Fecal Microbial Transplantation and Its Potential Application in Cardiometabolic Syndrome

Avner Leshem, Nir Horesh, Eran Elinav, Avner Leshem, Nir Horesh, Eran Elinav

Abstract

Newly revealed links between inflammation, obesity, and cardiometabolic syndrome have created opportunities to try previously unexplored therapeutic modalities in these common and life-risking disorders. One potential modulator of these complex disorders is the gut microbiome, which was described in recent years to be altered in patients suffering from features of cardiometabolic syndrome and to transmit cardiometabolic phenotypes upon transfer into germ-free mice. As a result, there is great interest in developing new modalities targeting the altered commensal bacteria as a means of treatment for cardiometabolic syndrome. Fecal microbiota transplantation (FMT) is one such modality in which a disease-associated microbiome is replaced by a healthy microbiome configuration. So far clinical use of FMT has been overwhelmingly successful in recurrent Clostridium difficile infection and is being extensively studied in other microbiome-associated pathologies such as cardiometabolic syndrome. This review will focus on the rationale, promises and challenges in FMT utilization in human disease. In particular, it will overview the role of the gut microbiota in cardiometabolic syndrome and the rationale, experience, and prospects of utilizing FMT treatment as a potential preventive and curative treatment of metabolic human disease.

Keywords: FMT; cardiometabolic disease; fecal microbiome transplantation; microbiome; microbiota.

Figures

Figure 1
Figure 1
Ongoing clinical trials to evaluate fecal microbial transplant. Data taken from www.clinicaltrial.gov. Search words: fecal microbial transplant/FMT.
Figure 2
Figure 2
Mechanisms of Gut Microbiota involvement in Cardiometabolic Syndrome. ANGPLT4–Angiopoietin-like 4, FIAF–Fast Induced Adipose Factor, FXR–Farnesoid-X Receptor, GLP1–Glucagon-like Peptide 1, LPL–Lipoprotein Lipase, LPS–Lipopolysaccharide, PPARγ-Peroxisome proliferator-activated receptor γ, PYY–Peptide YY, SCFA–Short Chain Fatty Acid, TMA–Trimethylamine, TMAO–Trimethylamine-N Oxidase, WAT–White Adipose Tissue (, , –93).
Figure 3
Figure 3
Challenges in fecal microbial transplant. Methodological uncertainties are present in almost every step of fecal microbial transplant. There is no single ideal protocol for FMT, rather different indications for FMT require appropriate methodology. Bullet points represent areas of uncertainty (135, 136).

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