Abstract
A growing body of literatures showed the interaction of dysbiotic gut with a wide range of disorders, and the clinical use of fecal microbiota transplantation (FMT) shifted from infectious disease to non-communicable disorders. Despite the promising therapeutic benefits of FMT, the exact mechanisms through which fecal recipients benefit from the fecal intervention are not well understood. However, owing to the advantages of having a healthy gut microbiome, possible mechanisms of actions of FMT has been described. On the one hand, through direct ecological competition, FMT may potentially stimulate decolonization of pathogenic microorganisms and increase host resistance to pathogens. Moreover, following dysbiosis, abnormal microbial colonization of the gastrointestinal tract may also cause excessive or dysregulated immune response, resulting in chronic inflam-mation and the development of mucosal lesions. In this regard, repopulating gut microbiome through FMT helps to restore immune function and reduce host damage. On the other hand, FMT helps to restore essential metabolites used for host metabolism, including short-chain fatty acids (SCFA), antimicrobial peptides (AMP), bacteriocins and bile acids. Therefore, in this review, the existing evidences regarding the mechanisms of action, current opportunities and challenges of FMT will be described.
Highlights
Fecal microbiota transplantation (FMT), known as fecal transplantation, is the transfer of stool from a healthy donor into patient’s gastrointestinal tract to restore the composition of recipient’s gut microbiota [1]
In a randomized controlled trial (RCT), FMT intervention demonstrated decolonization of carbapenem resistant Enterobacteriaceae (CRE) and extended-spectrum beta-lactamase (ESBL) producers in 41% (9/22) of patients who received a five-day course of oral antibiotics followed by FMT compared to 29% (5/17) of patients who didn't receive an intervention (OR = 1.7, 95% CI 0.4-6.4) [21]
The chances of developing Graft-versus-host disease (GVHD) were shown to decrease after FMT which helps to restore in butyrate-producing intestinal microbiota
Summary
Fecal microbiota transplantation (FMT), known as fecal transplantation, is the transfer of stool from a healthy donor into patient’s gastrointestinal tract to restore the composition of recipient’s gut microbiota [1]. Despite the promising therapeutic benefits of FMT, data regarding the mechanisms through which fecal recipient benefit from the intervention is scarce. In this regard, this review includes available evidences to show the possible mechanisms of action of FMT. Mechanisms of action of FMT Dysbiosis, which is an imbalance in the gut microbial community, results in the disturbance of several metabolic pathways that influence mechanical and immunological processes both in and outside the intestine. In this regard, gut microbiome dysbiosis leads to different disease conditions [9]. Intervention through different mechanisms, including but not limited to colonization resistance, restoration of metabolites and restoration of immune function
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