Key determinants of success in fecal microbiota transplantation: From microbiome to clinic

Serena Porcari; Nicolas Benech; Mireia Valles-Colomer; Nicola Segata; Antonio Gasbarrini; Giovanni Cammarota; Harry Sokol; Gianluca Ianiro

doi:10.1016/j.chom.2023.03.020

Key determinants of success in fecal microbiota transplantation: From microbiome to clinic

Cell Host Microbe. 2023 May 10;31(5):712-733. doi: 10.1016/j.chom.2023.03.020.

Authors

Serena Porcari¹, Nicolas Benech², Mireia Valles-Colomer³, Nicola Segata⁴, Antonio Gasbarrini¹, Giovanni Cammarota¹, Harry Sokol⁵, Gianluca Ianiro⁶

Affiliations

¹ Department of Medical and Surgical Sciences, Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
² Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France; Tumor Escape Resistance and Immunity Department, Cancer Research Center of Lyon (CRCL), Inserm U1052, CNRS UMR 5286, Lyon, France; French Fecal Transplant Group (GFTF), France.
³ Department CIBIO, University of Trento, Trento, Italy.
⁴ Department CIBIO, University of Trento, Trento, Italy; Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
⁵ French Fecal Transplant Group (GFTF), France; Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Gastroenterology Department, Paris, France; Paris Centre for Microbiome Medicine FHU, Paris, France; INRA, UMR1319 Micalis & AgroParisTech, Jouy en Josas, France.
⁶ Department of Medical and Surgical Sciences, Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: gianluca.ianiro@unicatt.it.

PMID: 37167953
DOI: 10.1016/j.chom.2023.03.020

Abstract

Fecal microbiota transplantation (FMT) has achieved satisfactory results in preventing the recurrence of Clostridioides difficile infection, but these positive outcomes have only been partially replicated in other diseases. Several factors influence FMT success, including those related to donors and recipients (including diversity and specific composition of the gut microbiome, immune system, and host genetics) as well as to working protocols (fecal amount and number of infusions, route of delivery, and adjuvant treatments). Moreover, initial evidence suggests that the clinical success of FMT may be related to the degree of donor microbial engraftment. The application of cutting-edge technologies for microbiome assessment, along with changes in the current vision of fecal transplants, are expected to improve FMT protocols and outcomes. Here, we review the key determinants of FMT success and insights and strategies that will enable a close integration of lab-based and clinical approaches for increasing FMT success.

Keywords: engraftment; fecal microbiota transplantation; host immunity; microbiome.

Publication types

Review

MeSH terms

Clostridioides difficile*
Clostridium Infections* / therapy
Fecal Microbiota Transplantation / methods
Feces
Gastrointestinal Microbiome*
Humans
Microbiota*
Treatment Outcome