ТРАНСПЛАНТАЦИЯ ФЕКАЛЬНОЙ МИКРОБИОТЫ У ДЕТЕЙ: ПЕРВЫЙ ОПЫТ И ПЕРСПЕКТИВЫ КЛИНИЧЕСКОГО ПРИМЕНЕНИЯ

Abstract

In recent years, the important role of disturbances in the intestinal microbiota and its possible correction in children with oncological and autoimmune diseases has been established. The aim of the article is to review the literature data on the issue and to describe own experience of fecal microbiota transplantation (FMT) in children with an intestinal form of acute graftversus-host disease (GVHD). Materials and methods of research: a prospective single-center study included 7 patients aged 3 to 10 years with gut GVHD developed after transplantation of allogeneic hematopoietic stem cells (allo-HSCT). The clinical effects of FMT have been studied in children using rating scales during 120 days after this procedure. Time-dependent changes in the composition of fecal microbiota were assessed by the method of multiplex polymerase chain reaction test-system (PCR). Results: the literature data show a significant role of the content and ratio of of the main bacterial classes of Firmicutes and Bacteroides in the development of the immune response in cancer and autoimmune processes, as well as the possibility of correcting disorders using FMT. The first-hand experience of FMT in children with gut GVHD and antibiotic-resistant colitis is presented. Complete or partial response to GVHD therapy after 120 days was achieved in 6 (86%) patients in the absence of serious adverse events after FMT. From day +3 after FMT, increased amounts of B. fragilis gr., F. prausnitzii and E. coli were registered in fecal microbiota (p<0,048, p<0,001, p<0,048, respectively) in the absence of differences in Bifidobacterium spp. and Lactobacillus spp. Conclusion: the combination of systemic immunosuppressive therapy with FMT in patients with intestinal forms of GVHD resistant to standard therapy is accompanied by pronounced clinical responses and typical changes in the composition of the intestinal microbiota in the absence of serious adverse events.