identify relevant studies. Expert opinion While data from available studies shows promise, more research is necessary before we can use FMT for liver diseases. Key areas that require further study are – determining the optimal FMT regimen for each disease, establishing efficacy and safety with larger clinical trials, ensuring safe and equitable access to the FMT product and mechanistic insights into the reasons for success or failure of FMT.

Multiple sclerosis (MS) affects millions of people worldwide, and recent data have identified the potential role of the gut microbiome in inducing autoimmunity in MS patients. To investigate the potential of fecal microbiota transplant (FMT) as a treatment option for MS, we conducted a comprehensive literature search (PubMed/Medline, Embase, Web of Science, Scopus, and Cochrane) and identified five studies that involved 15 adult MS patients who received FMT for gastrointestinal symptoms. The primary outcome of this review was to assess the effect of FMT in reversing and improving motor symptoms in MS patients, while the secondary outcome was to evaluate the safety of FMT in this patient population. Our findings suggest that all 15 patients who received FMT experienced improved and reversed neurological symptoms secondary to MS. This improvement was sustained even in follow-up years, with no adverse effects observed. These results indicate that FMT may hold promise as a treatment option for MS, although further research is necessary to confirm these findings.

Background: The potential therapeutic role of fecal microbiota transplantation (FMT) in various diseases has been thoroughly studied over the last few decades. However, the majority of studies focus on the adult population, therefore, conclusions regarding the application of FMT in the pediatric population are much less clear. This systematic review aims to summarize the research conducted so far on the efficacy and safety of FMT in the pediatric population, assess the quality of the evidence of its effectiveness, and outline the most promising areas for future research. Methods: We performed a systematic literature search from the index date to 8 June 2024 on the Embase, PubMed, and Web of Science databases. One author screened the resulting 121 articles. Eventually, 35 eligible studies that reported FMT use in seven different diseases were identified. Results: All of the studies assessed FMT as a safe procedure without many serious adverse effects. The best-documented application, which is the only one recommended in official guidelines, is recurrent Clostridioides difficile infection. Other disease entities in which the use of FMT has been studied with good clinical effects are inflammatory bowel disease, allergic colitis, autism, Tourette syndrome, and colonization with multi-drug-resistant organisms. However, it should be noted that the majority of studies are cohort and case-control studies, without randomization, which translates into low evidence quality. In one randomized, controlled trial focusing on the effect of FMT on weight loss in obese individuals, a lack of effect was found. Conclusions: While FMT and subsequent iterations of gut microbiota-targeted interventions hold promising therapeutic potential for various disease entities in the pediatric population, the current evidence behind this conclusion is of low quality. Based on current studies, these methods appear to be both effective and safe. However, further randomized clinical trials are necessary, especially within the pediatric population, for which such studies remain scarce.

Fecal microbiota transplantation involves the infusion of intestinal microorganisms via the transfer of a stool from a healthy individual into a diseased individual, with the intent of restoring normal intestinal flora. Fecal transplant is proposed for the treatment of refractory Clostridioides difficile infection. At present, recurrent Clostridioides difficile infection is the only indication supported by solid scientific evidence. Regulations by healthcare authorities vary among different countries. Considering that Romania does not have an available national guideline to offer standardization, this paper aimed to create a national fecal microbiota transplantation guideline concerning indications, techniques and donor screening, developed by international and local scientific working groups.

Although faecal microbiota transplantation (FMT) has a well-established role in the treatment of recurrent Clostridioides difficile infection (CDI), its widespread dissemination is limited by several obstacles, including lack of dedicated...

A growing body of evidence suggested that gut microbiota is associated with liver diseases through the gut-liver axis. The imbalance of gut microbiota could be correlated with the occurrence, development, and prognosis of a series of liver diseases, including alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), viral hepatitis, cirrhosis, primary sclerosing cholangitis (PSC), and hepatocellular carcinoma (HCC). Fecal microbiota transplantation (FMT) seems to be a method to normalize the patient's gut microbiota. This method has been traced back to the 4th century. In recent decade, FMT has been highly regarded in several clinical trials. As a novel approach to reconstruct the intestinal microecological balance, FMT has been used to treat the chronic liver diseases. Therefore, in this review, the role of FMT in the treatment of liver diseases was summarized. In addition, the relationship between gut and liver was explored through the gut-liver axis, and the definition, objectives, advantages, and procedures of FMT were described. Finally, the clinical value of FMT therapy in liver transplant (LT) recipients was briefly discussed.

Fecal microbiota transplantation (FMT) has changed the treatment landscape of Clostridium difficile infection (CDI). Emerging evidence has shown that FMT can also be an effective and safe treatment strategy in CDI with underlying inflammatory bowel disease (IBD). Recently, randomized controlled trials of FMT in ulcerative colitis support its expanding role in restoring gut homeostasis in this disease. However, heterogeneous study designs leave several questions yet to be answered, including how to best position this novel therapy in the treatment approach of Crohn’s disease and pouchitis. Additional studies are needed to validate whether FMT can assume a complementary role in the standard treatment of IBD.

INTRODUCTION: Fecal microbiota transplantation (FMT) is established as an effective treatment for recurrent Clostridioides (formerly Clostridium) difficile infection (CDI). Incidence and mortality from CDI are significantly higher in the elderly population (CDI is 10 times more common and 92% of CDI-related deaths occur in the elderly). Risk of cardiopulmonary complications from sedation prior to colonoscopy is increased in the elderly. Efficacy and safety of FMT via colonoscopy in the elderly are unknown. METHODS: A retrospective study comparing patients ≥75 years, and patients &lt; 75 years who had FMT at Sanford Medical Center, Sioux Falls, SD, between 2013–2018. All patients underwent FMT via colonoscopy. Antibiotics prior to FMT, donor screening, preparation and delivery of FMT, and post-procedural follow up were based on a standardized protocol in our institution. Data on baseline characteristics, co-morbidities, antibiotics-associated with CDI, safety, and success rate of treatment (defined by resolution of symptoms and absence of CDI recurrence at 8 and 52 weeks) were collected. RESULTS: Of 59 patients, 17 (28.8%) were ≥75 years with a mean age of 84.4 years, and 42 (71.2%) were &lt;75 years and a mean age of 46.4 years. Baseline characteristics of both groups are described in Table 1. Number of CDI before FMT, history of severe CDI, nosocomial CDI were similar. No fulminant CDI was reported in our study. In ≥75 years vs. &lt;75 years, serum albumin was lower (3.4 vs 4 g/dl, P &lt; 0.002) and hypertension was more common (52.9 vs 23.8%, P = 0.03). 80% of our study population had a history of antibiotics exposure prior to CDI, but there was no statistically significant difference between groups. Of antibiotics-associated with CDI, penicillins were more likely to be reported in ≥75 vs. &lt;75 years (38.1 vs 5.9%, P = 0.014). Cephalosporins, macrolides, fluoroquinolones, and clindamycin were similar in both groups. Prior to FMT, both groups were treated similarly with vancomycin with or without taper, oral or intravenous metronidazole, or fidaxomicin. No major complications related to anesthesia or FMT via colonoscopy or deaths attributed to FMT were reported in our study. The success rates at 8 and 52 weeks in both groups were similar (76.5 vs. 83.3%, and 76.5 vs. 71.4%, respectively). CONCLUSION: Despite the increased risk of CDI and colonoscopy in the elderly population, success rate and safety of FMT appears to be equivalent between elderly and non-elderly. Prospective studies with larger sample size are needed.

The Bower Manuscript (Bao Wei Er Xie Ben) is a Sanskrit document unearthed in Xinjiang in the 19th century. The ten drugs, which tasted sweet, and used widely were named as the "jīvanīya class of herbs" (Shi Tian Yao) in this document . It was found that "jīvanīya" tasted sweet, felt cold and was often used in tonic decoction for relieving serious vāta (Feng), with references to the ancient medical book Ayurveda and the modern Ayurvedic pharmacopoeia. "Jīvanīya" was constructed with different dossage forms, such as butter, oil, enema, ointment. It can treat some diseases of consumption of the lungs, epilepsy, consumptive diseases and fever of children in Bower Manuscript (Bao Wei Er Xie Ben). The theories of "jīvanīya" came from Ayurveda. Compared with the theories of traditional Chinese Medicine, the theory that "jīvanīya" can treat consumptive diseases appears similar to the theories in Su Wen about "Feng Xiao". The theories of Traditional Indian medicine and Chinese medicine appear resemblant, such as the commonalities in terms of using sweet tonics with liquorice and Fritillaria cirrhosa to treat comsumptive diseases.

Aging, a complex and multisystem process, has increasingly become a hot issue of global concern. Traditional Chinese medicine has accumulated rich understanding of aging during thousands of years of development, which provides valuable references for the in-depth study of overall aging. According to the Qi-collateral theory in traditional Chinese medicine, essence is the origin of life; Qi is the driving force of life; and spirit is the embodiment of life. This theory interprets key scientific issues such as the formation of life, the driving force of life, the function of Zang-Fu organs, and the spirit and consciousness. Furthermore, it reveals the key mechanism of aging. That is, the deficiency of kidney essence is the root of aging; the loss of vitality is the key of aging; and the depletion of body and spirit is the manifestation of aging. Based on the experience of medical practitioners in the past dynasties, such as nourishing essence, black food tonifying the kidney, and supplementing essence with flesh-blood products, the treatment method of invigorating kidney and supplementing essence, harmonizing Yin and Yang, reinforcing the vitality, and nourishing the body and spirit was proposed. Furthermore, an innovative Chinese patent medicine, Bazi Bushen capsules, is developed, which exerts the antiaging effect by replenishing Qi, invigorating the spirit, and nourishing the body and spirit. Pharmacological and clinical studies have confirmed that this preparation has antiaging effects and are effective in the prevention and treatment of age-related diseases. Experimental studies have shown that Bazi Bushen capsules can delay the overall aging, reduce the DNA methylation and extend the healthy life of naturally aging mice, mitigate the age-related cognitive dysfunction, improve neurological function, maintain redox homeostasis and telomere integrity, and inhibit apoptosis. Moreover, Bazi Bushen capsules can increase the dermal thickness and the collagen fiber and elastic fiber content to prevent skin aging. In addition, Bazi Bushen capsules can correct the lipid metabolism disorders and ameliorate multisystem age-related diseases such as osteoporosis in surgically induced menopausal rats. This article discusses the pathogenesis, treatment, and prescription of aging and the antiaging theory, aiming to provide a basis for delaying aging and preventing related diseases.

In current teaching material of basic theory of Traditional Chinese Medicine (TCM), the theory of "liver controlling conveyance and dispersion" covers the functional adjustment of many aspects, including the overall human physiology, digestion, mental activity, blood circulation, water metabolism and reproduction. Through the research of the teaching material of TCM basic theory since the establishment of the People's Republic of China, it can be considered that there are 3 stages for the construction of the theory of "liver controlling conveyance and dispersion". From the 1950s to 1970s, this theory was not mentioned in any teaching materials; from the 1970s to the mid 1980s, different views about this theory can be seen in the teaching materials; after the mid 1980s, this theory in the teaching materials became gradually basically identical.