Soveral LF, Korczaguin GG, Schmidt PS, Nunes IS, Fernandes C, Zárate-Bladés CR. Immunological mechanisms of fecal microbiota transplantation in recurrent Clostridioides difficile infection. World J Gastroenterol 2022; 28(33): 4762-4772 [PMID: 36156924 DOI: 10.3748/wjg.v28.i33.4762]
Corresponding Author of This Article
Carlos R Zárate-Bladés, MD, MSc, PhD, Assistant Professor, Laboratory of Immunoregulation, Department of Microbiology, Immunology, and Parasitology, Center for Dysbiosis Control, Federal University of Santa Catarina, CCB Novo, 8o andar, Rua da Prefeitura Universitária, Setor Córrego Grande, Campus UFSC, Florianopolis 88037-000, Brazil. zarate.blades@ufsc.br
Research Domain of This Article
Immunology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
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/
World J Gastroenterol. Sep 7, 2022; 28(33): 4762-4772 Published online Sep 7, 2022. doi: 10.3748/wjg.v28.i33.4762
Immunological mechanisms of fecal microbiota transplantation in recurrent Clostridioides difficile infection
Lucas F Soveral, Gabriela G Korczaguin, Pedro S Schmidt, Isabel S Nunes, Camilo Fernandes, Carlos R Zárate-Bladés
Lucas F Soveral, Gabriela G Korczaguin, Pedro S Schmidt, Isabel S Nunes, Camilo Fernandes, Carlos R Zárate-Bladés, Laboratory of Immunoregulation, Department of Microbiology, Immunology, and Parasitology, Center for Dysbiosis Control, Federal University of Santa Catarina, Florianopolis 88037-000, Brazil
Camilo Fernandes, Division of Infectious Diseases, Hospital Nereu Ramos, Florianopolis 88025-301, Brazil
Author contributions: Soveral LF, Korczaguin GG, and Schmidt PS collected the literature and wrote the first draft, conceptualized the table and figures, and contributed equally to this work; Nunes IS and Fernandes C corrected the first draft; Zárate-Bladés CR conceptualized the structure of the text and critically revised the manuscript for important intellectual content; and all authors read and approved the final version of the manuscript.
Supported bythe grant “Programa de ciência tecnologia e inovação aos grupos de pesquisa da Universidade Federal de Santa Catarina”, FAPESC (2021TR000301); Soveral LF is a graduate student fellow of Fundação de Amparo à Pesquisa e Inovação do Estado de Santa Catarina, FAPESC (3003/2021); Schmidt PS is student fellow of Programa Institucional de Iniciação Cientifica e Tecnológica, PIBIC of the Conselho Nacional de Desenvolvimento Científico e Tecnológico, CNPq (2021/949248); Nunes IS is a graduate student fellow of Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, CAPES (202003075).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Carlos R Zárate-Bladés, MD, MSc, PhD, Assistant Professor, Laboratory of Immunoregulation, Department of Microbiology, Immunology, and Parasitology, Center for Dysbiosis Control, Federal University of Santa Catarina, CCB Novo, 8o andar, Rua da Prefeitura Universitária, Setor Córrego Grande, Campus UFSC, Florianopolis 88037-000, Brazil. zarate.blades@ufsc.br
Received: March 12, 2022 Peer-review started: March 12, 2022 First decision: April 6, 2022 Revised: May 6, 2022 Accepted: August 16, 2022 Article in press: August 16, 2022 Published online: September 7, 2022 Processing time: 172 Days and 10.3 Hours
Abstract
Fecal microbiota transplantation (FMT) is a successful method for treating recurrent Clostridioides difficile (C. difficile) infection (rCDI) with around 90% efficacy. Due to the relative simplicity of this approach, it is being widely used and currently, thousands of patients have been treated with FMT worldwide. Nonetheless, the mechanisms underlying its effects are just beginning to be understood. Data indicate that FMT effectiveness is due to a combination of microbiological direct mechanisms against C. difficile, but also through indirect mechanisms including the production of microbiota-derived metabolites as secondary bile acids and short chain fatty acids. Moreover, the modulation of the strong inflammatory response triggered by C. difficile after FMT seems to rely on a pivotal role of regulatory T cells, which would be responsible for the reduction of several cells and soluble inflammatory mediators, ensuing normalization of the intestinal mucosal immune system. In this minireview, we analyze recent advances in these immunological aspects associated with the efficacy of FMT.
Core Tip: Fecal microbiota transplantation (FMT) is an excellent treatment option of pseudomembranous colitis due to Clostridiodes difficile infection (CDI) because of its remarkable effectiveness. Moreover, FMT is a promising therapy for several other disorders in which dysbiosis is an important pathological factor. The mechanisms of FMT have begun to be dissected and include the restoration of the commensal microbial community structure and the modulation of several components of the immune system. This minireview focus on the FMT immune-related mechanisms for CDI.
