Intestinal microbiota, fecal microbiota transplantation, and inflammatory bowel disease

摘要

Inflammatory bowel disease (IBD) affects over 1 million individuals in the United States alone, and the incidence of these diseases in both the US and in developed countries worldwide continues to grow.1'2 The current paradigm of the pathophysiology of IBD is an inappropriate immune response to the microbiota in a genetically susceptible individual.3'4 IBD is grouped into predominantly phenotypic patterns based on the location of inflammation: in Crohn's disease (CD), the inflammation can be in any part of the intestine, while in ulcerative colitis (UC) the inflammation is limited to the colon. In IBD, an abnormal intestinal microbiota (dysbiosis) is clearly associated with certain disease phenotypes, and may be a causal or synergistic factor in perpetuating chronic inflammation. Thus, manipulating the intestinal microbiota represents a potential treatment of IBD.2 One form of manipulating the microbiota is through fecal microbiota transplantation (FMT), where fecal microbiota from a healthy donor are transplanted into the distal GI tract of a patient. FMT has already emerged as a successful therapy for Clostridium difficile infection,5 7 and is currently being explored as a potential treatment of IBD.8"10 This review will outline the associations of IBD and the gut microbiota, and then discuss the current data on fecal microbiota transplantation in IBD.