| Abstract [eng] |
A dysbiosis of the intestinal microbiome is a major etiological factor in the pathogenesis of many different diseases. Especially in Clostridioides difficile infection, the imbalance is very prominent, but also in Inflammatory Bowel diseases, Psychiatric diseases, Metabolic syndrome, and malignancies it can be observed. One way of manipulating the composition of the gut microbiome is Fecal transplantation, which has become a routine treatment method for recurrent/refractory Clostridioides difficile infection and has proven to be more effective and at a reduced cost compared to antibiotic treatment. The different methods of application are Colonoscopy, Oral Capsules, Enema and Nasogastric tube, that all proved to be very effective, but Oral capsules are especially convenient for the patient and the health care provider. Regarding the side effects, fecal transplantation has also been confirmed to be safe. Also in Inflammatory Bowel diseases, several trials have been conducted and a disease remission could be observed, yet fecal transplantation for the treatment of Ulcerative Colitis showed more promising results than it did for Crohn’s disease. A depletion in gut microbiota has also been found in depressed patients and children with autism spectrum disorder. Fecal transplantation improved both gastrointestinal and autism spectrum disorder symptoms in these patients. Furthermore, also in patients with metabolic syndrome changes in the microbiota composition have been observed, though controversial results in the efficacy of fecal transplantation for the improvement of insulin sensitivity were detected. In metastatic melanoma patients that were unresponsive to a type of immunotherapy, received a fecal transplant from responders and as a result an advance in the response to the treatment was noted. Additionally, fecal transplantation could be a potential treatment option for chemotherapy associated gastrointestinal patients even in immunosuppressed individuals. The exact mechanism of action of fecal transplantation is still unknown, though several hypotheses have been suggested. Post fecal transplantation, an increase in butyrate-producing bacteria and an enhancement of secondary bile acid metabolism were found that both have a beneficial effect on the defense against imbalances and pathogens. Furthermore, niche exclusion and immunologic pathways are also a part of the mechanism of action of fecal transplantation. It is important to note that human stool is comprised of other parts but bacteria, that possibly also contribute to the pathophysiologic mechanism of the procedure. |
