Fecal microbiota transfer and inflammatory bowel disease: A therapy or risk?

Inflammatory bowel disease (IBD) results from the inappropriate stimulation of intestinal bacteria in a genetically susceptible host. IBD has a distinct microbiota pattern, although it is unclear if this is causal to inflammation or a result of ongoing inflammation. In addition to microbiota population differences, there are essential changes in the functions of the microbiota, which may result in chronic inflammation. Restoration of the intestinal microbiota may ameliorate inflammation. While there are multiple mechanisms of modulating the intestinal microbiota, fecal microbiota transplantation (FMT) has the potential to dramatically shift and restore the intestinal microbiota, and thus is a potential therapy for IBD. However, data to support efficacy in the IBD population remain limited. Additionally, optimization of donor selection, mode, route, and frequency of the fecal material remains under investigation. The challenge to identify long-term safety profiles, stable engraftment, and ideal bacterial populations remains but will provide the foundation for development of the next-generation FMT.