Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2022; 28(23): 2546-2560
Published online Jun 21, 2022. doi: 10.3748/wjg.v28.i23.2546
Fecal microbiota transplantation in the metabolic diseases: Current status and perspectives
Lie Zheng, Yong-Yi Ji, Xin-Li Wen, Sheng-Lei Duan
Lie Zheng, Xin-Li Wen, Sheng-Lei Duan, Department of Gastroenterology, Shaanxi Hospital of Traditional Chinese Medicine, Xi’an 710003, Shaanxi Province, China
Yong-Yi Ji, Department of Neurology, Xi’an Hospital of Traditional Chinese Medicine, Xi’an 710021, Shaanxi Province, China
Author contributions: Zheng L, Ji YY and Duan SL reviewed the literature and prepared the manuscript, performed to the writing, revising of the manuscript; Zheng L and Wen XL contributed to design this work, and performed overall supervision; Zheng L wrote and revised the paper; all authors approved the final manuscript.
Supported by Shaanxi Province Natural Science Basic Research Program-General Project, No. 2019JM-580 and No. 2021SF-314; Project of Shaanxi Administration of Traditional Chinese Medicine, No. 2019-ZZ-JC010; and Shaanxi Provincial Hospital of Traditional Chinese Medicine, No. 2018-04 and No. 2021-07.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest related to this study.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Yi Ji, MD, Department of Neurology, Xi’an Hospital of Traditional Chinese Medicine, No. 69 Fengcheng 8 Road, Xi’an 710003, Shaanxi Province, China. 925861033@qq.com
Received: January 4, 2022
Peer-review started: January 4, 2022
First decision: March 9, 2022
Revised: March 14, 2022
Accepted: May 7, 2022
Article in press: May 7, 2022
Published online: June 21, 2022
Abstract

With the development of microbiology and metabolomics, the relationship between the intestinal microbiome and intestinal diseases has been revealed. Fecal microbiota transplantation (FMT), as a new treatment method, can affect the course of many chronic diseases such as metabolic syndrome, malignant tumor, autoimmune disease and nervous system disease. Although the mechanism of action of FMT is now well understood, there is some controversy in metabolic diseases, so its clinical application may be limited. Microflora transplantation is recommended by clinical medical guidelines and consensus for the treatment of recurrent or refractory Clostridium difficile infection, and has been gradually promoted for the treatment of other intestinal and extraintestinal diseases. However, the initial results are varied, suggesting that the heterogeneity of the donor stools may affect the efficacy of FMT. The success of FMT depends on the microbial diversity and composition of donor feces. Therefore, clinical trials may fail due to the selection of ineffective donors, and not to faulty indication selection for FMT. A new understanding is that FMT not only improves insulin sensitivity, but may also alter the natural course of type 1 diabetes by modulating autoimmunity. In this review, we focus on the main mechanisms and deficiencies of FMT, and explore the optimal design of FMT research, especially in the field of cardiometabolic diseases.

Keywords: Fecal microbiota transplantation, Metabolic diseases, Inflammatory bowel disease, Type 1 diabetes, Metabolic syndrome

Core Tip: The success of fecal microbiota transplantation (FMT) depends on the microbial diversity and composition of donor feces. It is newly found that FMT may not only improve insulin sensitivity, but also alter the natural course of type I diabetes by modulating autoimmunity. In this review, we focus on the main mechanisms and deficiencies of FMT, and explore the optimal design of FMT research, especially in the field of cardiometabolic diseases.