Letter: Faecal microbiota transplantation--not a one-size-fits-all approach.

Abstract

Alimentary Pharmacology & TherapeuticsVolume 40, Issue 1 p. 119-119 Letter to the EditorFree Access Letter: faecal microbiota transplantation – not a one-size-fits-all approach G. Ianiro, G. Ianiro gianluca.ianiro@hotmail.it Division of Internal Medicine and Gastroenterology, Department of Medical Sciences, A. Gemelli University Hospital, Rome, ItalySearch for more papers by this authorA. Gasbarrini, A. Gasbarrini Division of Internal Medicine and Gastroenterology, Department of Medical Sciences, A. Gemelli University Hospital, Rome, ItalySearch for more papers by this authorG. Cammarota, G. Cammarota Division of Internal Medicine and Gastroenterology, Department of Medical Sciences, A. Gemelli University Hospital, Rome, ItalySearch for more papers by this author G. Ianiro, G. Ianiro gianluca.ianiro@hotmail.it Division of Internal Medicine and Gastroenterology, Department of Medical Sciences, A. Gemelli University Hospital, Rome, ItalySearch for more papers by this authorA. Gasbarrini, A. Gasbarrini Division of Internal Medicine and Gastroenterology, Department of Medical Sciences, A. Gemelli University Hospital, Rome, ItalySearch for more papers by this authorG. Cammarota, G. Cammarota Division of Internal Medicine and Gastroenterology, Department of Medical Sciences, A. Gemelli University Hospital, Rome, ItalySearch for more papers by this author First published: 06 June 2014 https://doi.org/10.1111/apt.12783Citations: 4AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Sirs, Sha et al. reviewed systematically the reported efficacy and safety of faecal microbiota transplantation (FMT) for digestive and nondigestive diseases in adults and children. They searched for all studies performing FMT, regardless of indication. Respectively, patients with C. difficile infection (CDI), inflammatory bowel disease (IBD), chronic constipation, irritable bowel syndrome (IBS), antibiotic-associated diarrhoea, metabolic syndrome and chronic fatigue syndrome were gathered together.1 The paramount role of gut microbiota seems to suggest the use of FMT in every gut microbiota-related disease.2 Actually, such approaches may bring along several methodological concerns. As each disease shows its own unbalanced microbiota composition, the application of a ‘one-for-all’ procedural protocol is conceptually wrong, starting from the donor selection protocol: the donor's microbiota composition is known to influence outcomes in IBD patients,3 and obese, but otherwise healthy, donors, even if suitable for CDI, should be excluded when dealing with metabolic disorders.4 The route of delivery represents another tricky matter. Gastric juice can damage Bacteroidetes, whereas some Firmicutes need to pass through the upper gastrointestinal tract to put themselves into action.5 A lower gastrointestinal route of administration appears to achieve better outcomes than upper in CDI.6 However, duodenal infusion showed interesting results on insulin sensitivity.4 Probably, the choice of route of administration depends on which microbes we want to infuse and which disease we are treating. Even the number of faecal infusions may make the difference: a single administration may be adequate for CDI,6 but not for chronic diseases such as IBD.3 In conclusion, the design of a specific methodology protocol for each disease will make FMT a model of personalised medicine, and will enhance its therapeutic perspectives. The application of metagenomics to assess microbiota composition, as well as the development of large, well-designed trials, is needed to make a step forward in this direction. Acknowledgement Declaration of personal and funding interests: None. References 1Sha S, Liang J, Chen M, et al. Systematic review: faecal microbiota transplantation therapy for digestive and nondigestive disorders in adults and children. Aliment Pharmacol Ther 2014; 39: 1003– 32. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 2Cammarota G, Ianiro G, Bibbò S, et al. Gut microbiota modulation: probiotics, antibiotics or fecal microbiota transplantation? Intern Emerg Med 2014; PMID: 24664520 [Epub ahead of print]. Google Scholar 3Angelberger S, Reinisch W, Makristathis A, et al. Temporal bacterial community dynamics vary among ulcerative colitis patients after fecal microbiota transplantation. Am J Gastroenterol 2013; 108: 1620– 30. CrossrefCASPubMedWeb of Science®Google Scholar 4Vrieze A, Van Nood E, Holleman F, et al. Transfer of intestinal microbiota from lean donors increases insulin sensitivity in individuals with metabolic syndrome. Gastroenterology 2012; 143: 913– 6. CrossrefCASPubMedWeb of Science®Google Scholar 5Damman CJ, Miller SI, Surawicz CM, et al. The microbiome and inflammatory bowel disease: is there a therapeutic role for fecal microbiota transplantation? Am J Gastroenterol 2012; 107: 1452– 9. CrossrefPubMedWeb of Science®Google Scholar 6Kassam Z, Lee CH, Yuan Y, et al. Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol 2013; 108: 500– 8. CrossrefPubMedWeb of Science®Google Scholar Citing Literature Volume40, Issue1July 2014Pages 119-119 ReferencesRelatedInformation