Treating From the Inside Out: Relevance of Fecal Microbiota Transplantation to Counteract Gut Damage in GVHD and HIV Infection

Frontiers in Medicine

article

Jing Ouyang¹  Stéphane Isnard¹  John Lin¹  Brandon Fombuena¹  Xiaorong Peng¹  Seema Nair Parvathy⁵  Yaokai Chen²  Michael S. Silverman⁵  Jean-Pierre Routy¹ 

[1] Infectious Diseases and Immunity in Global Health Program, McGill University Health Centre, Research Institute;Chongqing Public Health Medical Center;Department of Microbiology and Immunology, McGill University;State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, College of Medicine, The First Affiliated Hospital, Zhejiang University;Infectious Diseases Division, St. Joseph's Health Care;Division of Hematology, McGill University Health Centre

关键词: fecal microbiota transplantation;    graft-vs.-host disease;    HIV infection;    gut epithelial damage;    dysbiosis;   

DOI  :  10.3389/fmed.2020.00421

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

The gastrointestinal (GI) tract is a complex and well-balanced milieu of anatomic and immunological barriers. The epithelial surface of the GI tract is colonized by trillions of microorganisms, known as the gut microbiota, which is considered an “organ” with distinctive endocrine and immunoregulatory functions. Dysregulation of the gut microbiota composition, termed dysbiosis, has been associated with epithelial damage and translocation of microbial products into the circulating blood. Dysbiosis, increased gut permeability and chronic inflammation play a major role on the clinical outcome of inflammatory bowel diseases, graft-vs.-host disease (GVHD) and HIV infection. In this review, we focus on GVHD and HIV infection, conditions sharing gut immune damage leading to dysbiosis. The degree of dysbiosis and level of epithelial gut damage predict poor clinical outcome in both conditions. Emerging interventions are therefore warranted to promote gut microbiota homeostasis and improve intestinal barrier function. Interventions such as anti-inflammatory medications, and probiotics have toxicity and/or limited transitory effects, justifying innovative approaches. Fecal microbiota transplantation (FMT) is one such approach where fecal microorganisms are transferred from healthy donors into the GI tract of the recipient to restore microbiota composition in patients with Clostridium difficile- induced colitis or inflammatory bowel diseases. Preliminary findings point toward a beneficial effect of FMT to improve GVHD and HIV-related outcomes through the engraftment of beneficial donor bacteria, notably those producing anti-inflammatory metabolites. Herein, we critically review the potential for FMT in alleviating dysbiosis and gut damage in patients with GVHD or HIV-infection. Understanding the underlying mechanism by which FMT restores gut function will pave the way toward novel scalable and targeted interventions.

【 授权许可】

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