Cited by 158Clostridium difficile and Clostridium perfringens researchGut microbiota and healthGastrointestinal motility and disorders

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Faecal microbiota transplantation for Clostridioides difficile: mechanisms and pharmacology

Khoruts, Alexander, Staley, Christopher, Sadowsky, Michael J.·2021·Nature Reviews Gastroenterology & Hepatology

DOI 10.1038/s41575-020-0350-4

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Abstract

Faecal microbiota transplantation (FMT) has emerged as a remarkably successful treatment for recurrent Clostridioides difficile infection that cannot be cured with antibiotics alone. Understanding the complex biology and pathogenesis of C. difficile infection, which we discuss in this Perspective, is essential for understanding the potential mechanisms by which FMT cures this disease. Although FMT has already entered clinical practice, different microbiota-based products are currently in clinical trials and are vying for regulatory approval. However, all these therapeutics belong to an entirely new class of agents that require the development of a new branch of pharmacology. Characterization of microbiota therapeutics uses novel and rapidly evolving technologies and requires incorporation of microbial ecology concepts. Here, we consider FMT within a pharmacological framework, including its essential elements: formulation, pharmacokinetics and pharmacodynamics. From this viewpoint, multiple gaps in knowledge become apparent, identifying areas that require systematic research. This knowledge is needed to help clinical providers use microbiota therapeutics appropriately and to facilitate development of next-generation microbiota products with improved safety and efficacy. The discussion here is limited to FMT as a representative of microbiota therapeutics and recurrent C. difficile as the indication; however, consideration of the intrinsic basic principles is relevant to this entire class of microbiota-based therapeutics.

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Authors: Khoruts, A., Staley, C., & Sadowsky, M. J.
Affiliations: University of Minnesota (US)
Corresponding author: Khoruts, Alexander
ORCID: Khoruts, Alexander
Staley, Christopher
Sadowsky, Michael J.
Venue: Nature Reviews Gastroenterology & Hepatology
Publisher: Springer Science and Business Media LLC
Published: 2020-08-25
Volume: 18
Issue: 1
Pages: 67-80
ISSN: 1759-5045 (ISSN-L)
1759-5053
DOI: 10.1038/s41575-020-0350-4
OpenAlex: W3080453277
Cited by: 155
References: 195
Citations by year: 2026: 19 · 2025: 23 · 2024: 29 · 2023: 22 · 2022: 40 · 2021: 18 · 2020: 4
FWCI: 1.00
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
www.springer.com/tdm (vor)
Locations: Nature Reviews Gastroenterology & Hepatology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Infectious Diseases › Clostridium difficile and Clostridium perfringens research
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Keywords: fecal microbiota transplantation, Clostridium difficile infection, recurrent Clostridium difficile infection, pharmacokinetics, pharmacodynamics, microbiota-based therapy
MeSH terms: Gastrointestinal Microbiome, Fecal Microbiota Transplantation, Anti-Bacterial Agents, Clostridium Infections, Feces, Humans, Recurrence, Clostridioides difficile, Treatment Outcome

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Faecal microbiota transplantation for Clostridioides difficile: mechanisms and pharmacology

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