title: From stool transplants to next-generation microbiota therapeutics.
abstract: The epidemic of Clostridium difficile infection fueled by new virulent strains of the organism has led to increased use of fecal microbiota transplantation (FMT). The procedure is effective for even the most desperate cases after failure of multiple courses of antibiotics. The approach recognizes microbiota to be integral to normal human physiology, and microbiota being used in FMT represents a new class of therapeutics. Imbalance in the composition and altered activity of the microbiota are associated with many diseases. Consequently, there is growing interest in applying FMT to non-C difficile indications. However, this may succeed only if microbiota therapeutics are developed systematically, based on mechanistic understanding, and applying up-to-date principles of microbial ecology. We discuss 2 pathways in the development of this new therapeutic class: whole microbial communities separated from donor stool and an assembly of specific fecal microorganisms grown in vitro.
authors.affiliation: Department of Medicine, Division of Infectious Diseases & Gastrointestinal Research Unit; Queens University and Kingston General Hospital, Kingston, ON, Canada.
authors.forename: Elaine O
authors.initials: EO
authors.lastname: Petrof
authors.affiliation: Center for Immunology and Department of Medicine, Division of Gastroenterology; University of Minnesota, MN, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Khoruts
mesh_terms: D000818:Animals; D001691:Biological Therapy / Q000379:methods*; D016360:Clostridioides difficile / Q000254:growth & development* / Q000472:pathogenicity; D064806:Dysbiosis; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy*; D058872:Epidemics; D005243:Feces / Q000382:microbiology*; D054884:Host-Pathogen Interactions; D006801:Humans; D007422:Intestines / Q000382:microbiology*; D064307:Microbiota; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Defined Microbiota Ecosystems; Fecal Microbiota Transplantation; Full Spectrum Microbiota; Recurrent Clostridium difficile Infection