From fecal microbiota transplantation to microbiota transplantation

Abstract

The history of using the stool from healthy human to treat human diseases dates back to the ancient China. Fecal microbiota transplantation (FMT), which has been regarded as a medical breakthrough in recent years, is essentially a modern medical application based on the new understanding and development on traditional Chinese medicine. The therapeutic value of FMT for microbiota-related diseases such as Clostridium difficile infection highlights the important relationship between microbiota and diseases. However, FMT is a breakthrough not in technological or theoretical research, but in medical recognition. FMT has been used in many indications beyond Clostridium difficile infection, such as Crohns disease, ulcerative disease, constipation, diabetes mellitus, cancer, liver cirrhosis, microbiota-gut-brain disease and others. Increasing evidence on FMT revolutionizes our understanding on the mechanism and treatment of microbiota-related diseases. The main progress of FMT in the recent two years focuses on the clinical strategy in refractory disease, methodology in lab and delivering way of FMT by colonic transendoscopic enteral tubing. It is time to end the crude stool transplant in humans and develop standardized FMT into a mainstream therapeutic option to bring benefits to more patients. The systematic development of FMT is pushing it into the mainstream of medicine to meet the common needs of both doctors and patients for safety, efficacy, technology and aesthetics. Therefore, the recent coined name, selective microbiota transplantation (SMT) for partially replacing FMT has gained more attention than FMT from the researchers in microbiology and clinical medicine in the recent years. SMT could transplant the selective microbiota in the digestive tract, reproductive tract, nasal cavity, skin and others. The range of therapeutic indications for SMT used in gastrointestinal tract exceeds FMT, but its efficacy for serious diseases may be inferior to FMT. Microbiota transplantation, including FMT and SMT will be promising to be used for the treatment of various diseases in the future. According to the published reports and our experience based on more than 4000 cases of diseases we have treated, many patients complicated with pneumonia, asthma, liver disease, diabetes, skin diseases, hematopoietic dysfunction, epilepsy, autism, sleep disorders, sexual dysfunction and other comorbidities can be alleviated or even cured by microbiota transplantation. The real-world study for microbiota transplantation in long term will be critical research to answer the efficacy and the safety in short term and long term. This paper commented the prominent understanding and the latest progress of microbiota transplantation in the recent years.