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Faecal microbiota transplantation for Clostridioides difficile: mechanisms and pharmacology
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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“However, FMT has undergone significant advancements over the years, evolving from a relatively crude procedure of transferring fresh donor stool to a mainstream treatment option.”
From Microbiota–gut–brain axis and its therapeutic applications in neurodegenerative diseases (2024) · cites this paper as [727]
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“This evolution is enabled by the development of standardized FMT products, with increased emphasis on their pharmaceutical formulation, pharmacokinetics, pharmacodynamics, and toxicity.727”
From Microbiota–gut–brain axis and its therapeutic applications in neurodegenerative diseases (2024) · cites this paper as [727]
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Metadata
- Authors
- Khoruts, A., Staley, C., & Sadowsky, M. J.
- Affiliations
- University of Minnesota (US)
- Corresponding author
- Khoruts, Alexander
- Venue
- Nature Reviews Gastroenterology & Hepatology
- Published
- 2020-08-25
- Volume
- 18
- Issue
- 1
- Pages
- 67-80
- ISSN
- 1759-5045 (ISSN-L)
- 1759-5053
- 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
- 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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