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World J Gastroenterol. Dec 21, 2016; 22(47): 10304-10315
Published online Dec 21, 2016. doi: 10.3748/wjg.v22.i47.10304
Fecal microbial transplant for the treatment of pediatric inflammatory bowel disease
Alice Yuxin Wang, Jelena Popov, Nikhil Pai
Alice Yuxin Wang, Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
Jelena Popov, Nikhil Pai, Department of Pediatrics, Division of Pediatric Gastroenterology, McMaster Children’s Hospital, McMaster University, Hamilton, Ontario L8N 3Z5, Canada
Jelena Popov, McMaster Integrative Neuroscience Discovery and Study Graduate Program, McMaster University, Hamilton, Ontario L8S 4L8, Canada
Author contributions: Wang AY and Popov J contributed equally to this work; Pai N was responsible for providing overall review and editing of the final paper.
Conflict-of-interest statement: The authors wish to declare no relevant conflicts of interest to the preparation, or content of this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nikhil Pai, MD FAAP FRCPC, Assistant Professor, Department of Pediatrics, Division of Pediatric Gastroenterology, McMaster Children’s Hospital, McMaster University, Hamilton, 1280 Main Street West, HSC 3A21, Ontario L8N 3Z5, Canada. pain@mcmaster.ca
Telephone: +1-905-5212100 Fax: +1-905-5212655
Received: August 3, 2016
Peer-review started: August 5, 2016
First decision: September 21, 2016
Revised: November 1, 2016
Accepted: November 16, 2016
Article in press: November 16, 2016
Published online: December 21, 2016
Abstract

The role of fecal microbial transplant (FMT) in the treatment of pediatric gastrointestinal disease has become increasingly popular among pediatric practitioners, patients, and parents. The success of FMT for the treatment of recurrent Clostridium difficile infection (RCDI) has bolstered interest in its potential application to other disease states, such as inflammatory bowel disease (IBD). FMT has particular interest in pediatrics, given the concerns of patients and parents about rates of adverse events with existing therapeutic options, and the greater cumulative medication burden associated with childhood-onset disease. Published literature on the use of FMT in pediatrics is sparse. Only 45 pediatric patients treated for RCDI have been reported, and only 27 pediatric patients with pediatric IBD. The pediatric microbiome may uniquely respond to microbial-based therapies. This review will provide a comprehensive overview of fecal microbial transplant and its potential role in the treatment of pediatric inflammatory bowel disease. We will discuss the microbiome in pediatric inflammatory bowel disease, existing adult and pediatric literature on the use of FMT in IBD treatment, and pediatric FMT trials that are currently recruiting patients. This review will also discuss features of the microbiome that may be associated with host response in fecal transplant, and potential challenges and opportunities for the future of FMT in pediatric IBD treatment.

Keywords: Inflammatory bowel disease, Microbiome, Microbiota, Fecal microbial transplant, Pediatric, Crohn’s disease, Ulcerative colitis

Core tip: There is growing interest in fecal microbial transplant (FMT) for the treatment of pediatric inflammatory bowel disease (IBD). The therapeutic potential of bacterial therapies is intriguing. FMT is effective for treating recurrent Clostridium difficile infection, distinct microbial signatures in IBD continue to be described, and patients are increasingly looking for therapeutic options with lower rates of morbidity. This review describes existing adult and pediatric literature on the role of FMT in IBD, features of the IBD microbiome that may be associated with response, current trials, and the potential challenges and opportunities for the future of FMT in pediatric IBD treatment.