Article Text
Abstract
Objective The underlying microbial basis, predictors of therapeutic outcome and active constituent(s) of faecal microbiota transplantation (FMT) mediating benefit remain unknown. An international panel of experts presented key elements that will shape forthcoming FMT research and practice.
Design Systematic search was performed, FMT literature was critically appraised and a 1-day round-table discussion was conducted to derive expert consensus on key issues in FMT research.
Results 16 experts convened and discussed five questions regarding (1) the role of donor and recipient microbial (bacteria, viruses, fungi) parameters in FMT; (2) methods to assess microbiota alterations; (3) concept of keystone species and microbial predictors of FMT, (4) influence of recipient profile and antibiotics pretreatment on FMT engraftment and maintenance and (5) new developments in FMT formulations and delivery. The panel considered that variable outcomes of FMT relate to compositional and functional differences in recipient’s microbiota, and likely donor-associated and recipient-associated physiological and genetic factors. Taxonomic composition of donor intestinal microbiota may influence the efficacy of FMT in recurrent Clostridioides difficile infections and UC. FMT not only alters bacteria composition but also establishes trans-kingdom equilibrium between gut fungi, viruses and bacteria to promote the recovery of microbial homeostasis. FMT is not a one size fits all and studies are required to identify microbial components that have specific effects in patients with different diseases.
Conclusion FMT requires optimisation before their therapeutic promise can be evaluated for different diseases. This summary will guide future directions and priorities in advancement of the science and practice of FMT.
- faecal microbiota transplantation
- donor
- recipient
- bacteria
- virus
- fungi
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Footnotes
Contributors SCN, MAK, FKLC planned the meeting and established the main topics. WT and TZ performed the systematic search. All panel members were involved in presenting the literature in a Frontiers meeting in Hong Kong in June 2018. All panel members provided supporting evidence and drafted the text of discussion relevant to their topic. SCN, TZ and YKY wrote the initial draft of the manuscript. All panel faculties read and revised the manuscript for important intellectual content and approved the final manuscript. CJO, VM and KS are representatives of APAGE and NO is representative of APSDE.
Funding Funding from the Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong to support the Frontiers Meeting in Hong Kong, and Martin Ho (Imperial College London) for his input in the section on new deliveries of FMT.
Competing interests FZ invented the concept of GenFMTer and TET and devices related to it.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.