Fekal Mikrobiyota Transplantasyonu (FMT)
Gaita nakli, Clostridium difficile infeksiyonu için önemli bir tedavi seçeneğidir. Gaita naklinin, bağırsak mikroflorasındaki değişiklikler ile ilgili diğer hastalıkların tedavisinde, rol oynayabileceği konusunda ümit verici bulgular tespit edilmiştir. Gaita nakli, bağırsak mikroflorasındaki değişiklikler ile ilgili spesifik hastalıkları tedavi etmek için, sağlıklı bir donörden alınan gaitanın, alıcı hastanın bağırsağına yerleştirilmesidir. Gaita nakli ile ilgili olarak, donör seçimi, donör taraması, yapılması gereken standart protokoller, metodlar ve uzun dönem güvenlik sonuçları dahil, cevaplanmamış bir çok soru hala vardır.
Fecal Microbiota Transplantation (FMT)
Fecal microbiota transplantation (FMT) is an important therapeutic option for Clostridium diffi cile infection. Promising findings suggest that FMT may play a role also in the management of other disorders associated with the alteration of gut microbiota. Fecal microbiota transplantation (FMT) consists of the infusion of feces from a healthy donor to the GI tract of a recipient patient, in order to treat a specifi c disease associated with alteration of gut microbiota. There are still many unanswered questions regarding FMT, including donor selection and screening, standardized protocols, methodology, long-term safety, and regulatory issues.
___
- 1. Whitman WB, Coleman DC, Wiebe WJ. Prokaryotes: the unseen
majority. Proc Natl Acad Sci U S A. 1998 Jun 9;95(12):6578-83.
Review.
- 2. Duncan SH, Lobley GE, Holtrop G, Ince J, Johnstone AM, Louis P,
Flint HJ. Human colonic microbiota associated with diet, obesity
and weight loss. Int J Obes (Lond). 2008 Nov;32(11):1720-4. doi:
10.1038/ijo.2008.155.
- 3. Koren O, Spor A, Felin J, Fåk F, Stombaugh J, Tremaroli V, Behre
CJ, Knight R, Fagerberg B, Ley RE, Bäckhed F. Human oral, gut,
and plaque microbiota in patients with atherosclerosis. Proc Natl
Acad Sci U S A. 2011 Mar 15;108 Suppl 1:4592-8. doi: 10.1073/
pnas.1011383107.
- 4. Choi HH, Cho Y-S. Fecal Microbiota Transplantation: Current
Applications, Effectiveness, and Future Perspectives. Clinical
Endoscopy. 2016;49(3):257-265. doi:10.5946/ce.2015.117.
- 5. Lee HJ, Choi JK, Ryu HS, et al. Therapeutic Modulation of
Gut Microbiota in Functional Bowel Disorders. Journal of
Neurogastroenterology and Motility. 2017;23(1):9-19.
doi:10.5056/jnm16124.
- 6. Borody TJ, Warren EF, Leis S, Surace R, Ashman O. Treatment of
ulcerative colitis using fecal bacteriotherapy. J Clin Gastroenterol.
2003 Jul;37(1):42-7.
- 7. Zhang F, Luo W, Shi Y, Fan Z, Ji G. Should we standardize the
1,700-year-old fecal microbiota transplantation? Am J Gastroenterol.
2012 Nov;107(11):1755; author reply p.1755-6. doi: 10.1038/
ajg.2012.251.
- 8. EISEMAN B, SILEN W, BASCOM GS, KAUVAR AJ. Fecal enema as
an adjunct in the treatment of pseudomembranous enterocolitis.
Surgery. 1958 Nov;44(5):854-9.
- 9. Frank DN, St Amand AL, Feldman RA, Boedeker EC, Harpaz N,
Pace NR. Molecular-phylogenetic characterization of microbial
community imbalances in human infl ammatory bowel diseases.
Proc Natl Acad Sci U S A. 2007 Aug 21;104(34):13780-5.
- 10. Eckburg PB, Bik EM, Bernstein CN, Purdom E, Dethlefsen L, Sargent
M, Gill SR, Nelson KE, Relman DA. Diversity of the human intestinal
microbial fl ora. Science. 2005 Jun 10;308(5728):1635-8.
- 11. Ramirez-Farias C, Slezak K, Fuller Z, Duncan A, Holtrop G, Louis
P. Effect of inulin on the human gut microbiota: stimulation
of Bifi dobacterium adolescentis and Faecalibacterium
prausnitzii. Br J Nutr. 2009 Feb;101(4):541-50. doi: 10.1017/
S0007114508019880.
- 12. Dominguez-Bello MG, Costello EK, Contreras M, Magris M, Hidalgo
G, Fierer N, Knight R. Delivery mode shapes the acquisition and
structure of the initial microbiota across multiple body habitats in
newborns. Proc Natl Acad Sci U S A. 2010 Jun 29;107(26):11971-
5. doi: 10.1073/pnas.1002601107.
- 13. Penders J, Thijs C, Vink C, Stelma FF, Snijders B, Kummeling I, van
den Brandt PA, Stobberingh EE. Factors infl uencing the composition
of the intestinal microbiota in early infancy. Pediatrics. 2006
Aug;118(2):511-21.
- 14. Sjögren YM, Jenmalm MC, Böttcher MF, Björkstén B, Sverremark-
Ekström E. Altered early infant gut microbiota in children developing
allergy up to 5 years of age. Clin Exp Allergy. 2009 Apr;39(4):518-
26. doi: 10.1111/j.1365-2222.2008.03156.x.
- 15. Mariat D, Firmesse O, Levenez F, Guimarβes V, Sokol H, Doré J,
Corthier G, Furet JP. The Firmicutes/Bacteroidetes ratio of the
human microbiota changes with age. BMC Microbiol. 2009 Jun
9;9:123. doi: 10.1186/1471-2180-9-123.
- 16. Claesson MJ, Cusack S, O'Sullivan O, Greene-Diniz R, de Weerd H,
Flannery E, Marchesi JR, Falush D, Dinan T, Fitzgerald G, Stanton C,
van Sinderen D, O'Connor M, Harnedy N, O'Connor K, Henry C,
O'Mahony D, Fitzgerald AP, Shanahan F, Twomey C, Hill C, Ross RP,
O'Toole PW. Composition, variability, and temporal stability of the
intestinal microbiota of the elderly. Proc Natl Acad Sci U S A. 2011
Mar 15;108 Suppl 1:4586-91. doi: 10.1073/pnas.1000097107.
- 17. Kau AL, Ahern PP, Griffi n NW, Goodman AL, Gordon JI. Human
nutrition, the gut microbiome and the immune system. Nature. 2011
Jun 15;474(7351):327-36. doi: 10.1038/nature10213. Review.
- 18. Ley RE. Obesity and the human microbiome. Curr Opin Gastroenterol.
2010 Jan;26(1):5-11. doi: 10.1097/MOG.0b013e328333d751.
Review.
- 19. Wu X, Ma C, Han L, Nawaz M, Gao F, Zhang X, Yu P, Zhao C, Li L,
Zhou A, Wang J, Moore JE, Millar BC, Xu J. Molecular characterisation
of the faecal microbiota in patients with type II diabetes. Curr
Microbiol. 2010 Jul;61(1):69-78. doi: 10.1007/s00284-010-
9582-9.
- 20. Choi HH, Cho Y-S. Fecal Microbiota Transplantation: Current
Applications, Effectiveness, and Future Perspectives. Clinical
Endoscopy. 2016;49(3):257-265. doi:10.5946/ce.2015.117.
- 21. Evrensel A, Ceylan ME. Fecal Microbiota Transplantation and Its
Usage in Neuropsychiatric Disorders. Clinical Psychopharmacology
and Neuroscience. 2016;14(3):231-237. doi:10.9758/
cpn.2016.14.3.231.
- 22. Drekonja D, Reich J, Gezahegn S, Greer N, Shaukat A, MacDonald
R, Rutks I, Wilt TJ. Fecal Microbiota Transplantation for Clostridium
diffi cile Infection: A Systematic Review. Ann Intern Med. 2015 May
5;162(9):630-8. doi: 10.7326/M14-2693. Review.
- 23. Youngster I, Sauk J, Pindar C, et al. Fecal Microbiota Transplant for
Relapsing Clostridium diffi cile Infection Using a Frozen Inoculum
From Unrelated Donors: A Randomized, Open-Label, Controlled
Pilot Study. Clinical Infectious Diseases: An Offi cial Publication of
the Infectious Diseases Society of America. 2014;58(11):1515-
1522. doi:10.1093/cid/ciu135.
- 24. Gough E, Shaikh H, Manges AR. Systematic review of intestinal
microbiota transplantation (fecal bacteriotherapy) for recurrent
Clostridium diffi cile infection. Clin Infect Dis. 2011 Nov;53(10):994-
1002. doi: 10.1093/cid/cir632. Review.
- 25. Cammarota G, Ianiro G, Tilg H, Rajiliβ-Stojanoviβ M, Kump P, Satokari
R, Sokol H, Arkkila P, Pintus C, Hart A, Segal J, Aloi M, Masucci L,
Molinaro A, Scaldaferri F, Gasbarrini G, Lopez-Sanroman A, Link A,
de Groot P, de Vos WM, Högenauer C, Malfertheiner P, Mattila E,
Milosavljeviβ T, Nieuwdorp M, Sanguinetti M, Simren M, Gasbarrini
A; European FMT Working Group. European consensus conference
on faecal microbiota transplantation in clinical practice. Gut. 2017
Apr;66(4):569-580. doi: 10.1136/gutjnl-2016-313017.
- 26. Bennet JD, Brinkman M. Treatment of ulcerative colitis
by implantation of normal colonic fl ora. Lancet. 1989 Jan
21;1(8630):164.
- 27. Borody TJ, Warren EF, Leis S, Surace R, Ashman O. Treatment of
ulcerative colitis using fecal bacteriotherapy. J Clin Gastroenterol.
2003 Jul;37(1):42-7.
- 28. Borody T, Wettstein A, Campbell J, Leis S, Torres T, Finlayson S,
Nowak A. Fecal microbiota transplantation in ulcerative colitis:
review of 24 years experience. Am J Gastroenterol 2012. Abstract
1644.
- 29. Vermeire S, Joossens M, Verbeke K, et al. Pilot study on the safety
and effi cacy of faecal microbiota transplantation in refractory
Crohn’s disease. Gastroenterology. 2012;142(5 suppl 1):S360.
- 30. Anderson JL, Edney RJ, Whelan K. Systematic review: faecal
microbiota transplantation in the management of infl ammatory
bowel disease. Aliment Pharmacol Ther. 2012 Sep;36(6):503-16.
doi: 10.1111/j.1365-2036.2012.05220.x.
- 31. Sha S, Liang J, Chen M, Xu B, Liang C, Wei N, Wu K. Systematic
review: faecal microbiota transplantation therapy for digestive and
nondigestive disorders in adults and children. Aliment Pharmacol
Ther. 2014 May;39(10):1003-32. doi: 10.1111/apt.12699.
- 32. Colman RJ, Rubin DT. Fecal microbiota transplantation as therapy for
infl ammatory bowel disease: a systematic review and meta-analysis.
J Crohns Colitis. 2014 Dec;8(12):1569-81. doi: 10.1016/j.
crohns.2014.08.006.
- 33. Moayyedi P, Surette MG, Kim PT, Libertucci J, Wolfe M, Onischi
C, Armstrong D, Marshall JK, Kassam Z, Reinisch W, Lee CH.
Fecal Microbiota Transplantation Induces Remission in Patients
With Active Ulcerative Colitis in a Randomized Controlled Trial.
Gastroenterology. 2015 Jul;149(1):102-109.e6. doi: 10.1053/j.
gastro.2015.04.001.
- 34. Rossen NG, Fuentes S, van der Spek MJ, Tijssen JG, Hartman JH,
Dufl ou A, Löwenberg M, van den Brink GR, Mathus-Vliegen EM, de
Vos WM, Zoetendal EG, D'Haens GR, Ponsioen CY. Findings From
a Randomized Controlled Trial of Fecal Transplantation for Patients
With Ulcerative Colitis. Gastroenterology. 2015 Jul;149(1):110-118.
e4. doi: 10.1053/j.gastro.2015.03.045.
- 35. Cui B, Feng Q, Wang H, Wang M, Peng Z, Li P, Huang G, Liu Z,
Wu P, Fan Z, Ji G, Wang X, Wu K, Fan D, Zhang F. Fecal microbiota
transplantation through mid-gut for refractory Crohn's disease:
safety, feasibility, and effi cacy trial results. J Gastroenterol Hepatol.
2015 Jan;30(1):51-8. doi: 10.1111/jgh.12727.
- 36. Uygun A, Ozturk K, Demirci H, et al. Fecal microbiota transplantation
is a rescue treatment modality for refractory ulcerative colitis.
Scalisi. G, ed. Medicine. 2017;96(16):e6479. doi:10.1097/
MD.0000000000006479.
- 37. Li N, Tian H, Ma C, Ding C, Ge X, Gu L, Zhang X, Yang B, Hua Y, Zhu
Y, Zhou Y. Effi cacy analysis of fecal microbiota transplantation in the
treatment of 406 cases with gastrointestinal disorders. Zhonghua
Wei Chang Wai Ke Za Zhi; 2017 Jan 25;20(1):40-46
- 38. Paramsothy S, Kamm MA, Kaakoush NO, Walsh AJ, van den
Bogaerde J, Samuel D, Leong RWL, Connor S, Ng W, Paramsothy R,
Xuan W, Lin E, Mitchell HM, Borody TJ. Multidonor intensive faecal
microbiota transplantation for active ulcerative colitis: a randomised
placebo-controlled trial. Lancet. 2017 Mar 25;389(10075):1218-
1228. doi: 10.1016/S0140-6736(17)30182-4.
- 39. Pinn DM, Aroniadis OC, Brandt LJ. Is fecal microbiota
transplantation (FMT) an effective treatment for patients with
functional gastrointestinal disorders (FGID)? Neurogastroenterol
Motil. 2015 Jan;27(1):19-29. doi: 10.1111/nmo.12479. Epub 2014
Nov 25. Review.
- 40. Rajiliβ-Stojanoviβ M, Biagi E, Heilig HG, Kajander K, Kekkonen
RA, Tims S, de Vos WM. Global and deep molecular analysis of
microbiota signatures in fecal samples from patients with irritable
bowel syndrome. Gastroenterology. 2011 Nov;141(5):1792-801.
doi: 10.1053/j.gastro.2011.07.043.
- 41. Borody TJ, Campbell J. Fecal microbiota transplantation: techniques,
applications, and issues. Gastroenterol Clin North Am. 2012
Dec;41(4):781-803. doi: 10.1016/j.gtc.2012.08.008. Review.
- 42. roniadis OC, Brandt LJ. Fecal microbiota transplantation: past,
present and future. Curr Opin Gastroenterol. 2013 Jan;29(1):79-
84. doi: 10.1097/MOG.0b013e32835a4b3e. Review.
- 43. Youngster I, Sauk J, Pindar C, et al. Fecal Microbiota Transplant for
Relapsing Clostridium diffi cile Infection Using a Frozen Inoculum
From Unrelated Donors: A Randomized, Open-Label, Controlled
Pilot Study. Clinical Infectious Diseases: An Offi cial Publication of
the Infectious Diseases Society of America. 2014;58(11):1515-
1522. doi:10.1093/cid/ciu135.
- 44. Satokari R, Mattila E, Kainulainen V, Arkkila PE. Simple faecal
preparation and effi cacy of frozen inoculum in faecal microbiota
transplantation for recurrent Clostridium diffi cile infection--
an observational cohort study. Aliment Pharmacol Ther. 2015
Jan;41(1):46-53. doi: 10.1111/apt.13009.
- 45. Brandt LJ, Aroniadis OC. An overview of fecal microbiota
transplantation: techniques, indications, and outcomes.
Gastrointest Endosc. 2013 Aug;78(2):240-9. doi: 10.1016/j.
gie.2013.03.1329.
- 46. Kelly CR, Kahn S, Kashyap P, Laine L, Rubin D, Atreja A, Moore T, Wu
G. Update on Fecal Microbiota Transplantation 2015: Indications,
Methodologies, Mechanisms, and Outlook. Gastroenterology.
2015 Jul;149(1):223-37. doi: 10.1053/j.gastro.2015.05.008.
- 47. Liao CH, Shollenberger LM. Survivability and long-term preservation
of bacteria in water and in phosphate-buffered saline. Lett Appl
Microbiol. 2003;37(1):45-50.
- 48. Costello SP, Tucker EC, La Brooy J, Schoeman MN, Andrews
JM. Establishing a Fecal Microbiota Transplant Service for the
Treatment of Clostridium diffi cile Infection. Clin Infect Dis. 2016
Apr 1;62(7):908-14. doi: 10.1093/cid/civ994.
- 49. Lee CH, Steiner T, Petrof EO, Smieja M, Roscoe D, Nematallah
A, Weese JS, Collins S, Moayyedi P, Crowther M, Ropeleski MJ,
Jayaratne P, Higgins D, Li Y, Rau NV, Kim PT. Frozen vs Fresh Fecal
Microbiota Transplantation and Clinical Resolution of Diarrhea
in Patients With Recurrent Clostridium diffi cile Infection: A
Randomized Clinical Trial. JAMA. 2016 Jan 12;315(2):142-9. doi:
10.1001/jama.2015.18098.
- 50. Frank, J; Hogenauer, C; Grochenig, HP; Hoffmann, KM;
Reicht, G; Wenzl, HH; Petritsch, W; Kump, PK. Safety of fecal
microbiota transplantation in patients with chronic colitis and
immunosuppressive treatement. J CROHNS COLITIS. 2015; 9:
S245-S246.
- 51. Baxter M, Ahmad T, Colville A, Sheridan R. Fatal Aspiration
Pneumonia as a Complication of Fecal Microbiota Transplant. Clin
Infect Dis. 2015 Jul 1;61(1):136-7. doi: 10.1093/cid/civ247.
- 52. Link A, Lachmund T, Schulz C, Weigt J, Malfertheiner P, Endoscopic
peroral jejunal fecal microbiota transplantation., Digestive and Liver
Disease (2016), http://dx.doi.org/10.1016/j.dld.2016.08.110
- 53. Agrawal M, Aroniadis OC, Brandt LJ, Kelly C, Freeman S, Surawicz
C, Broussard E, Stollman N, Giovanelli A, Smith B, Yen E, Trivedi
A, Hubble L, Kao D, Borody T, Finlayson S, Ray A, Smith R. The
Long-term Effi cacy and Safety of Fecal Microbiota Transplant for
Recurrent, Severe, and Complicated Clostridium diffi cile Infection
in 146 Elderly Individuals. J Clin Gastroenterol. 2016 May-
Jun;50(5):403-7. doi: 10.1097/MCG.0000000000000410.
- 54. Alang N, Kelly CR. Weight Gain After Fecal Microbiota Transplantation.
Open Forum Infectious Diseases. 2015;2(1):ofv004. doi:10.1093/
ofi d/ofv004.
- 55. Baxter M, Colville A. Adverse events in faecal microbiota transplant:
a review of the literature. J Hosp Infect. 2016 Feb;92(2):117-27. doi:
10.1016/j.jhin.2015.10.024.
- 56. Satokari R, Fuentes S, Mattila E, Jalanka J, de Vos WM, Arkkila P.
Fecal transplantation treatment of antibiotic-induced, noninfectious
colitis and long-term microbiota follow-up. Case Rep Med 2014.
Article ID 913867. http://dx.doi.org/10.1155/2014/913867