Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Dec 28, 2021; 9(6): 496-504
Published online Dec 28, 2021. doi: 10.13105/wjma.v9.i6.496
Preclinical safety, effectiveness evaluation, and screening of functional bacteria for fecal microbiota transplantation based on germ-free animals
Ya-Peng Yang, Xue-Ying Zhang, Bo-Ta Cui, Hang Zhang, Zhi-Feng Wu, Xiang Tan, Wei Cheng, Xi Zhu, Fa-Ming Zhang, Huan-Long Qin, Hong Wei
Ya-Peng Yang, Hang Zhang, Zhi-Feng Wu, Xiang Tan, Wei Cheng, Xi Zhu, Hong Wei, State Key Laboratory of Agricultural Microbiology, College of Animal Sciences and Technology, Huazhong Agricultural University, Wuhan 430070, Hubei Province, China
Xue-Ying Zhang, Huan-Long Qin, Intestinal Microenvironment Treatment Center, Tenth People’s Hospital of Tongji University, Shanghai 200072, China
Bo-Ta Cui, Fa-Ming Zhang, Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
Bo-Ta Cui, Fa-Ming Zhang, Key Lab of Holistic Integrative Enterology, Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
Fa-Ming Zhang, Division of Microbiotherapy, Sir Run Run Shaw Hospital, Nanjing Medical University, Nanjing 211166, Jiangsu Province, China
Hong Wei, Central Laboratory, Clinical Medicine Scientific and Technical Innovation Park, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200435, China
Author contributions: Yang YP, Zhang XY and Cui BT contributed equally to this work; Wei H conceptualized the review; Yang YP drafted the manuscript; Zhang XY and Cui BT revised the manuscript; Zhang H, Tan X, Wu ZF, Cheng W and Zhu X reviewed and compiled the data and drafted the manuscript; Zhang FM and Qin HL made critical comments on the manuscript; all authors have read and edited the manuscript.
Supported by National Natural Science Foundation of China, No. 8177020321; and the Emerging Cutting-Edge Technology Joint Research Projects of Shanghai, No. SHDC12019114.
Conflict-of-interest statement: The authors declare no conflict of interests 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: Hong Wei, PhD, Professor, State Key Laboratory of Agricultural Microbiology, College of Animal Sciences and Technology, Huazhong Agricultural University, No. 1 Shizishan Street, Huazhong Agricultural University, Wuhan 430070, Hubei Province, China. weihong63528@163.com
Received: April 8, 2021
Peer-review started: April 8, 2021
First decision: October 3, 2021
Revised: October 14, 2021
Accepted: December 24, 2021
Article in press: December 24, 2021
Published online: December 28, 2021
Processing time: 263 Days and 22.9 Hours
Abstract

Fecal microbiota transplantation (FMT), also known as fecal bacterial therapy, is a treatment option that can quickly reconstruct the normal composition of intestinal microbes, and it has a good therapeutic effect on Clostridium difficile infection, as well as on other microecological disorders. However, the causal mechanism of FMT efficacy remains to be clarified, its safety is a major problem, and the standardization and acceptability of FMT need to be improved. This review summarizes its current research status and potential research areas that need to be strengthened, and proposes to clarify the safety of FMT and the causal relationship between FMT and therapeutic effectiveness based on germ-free animals. Meanwhile, the research system is combined with multiomics technology to screen the effective bacteria in FMT, and develop standard, safe, effective and controllable flora of FMT.

Keywords: Fecal microbiota transplantation; Effectiveness; Safety; Germ-fee animals; Functional bacteria

Core Tip: Gut microbiota plays an important role in the development and treatment of many diseases, especially gastrointestinal disorders. Fecal microbiota transplantation (FMT) has potential application in treating various diseases. However, the mechanism of FMT is unclear, its safety needs to be improved, and it is not standardized due to a variety of reasons. Therefore, in this review, we analyze the current dilemma of FMT and propose the importance of establishing a germ-free animal evaluation system, with an aim to help establish standard, safe, effective, controllable, and product-oriented formula flora of FMT.