Therapeutic Use of Commensal Microbes: Fecal/Gut Microbiota Transplantation
- Pp. 41-110 (70)Patricia A. Vanny, Aline Machiavelli, Catherine W. Wippel, Jéssica de Andrade, Caetana P. Zamparette, Daniela C. Tartari, Thaís C.M. Sincero, Aguinaldo R. Pinto and Carlos R. Zárate-Bladés
Recognition of the microbial component of human physiology has gained attention in recent years. Several discoveries in different medical disciplines about the participation of commensal microorganisms, broadly known as the microbiota, have guided both basic research and the development of novel therapeutic strategies. In parallel, the broad use of antibiotics has directly impacted microbiota composition with collateral effects, such as the emergence of antibiotic-associated diarrheas (AADs), with the best example being intestinal infection with Clostridium difficile. An ancient Chinese methodology called “fecal microbiota transplantation (FMT)” – referred to here as “gut microbiota transplantation (GMT)” – is currently being used around the world with impressive success against recurrent C. difficile infections (CDIs). This success has inspired several investigators to test this microbiota-based therapy in other conditions, including non-infectious diseases. We introduce this chapter with a review on the main microbiota effects on human health and the immune system. Then, a comprehensive discussion of GMT is provided including the pathogenesis of CDI, GMT history, methodology and ethical aspects, followed by a review of clinical and experimental studies on the therapeutic effects and mechanisms of GMT against recurrent CDI. Finally, GMT testing in other conditions is discussed.