Трансплантация фекальной микробиоты – шаг в прошлое или будущее?

Захарова И.Н, Гостюхина А.Д. Трансплантация фекальной микробиоты – шаг в прошлое или будущее? Педиатрия. Consilium Medicum. 2024;2:173–178. DOI: 10.26442/26586630.2024.2.202972

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Zakharova IN, Gostyukhina AD. Fecal microbiota transplantation: A step into the past or the future? A review. Pediatrics. Consilium Medicum. 2024;2:173–178. DOI: 10.26442/26586630.2024.2.202972

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Аннотация

В связи с появлением новых данных об ассоциации изменений кишечного микробиома с целым рядом тяжелых заболеваний закономерен вопрос о том, какую роль в поддержании здоровья человека играют обитающие в кишечнике бактерии. Одним из способов изучения состава и функции микробиома, а также его коррекции является трансплантация фекальной микробиоты (ТФМ) – процедура перемещения кишечной микробиоты донора в организм реципиента для модификации ее видового разнообразия. В настоящее время ТФМ входит в стандарты лечения рецидивирующих и рефрактерных форм клостридиальной инфекции во многих странах. Изучается ее возможное влияние на течение таких заболеваний, как воспалительные заболевания кишечника, синдром раздраженного кишечника, метаболический синдром, некоторые неврологические и другие заболевания. С целью облегчить подбор донора, хранение и доставку биоматериала до реципиента, а также для упрощения контроля за проведением процедуры, безопасностью и нежелательными явлениями в Европе, Азии и США появились банки хранения фекального биоматериала. В Австралии одобрен к выпуску лекарственный препарат, в состав которого входят фекалии специально обследованных и подготовленных доноров. Несмотря на наличие большого количества нерешенных технологических, правовых и этических вопросов, ТФМ уже зарекомендовала себя как перспективный потенциальный метод лечения многих заболеваний.

Ключевые слова: дети, трансплантация фекальной микробиоты, микробиом, клостридиальная инфекция, болезнь Крона, язвенный колит, синдром раздраженного кишечника, метаболический синдром, расстройство аутистического спектра, рассеянный склероз

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New data on the association of intestinal microbiome changes with some serious diseases raised the question of the role of the bacteria living in the intestine in maintaining human health. One way to study the composition and function of the microbiome and adjust it is fecal microbiota transplantation (FMT), which refers to the transfer of the donor's intestinal microbiota into the recipient's body to modify species diversity. Currently, FMT is included in the standards of care for relapsed and refractory types of clostridial infection in many countries. Its possible effect on the course of diseases such as inflammatory bowel disease, irritable bowel syndrome, metabolic syndrome, and some neurological and other diseases is being studied. Fecal biomaterial storage banks have been established in Europe, Asia, and the USA to facilitate donor selection, storage and delivery of the biomaterial to the recipient and simplify the control of the procedure, safety and adverse events. In Australia, a medicinal product is approved, which includes feces of specially examined and prepared donors. Despite many unresolved technological, legal and ethical issues, FMT has already been established as a promising potential treatment for many diseases.

Keywords: children, fecal microbiota transplantation, microbiome, clostridial infection, Crohn's disease, ulcerative colitis, irritable bowel syndrome, metabolic syndrome, autism spectrum disorder, multiple sclerosis

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1. Sun Y, Chen Q, Lin P, et al. Characteristics of Gut Microbiota in Patients with Rheumatoid Arthritis in Shanghai, China. Front Cell Infect Microbiol. 2019;9:369. DOI:10.3389/fcimb.2019.00369
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3. Mejía-León ME, Petrosino JF, Ajami NJ, et al. Fecal microbiota imbalance in Mexican children with type 1 diabetes. Sci Rep. 2014;4:3814. DOI:10.1038/srep03814
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7. Liu X, Liu M, Zhao M, et al. Fecal microbiota transplantation for the management of autoimmune diseases: Potential mechanisms and challenges. J Autoimmun. 2023;141:103109. DOI:10.1016/j.jaut.2023.103109
8. Zhang F, Luo W, Shi Y, et al. Should we standardize the 1,700-year-old fecal microbiota transplantation? Am J Gastroenterol. 2012;107(11):1755. DOI:10.1038/ajg.2012.251
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17. McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66:e1-48. DOI:10.1093/cid/cix1085
18. Wang JW, Kuo CH, Kuo FC, et al. Fecal microbiota transplantation: Review and update. J Formos Med Assoc. 2019;118(Suppl. 1):S23-31. DOI:10.1016/j.jfma.2018.08.011
19. Van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013;368(5):407-15. DOI:10.1056/NEJMoa1205037
20. Louie T, Cannon K, O’Grady H, et al. Fecal microbiome transplantation (FMT) via oral fecal microbial capsules for recurrent Clostridium difficile infection (rCDI). 2015.
21. U.S. Food and Drug Administration. Enforcement Policy Regarding Investigational New Drug Requirements for Use of Fecal Microbiota for Transplantation to Treat Clostridium difficile Infection Not Responsive to Standard Therapies. Available at: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/enforcement-policy-regardin.... Accessed: 13.07.2024.
22. Cammarota G, Ianiro G, Tilg H, et al. European FMT Working Group. European consensus conference on faecal microbiota transplantation in clinical practice. Gut. 2017;66(4):569-80. DOI:10.1136/gutjnl-2016-313017
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Авторы

И.Н. Захарова*¹, А.Д. Гостюхина^1,2

¹ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
²ГБУЗ «Детская городская клиническая больница им. З.А. Башляевой» Департамента здравоохранения г. Москвы, Москва, Россия
*zakharova-rmapo@yandex.ru

________________________________________________

Irina N. Zakharova*¹, Anastasia D. Gostyukhina^1,2

¹Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
²Bashlyaeva Children`s City Clinical Hospital, Moscow, Russia
*zakharova-rmapo@yandex.ru

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