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• Subject Code :

  BMS3336

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  United Kingdom

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Background: Interest in understanding the role of human gut microbiota has raised to gain advantage from the therapeutic potential of its manipulation due the major protective role of gut microbiota. Today, applications of faecal microbiota transplantation (FMT) outside of Clostridium difficile infection (CDI) to patients suffering from additional gastrointestinal disorders are emerging.

Aim: To compare the effectiveness of FMT between CDI only and CDI with underlying inflammatory bowel disease (CDI+IBD) group; and to evaluate its effectiveness on IBD group. Moreover, the reasons for failure and possible adverse effects of the treatment were reviewed.

Methods: Electronic databases were searched for full-text studies on FMT to treat CDI and IBD published between 2010 and December 2018. There was no restriction of different age groups, gender, routes of administration and state of transplant matter. Studies focused on patients with severe immunodeficiency or where FMT was used to treat any other disease conditions were excluded. Data were analysed using Chi-Square test. Results: 38 studies (1203 individuals) were analysed, of which 6 were randomised controlled trials. CDI: CDI group presented a higher resolution (95%) than CDI+IBD group (73%) (p=
IBD: Total resolution of 47% increasing significantly from 5.9% to 41.7?ter multiple FMTs. Subgroups including mixed-age (36%), enriched FMT (34%), and Crohn’s disease (31%) had a higher resolution than adults (11%), standard FMT (12%) and ulcerative colitis subgroups (15%), respectively (p-value=
Conclusions: FMT is successful in treating CDI with a higher cure rate in patients without underlying IBD. FMT seems to be successful in patients with IBD. Nevertheless, despite its effectiveness, several adverse events have been reported.

Introduction to microbiota

Microbiota refers to the community of microorganisms naturally found in humans, animals and plants. The microbiota of human body is estimated to comprise 10-100 trillion microbial cells, the intestinal microbiota being the largest and most diverse microorganism population, primarily bacteria (Ursell et al., 2012). Recent studies concluded that the ratio of bacteria to human cells is approximately 1:1 (Sender, Fuchs and Milo, 2016). The composition of microbiota differs depending on the location across the gastrointestinal tract and axial depth. The microbiota may exhibit a commensal, symbiotic or mutualistic relationship with humans, however, some microbiota may also develop a pathogenic feature as they can become opportunistic (Haque and Haque, 2017).

Development of gut microbiota

The establishment of human microbiota begins prenatally. Today, it is shown that a unique bacteria ecosystem is harboured in placenta, its composition, in fact, presents similarities to the mother’s oral bacterial community. Mounting evidence suggests placenta may be colonised via haematogenous spread from the oral cavity (Han et al., 2004; Aagaard, 2014). In addition, bacteria are also present in the umbilical cord, amniotic fluid, the membrane surrounding the foetus and even meconium. Therefore, the maternal microbiota has been considered to prepare the immune system of the new-born for the postnatal immune development to avoid inflammatory responses to microbial molecules and penetration of intestinal microbes (Gomez de Aguero et al., 2016). 

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• Posted on : January 04th, 2020

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