Faecal/intestinal microbiota transplant (FMT/IMT) is an efficacious treatment option for recurrent Clostridioides difficile infection, which has prompted substantial interest in FMT's potential role in the management of a much broader range of diseases associated with the gut microbiome. Despite its promise, the success rates of FMT in these other settings have been variable. This review critically evaluates the current evidence on the impact of clinical, biological, and procedural factors upon the therapeutic efficacy of FMT, and identifies areas that remain nebulous. Due to some of these factors, the optimal therapeutic approach remains unclear; for example, the preferred timing of FMT administration in a heavily antibiotic-exposed hematopoietic cell transplant recipient is not standardized, with arguments that can be made in alternate directions. We explore how these factors may impact upon more informed selection of donors, potential matching of donors to recipients, and aspects of clinical care of FMT recipients. This includes consideration of how gut microbiome composition and functionality may strategically inform donor selection criteria. Furthermore, we review how the most productive advances within the FMT space are those where clinical and translational outcomes are assessed together, and where this model has been used productively in recent years to better understand the contribution of the gut microbiome to human disease, and start the process toward development of more targeted microbiome therapeutics.

中文翻译：

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粪便（或肠道）微生物群移植：一种修复肠道微生物组的工具。


粪便/肠道微生物群移植 （FMT/IMT） 是复发性艰难梭菌感染的有效治疗选择，这引起了人们对 FMT 在管理与肠道微生物组相关的更广泛疾病中的潜在作用的浓厚兴趣。尽管 FMT 前景广阔，但在这些其他情况下，FMT 的成功率一直存在差异。本综述批判性地评估了当前关于临床、生物学和程序因素对 FMT 治疗效果影响的证据，并确定了仍然模糊不清的领域。由于其中一些因素，最佳治疗方法仍不清楚;例如，在大量抗生素暴露的造血细胞移植受者中，FMT 给药的首选时间不是标准化的，可以有不同的争论。我们探讨了这些因素如何影响更明智的供体选择、供体与受体的潜在匹配以及 FMT 受体的临床护理方面。这包括考虑肠道微生物组的组成和功能如何从战略上为供体选择标准提供信息。此外，我们回顾了 FMT 领域内最有成效的进步是如何一起评估临床和转化结果的，以及该模型近年来被有效地用于更好地了解肠道微生物组对人类疾病的贡献，并开始开发更具针对性的微生物组疗法的过程。