粪菌移植治疗炎症性肠病的争议Controversy of Fecal Microbiota Transplantation in Treating Patients with Inflammatory Bowel Disease
张发明;李玥;
ZHANG Fa-ming;LI Yue;Medical Center for Digestive Diseases,the Second Affiliated Hospital,Nanjing Medical University;Department of Microbiotherapy,the Sir Run Run Hospital,Nanjing Medical University;Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;
摘要(Abstract):
已有报道表明粪菌移植治疗炎症性肠病前景可观,且针对溃疡性结肠炎的临床随机对照研究支持粪菌移植的有效性。但涉及粪菌制备的方法学、移植途径、供体筛选、患者选择以及诱发病情活动的潜在风险等方面尚存诸多未知,因此,粪菌移植目前仅适合在临床试验等特定条件下用于炎症性肠病治疗。
Fecal microbiota transplantation( FMT) is reported to be a promising therapy for patients with inflammatory bowel disease( IBD). Randomized controlled trials have reported the effectiveness of FMT in the treatment of ulcerative colitis. However,many associated unknowns still remain,such as the preparation,the transplantation route,donor and recipient selection,and potential adverse events including the risk of IBD flare post-FMT. Therefore,FMT should only be administered in patients with IBD in a circumstanced setting,such as clinical trials.
关键词(KeyWords):
粪菌移植;溃疡性结肠炎;克罗恩病;不良事件
fecal microbiota transplantation;ulcerative colitis;Crohn's disease;adverse events
基金项目(Foundation): 中国医学科学院医学与健康科技创新工程协同创新团队“人体微生物组平台建设与应用研究”(2017-I2M-3-017);; 江苏省重大研发计划(BE2018751)
作者(Author):
张发明;李玥;
ZHANG Fa-ming;LI Yue;Medical Center for Digestive Diseases,the Second Affiliated Hospital,Nanjing Medical University;Department of Microbiotherapy,the Sir Run Run Hospital,Nanjing Medical University;Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;
Email:
DOI:
参考文献(References):
- [1]Paramsothy S,Kamm MA,Kaakoush NO,et al.Multidonor intensive faecal microbiota transplantation for active ulcerative colitis:a randomised placebo-controlled trial[J].Lancet,2017,389:1218-1228.
- [2]Costello SP,Hughes PA,Waters O,et al.Effect of Fecal Microbiota Transplantation on 8-Week Remission in Patients With Ulcerative Colitis:A Randomized Clinical Trial[J].JAMA,2019,321:156-164.
- [3]Ding X,Li Q,Li P,et al.Efficacy,safety and long-term follow up of step-up fecal microbiota transplantation strategy in moderate to severe ulcerative colitis[J].Drug Saf,2019.doi:10.1007/s40264-019-00809-2.[Epub ahead of print].
- [4]Wang H,Cui B,Li Q,et al.The safety of fecal microbiota transplantation for Crohn's disease:Findings from long-term study[J].Adv Ther,2018,35:1935-1944.
- [5]Qazi T,Amaratunga T,Barnes EL,et al.The risk of inflammatory bowel disease flares after fecal microbiota transplantation:systematic review and meta-analysis[J].Gut Microbes,2017,8:574-588.
- [6]Kump P,Wurm P,Grochenig HP,et al.The taxonomic composition of the donor intestinal microbiota is a major factor influencing the efficacy of faecal microbiota transplantation in therapy refractory ulcerative colitis.Aliment[J].Pharmacol Ther,2018,47,67-77.
- [7]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,2015,149:102-109.
- [8]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,2015,149:110-118.
- [9]Fuentes S,Rossen NG,van der Spek MJ,et al.Microbial shifts and signatures of long-term remission in ulcerative colitis after faecal microbiota transplantation[J].ISME J,2017,11:1877-1889.
- [10]Zhang F,Cui B,He X,et al.FMT-standardization Study Group.Microbiota transplantation:concept,methodology and strategy for its modernization[J].Protein Cell,2018,9:462-473.
- [11]Wilson BC,Vatanen T,Cutfield WS,et al.The SuperDonor Phenomenon in Fecal Microbiota Transplantation[J].Front Cell Infect Microbiol,2019,9:2.
- [12]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,2015,42:1011-1018.
- [13]Staley C,Hamilton MJ,Vaughn BP,et al.Successful resolution of recurrent Clostridium difficile infection using freezedried,encapsulated fecal microbiota;pragmatic cohort study[J].Am J Gastroenterol,2017,112:940-947.
- [14]Kao D,Roach B,Silva M,et al.Effect of oral capsule-vs colonoscopy-delivered fecal microbiota transplantation on recurrent Clostridium difficile infection:a randomized clinical trial[J].JAMA,2017,318:1985-1993.
- [15]Uygun A,Ozturk K,Demirci H,et al.Fecal microbiota transplantation is a rescue treatment modality for refractory ulcerative colitis[J].Medicine(Baltimore),2017,96:e6479.
- [16]Sood A,Mahajan R,Juyal G,et al.Efficacy of fecal microbiota therapy in steroid dependent ulcerative colitis:a real world intention-to-treat analysis[J].Intest Res,2019,17:78-86.
- [17]Li P,Zhang T,Xiao Y,et al.Timing for the second fecal microbiota transplantation to maintain the long-term benefit from the first treatment for Crohn's disease[J].Appl Microbiol Biotechnol,2019,103:349-360.
- [18]Singh S,Feuerstein JD,Binion DG,et al.AGA Technical Review on the Management of Mild-to-Moderate Ulcerative Colitis[J].Gastroenterology,2019,156:769-808.
- [19]Imdad A,Nicholson MR,Tanner-Smith EE,et al.Fecal transplantation for treatment of inflammatory bowel disease[J].Cochrane Database Syst Rev,2018,11:CD012774.
- 张发明
- 李玥
ZHANG Fa-ming- LI Yue
- Medical Center for Digestive Diseases
- the Second Affiliated Hospital
- Nanjing Medical University
- Department of Microbiotherapy
- the Sir Run Run Hospital
- Nanjing Medical University
- Department of Gastroenterology
- Peking Union Medical College Hospital
- Chinese Academy of Medical Sciences & Peking Union Medical College
- 张发明
- 李玥
ZHANG Fa-ming- LI Yue
- Medical Center for Digestive Diseases
- the Second Affiliated Hospital
- Nanjing Medical University
- Department of Microbiotherapy
- the Sir Run Run Hospital
- Nanjing Medical University
- Department of Gastroenterology
- Peking Union Medical College Hospital
- Chinese Academy of Medical Sciences & Peking Union Medical College