Therapeutic application of fecal microbiota transplantation in inflammatory bowel disease
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摘要: 炎症性肠病是一组慢性非特异性肠道炎症性疾病,包括溃疡性结肠炎和克罗恩病,其发病原因尚不明确,研究表明肠道菌群紊乱在炎症性肠病的发病中起重要作用,而粪菌移植作为一种可以重建肠道菌群的疗法,在炎症性肠病的临床应用上有重要价值。粪菌移植是将健康个体的粪便处理成混悬液,输注到炎症性肠病患者消化道内,重建肠道微生态,从而有效缓解炎症性肠病病情。但目前粪菌移植在炎症性肠病上的临床应用仍存在不少问题,如供体的筛选、粪菌液的制备、移植的途径及频次等方面均未形成共识。本文就粪菌移植的在炎症性肠病中的应用进展进行综述。Abstract: Inflammatory bowel disease(IBD)is a group of chronic non-specific intestinal inflammatory diseases, including ulcerative colitis(UC)and Crohn’s disease(CD).The causes are not clear. The intestinal flora disorder plays an important role in the pathogenesis of IBD. Fecal microbiota transplantation can reconstruct intestinal flora.It has great value in the clinical application of IBD. Fecal microbiota transplantation treat the feces of healthy individuals into suspension.It infuses them into the digestive tract of ibd patients, and reconstruct intestinal microecology, so as to effectively alleviate the condition of IBD patients. However, the problems exist in the clinical application of fecal microbiota transplantation in IBD, such as the selection of donors, the preparation of fecal bacteria solution, the way and frequency of transplantation. This review summarizes the therapeutic application of fecal microbiota transplantation in IBD.
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[1] 吴开春, 梁 洁, 冉志华, 等. 炎症性肠病诊断与治疗的共识意见(2018年·北京)[J]. 中国实用内科杂志, 2018, 32(9): 796-813. [2] 王玉芳, 欧阳钦, 胡仁伟, 等. 炎症性肠病流行病学研究进展[J]. 胃肠病学, 2013, 18(1): 48-51. doi: 10.3969/j.issn.1008-7125.2013.01.012 [3] Regner EH, Ohri N, Stahly A, et al. Functional intraepithelial lymphocyte changes in inflammatory bowel disease and spondyloarthritis have disease specific correlations with intestinal microbiota[J]. Arthritis Res Ther, 2018, 20(1): 149-61. doi: 10.1186/s13075-018-1639-3 [4] Manichanh C, Borruel N, Casellas FA. The gut microbiota in IBD[J]. Nat Rev Gastroenterol Hepatol, 2012, 9(10): 599-608. doi: 10.1038/nrgastro.2012.152 [5] Sartor RB, Mazmanian SK. Intestinal microbes in inflammatory bowel diseases[J]. Am J Gastroenterol Suppl, 2012, 1(1): 15-21. doi: 10.1038/ajgsup.2012.4 [6] 孙铭晟, 逯茂洋. 肠道菌群与炎症性肠病研究进展[J]. 世界最新医学信息文摘, 2017, 23(102): 48-9. [7] Surawicz CM, Brandt LJ, Binion DG, et al. Guidelines for diagnosis, treatment, and prevention of clostridium difficile infections[J]. Am J Gastroenterol, 2013, 108(4): 478-99. doi: 10.1038/ajg.2013.4 [8] Halkjaer SI, Christensen AH, Lo BZ, et al. Faecal microbiota transplantation alters gut microbiota in patients with irritable bowel syndrome: results from a randomised, double-blind placebo-controlled study[J]. Gut, 2018, 67(12): 2107-15. doi: 10.1136/gutjnl-2018-316434 [9] Bajaj JS, Kassam Z, Fagan A, et al. Fecal microbiota transplant from a rational stool donor improves hepatic encephalopathy: a randomized clinical trial[J]. Hepatology, 2017, 66(6): 1727-38. doi: 10.1002/hep.29306 [10] Cammarota G, Ianiro G, Tilg HA, et al. European consensus conference on faecal microbiota transplantation in clinical practice[J]. Gut, 2017, 66(4): 569-80. doi: 10.1136/gutjnl-2016-313017 [11] Rossen NG, Fuentes S, van der Spek MJ, et al. Findings from a randomized controlled trial of fecal transplantation for patients with ulcerative colitis[J]. Gastroenterology, 2015, 149(1): 110-8. doi: 10.1053/j.gastro.2015.03.045 [12] Fang H, Fu L, Wang J. Protocol for fecal microbiota transplantation in inflammatory bowel disease: a systematic review and meta-analysis[J]. Biomed Res Int, 2018, 20(1): 1-11. [13] 向 杰, 张发明, 黄光明. 粪菌移植的方法学及其治疗炎症性肠病的研究进展[J]. 胃肠病学, 2016, 21(2): 121-4. doi: 10.3969/j.issn.1008-7125.2016.02.015 [14] 张发明. 粪菌移植体系[J]. 科技导报, 2016, 34(20): 86-92. [15] Smits LP, Bouter KE, de Vos WM, et al. Therapeutic potential of fecal microbiota transplantation[J]. Gastroenterology, 2013, 145(5): 946-53. doi: 10.1053/j.gastro.2013.08.058 [16] Hamilton MJ, Weingarden AR, Sadowsky MJ, et al. Standardized frozen preparation for transplantation of fecal microbiota for recurrent clostridium difficile infection[J]. Am J Gastroenterol, 2012, 107(5): 761-7. doi: 10.1038/ajg.2011.482 [17] Costello SP, Conlon MA, Vuaran MS, et al. Faecal microbiota transplant for recurrent clostridium difficile infection using long-term frozen stool is effective: clinical efficacy and bacterial viability data[J]. Aliment Pharmacol Ther, 2015, 42(8): 1011-8. doi: 10.1111/apt.13366 [18] Kunde S, Pham A, Bonczyk S, et al. Safety, tolerability, and clinical response after fecal transplantation in children and young adults with ulcerative colitis[J]. J Pediatr Gastroenterol Nutr, 2013, 56(6): 597-601. doi: 10.1097/MPG.0b013e318292fa0d [19] Peng Z, Xiang J, He Z, et al. Colonic transendoscopic enteral tubing: A novel way of transplanting fecal microbiota[J]. Endosc Int Open, 2016, 4(6): E610-3. doi: 10.1055/s-00025476 [20] Kellermayer R, Nagy-Szakal D, Harris R, et al. Serial fecal microbiota transplantation alters mucosal gene expression in pediatric ulcerative colitis[J]. Am J Gastroenterol, 2015, 110(4): 604-6. doi: 10.1038/ajg.2015.19 [21] Angelberger S, Reinisch W, Makristathis A, et al. Temporal bacterial community dynamics vary among ulcerative colitis patients after fecal microbiota transplantation[J]. Am J Gastroenterol, 2013, 108(10): 1620-30. doi: 10.1038/ajg.2013.257 [22] Bennet JD, Brinkman M. Treatment of ulcerative colitis by implantation of normal colonic flora[J]. Lancet, 1989, 1(8630): 164-75. [23] Moayyedi P, Surette MG, Kim PT, et al. Fecal microbiota transplantation induces remission in patients with active ulcerative colitis in a randomized controlled trial[J]. Gastroenterology, 2015, 149(1): 102-9. doi: 10.1053/j.gastro.2015.04.001 [24] Paramsothy S, Kamm MA, Kaakoush NO, et al. Multidonor intensive faecal microbiota transplantation for active ulcerative colitis: a randomised placebo-controlled trial[J]. Lancet, 2017, 389(175): 1218-28. [25] Costello S, Waters O, Bryant R, et al. OP036 short duration, low intensity pooled faecal microbiota transplantation induces remission in patients with mild-moderately active ulcerative colitis: a randomised controlled trial[J]. J Crohns Colitis, 2017, 11(suppl): S23-35. [26] Borody TJ, George L, Andrews P, et al. Bowel-flora alteration: a potential cure for inflammatory bowel disease and irritable bowel syndrome[J]. Med J Aust, 1989, 150(10): 604-17. [27] Suskind DL, Brittnacher MJ, Wahbeh G, et al. Fecal microbial transplant effect on clinical outcomes and fecal microbiome in active Crohn's disease[J]. Inflamm Bowel Dis, 2015, 21(3): 556-63. doi: 10.1097/MIB.0000000000000307 [28] Cui B, Feng Q, Wang H, et al. Fecal microbiota transplantation through mid-gut for refractory Crohn's disease: safety, feasibility, and efficacy trial results[J]. J Gastroenterol Hepatol, 2015, 30(1): 51-8. doi: 10.1111/jgh.12727 [29] Vaughn BP, Vatanen T, Allegretti JR, et al. Increased intestinal microbial diversity following fecal microbiota transplant for active crohn's disease[J]. Inflamm Bowel Dis, 2016, 22(9): 2182-90. doi: 10.1097/MIB.0000000000000893 [30] Colman RJ, Rubin DT. Fecal microbiota transplantation as therapy for inflammatory bowel disease: a systematic review and meta-analysis[J]. J Crohns Colitis, 2014, 8(12): 1569-81. doi: 10.1016/j.crohns.2014.08.006 [31] Wang S, Xu MQ, Wang WQ, et al. Systematic review: adverse events of fecal microbiota transplantation[J]. PLoS One, 2016, 11(8): e161174-85. [32] Baxter M, Colville A. Adverse events in faecal microbiota transplant: a review of the literature[J]. J Hosp Infect, 2016, 92(2): 117-27. doi: 10.1016/j.jhin.2015.10.024 [33] Kelly BJ, Tebas P. Clinical practice and infrastructure review of fecal microbiota transplantation for clostridium difficile infection[J]. Chest, 2018, 153(1): 266-77. doi: 10.1016/j.chest.2017.09.002 [34] Wang HG, Cui BT, Li Q, et al. The safety of fecal microbiota transplantation for crohn's disease: findings from a Long-Term study[J]. Adv Ther, 2018, 35(11): 1935-44. doi: 10.1007/s12325-018-0800-3 [35] Hsu WH, Wang JY, Kuo CH. Current applications of fecal microbiota transplantation in intestinal disorders[J]. Kaohsiung J Med Sci, 2019, 35(6): 327-31. [36] Vermeire S, Joossens M, Verbeke K, et al. Donor species richness determines faecal microbiota transplantation success in inflammatory bowel disease[J]. J Crohns Colitis, 2016, 10(4): 387-94. doi: 10.1093/ecco-jcc/jjv203 [37] Wilson BC, Vatanen T, Cutfield WS. The super-donor phenomenon in fecal microbiota transplantation[J]. Front Cell Infect Microbiol, 2019, 9(2): 135-45. [38] Hohmann EL, Ananthakrishnan AN, Deshpande V. Case records of the Massachusetts general hospital case 25-2014, a 37-year-old man with ulcerative colitis and bloody diarrhea[J]. N Engl J Med, 2014, 371(7): 668-75. doi: 10.1056/NEJMcpc1400842 [39] Hocquart M, Lagier JC, Cassir NA, et al. Early fecal microbiota transplantation improves survival in severe clostridium difficile infections[J]. Clinical Infectious Diseases, 2018, 66(5): 645-50. doi: 10.1093/cid/cix762 [40] Bakken JS, Borody T, Brandt LJ, et al. Treating clostridium difficile infection with fecal microbiota transplantation[J]. Clin Gastroenterol Hepatol, 2011, 9(12): 1044-9. doi: 10.1016/j.cgh.2011.08.014
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