Abstract

Newly revealed links between inflammation, obesity, and cardiometabolic syndrome have created opportunities to try previously unexplored therapeutic modalities in these common and life-risking disorders. One potential modulator of these complex disorders is the gut microbiome, which was described in recent years to be altered in patients suffering from features of cardiometabolic syndrome and to transmit cardiometabolic phenotypes upon transfer into germ-free mice. As a result, there is great interest in developing new modalities targeting the altered commensal bacteria as a means of treatment for cardiometabolic syndrome. Fecal microbiota transplantation (FMT) is one such modality in which a disease-associated microbiome is replaced by a healthy microbiome configuration. So far clinical use of FMT has been overwhelmingly successful in recurrent Clostridium difficile infection and is being extensively studied in other microbiome-associated pathologies such as cardiometabolic syndrome. This review will focus on the rationale, promises and challenges in FMT utilization in human disease. In particular, it will overview the role of the gut microbiota in cardiometabolic syndrome and the rationale, experience, and prospects of utilizing FMT treatment as a potential preventive and curative treatment of metabolic human disease.

Highlights

  • Reviewed by: Christopher Staley, University of Minnesota Twin Cities, United States Anna Maria Seekatz, Clemson University, United States

  • Several studies estimated that the relative risk (RR) for developing cardiovascular disease is double than the general population (RR = 1.53–2.18) in patients suffering from cardiometabolic syndrome [5,6,7], coupled with an increase in all-cause mortality (RR = 1.27–1.6)

  • Following these revelations a plethora of evidence of varying quality demonstrated the clinical effect that Fecal microbiota transplantation (FMT) has on pseudomembranous colitis, culminating with a landmark randomized clinical trial demonstrating the significant superiority that FMT has on recurrent C. difficile infection over the standard antibiotic treatment [55]

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Summary

CARDIOMETABOLIC SYNDROME

Cardiometabolic syndrome ( termed “Metabolic syndrome”) consists of the co-occurrence of a cluster of pathogenically-associated metabolic disorders including obesity, insulin resistance, non-alcoholic fatty liver disease, hypertension, and hypercholesterolemia. The combined effect of these disorders significantly increases the risk of developing cardiovascular disease and type 2 Diabetes Mellitus (TIIDM) [1]. The clinical implications of cardiometabolic syndrome are predominantly related to the increased risk of developing cardiovascular complications of atherosclerosis and micro- or macrovascular complications of TIIDM. Several studies estimated that the relative risk (RR) for developing cardiovascular disease is double than the general population (RR = 1.53–2.18) in patients suffering from cardiometabolic syndrome [5,6,7], coupled with an increase in all-cause mortality (RR = 1.27–1.6). The relative risk of developing TIIDM was significantly higher in patients suffering from other features of cardiometabolic disease (RR = 3.53–5.17) as compared to the general population [8]

Fecal Microbial Transplantation in Cardiometabolic Syndrome
THE GUT MICROBIOTA
FECAL MICROBIOTA TRANSPLANTATION
GLUCOSE METABOLISM
No different in net weight gain No insulin sensitivity assessment
No mechanism proposed
Donor Selection and Preparation
Sample Handling
Mode of Administration
Colonization Resistance
Adverse Effects
Cost Effectiveness
Findings
PROSPECTS AND CONCLUSIONS
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