摘要
粪菌移植本质上是在认识微生物与疾病关系基础上,对传统中医药治疗方法的现代化应用,是近几年的医学突破.然而,在被评价为医学突破之前,这既不是技术的突破,也不是理论的突破,而是思维方式的突破.粪菌移植在近几年的应用中正经历巨大的变化,包括治疗适应症、实验室方法学、治疗策略、给入路径等,特别是粪菌智能分离系统用于粪菌制备、经内镜肠道植管术用于结肠途径的重复移植等,为粪菌移植实现现代化奠定了关键性基础.中华粪菌库和Openbiome作为世界上最大的两个非营利性粪菌库,分别在中国和北美地区实施粪菌移植的异地救援性治疗.由于粪菌移植也存在局限性,研究用于部分替代粪菌移植的选择性菌群移植技术已经成为微生物学家和临床医学家的共同追求.选择性菌群移植与粪菌移植共同成为菌群移植的重要内涵,并促进新型益生菌的研究得以快速发展.菌群移植可望用于包括感染、免疫性疾病、肠脑轴疾病、肝病、肿瘤等多种疾病的治疗.虽然来自国内外大中心的数据支持菌群移植具有很高的安全性,但也不能忽略一些不良事件.菌群移植的安全性,特别是远期风险,需要通过大数据、长期真实世界研究来回答.本文主要涉及对菌群移植的新认识和研究进展,从中总结发现、思维与技术的共变,促进了粪菌移植向菌群移植发展.
The history of using the stool from healthy human to treat human diseases dates back to the ancient China. Fecal microbiota transplantation(FMT), which has been regarded as a medical breakthrough in recent years, is essentially a modern medical application based on the new understanding and development on traditional Chinese medicine. The therapeutic value of FMT for microbiota-related diseases such as Clostridium difficile infection highlights the important relationship between microbiota and diseases. However, FMT is a breakthrough not in technological or theoretical research, but in medical recognition. FMT has been used in many indications beyond Clostridium difficile infection, such as Crohn’s disease, ulcerative disease, constipation, diabetes mellitus, cancer, liver cirrhosis, microbiota-gut-brain disease and others. Increasing evidence on FMT revolutionizes our understanding on the mechanism and treatment of microbiota-related diseases. The main progress of FMT in the recent two years focuses on the clinical strategy in refractory disease, methodology in lab and delivering way of FMT by colonic transendoscopic enteral tubing. It is time to end the crude stool transplant in humans and develop standardized FMT into a mainstream therapeutic option to bring benefits to more patients. The systematic development of FMT is pushing it into the mainstream of medicine to meet the common needs of both doctors and patients for safety, efficacy, technology and aesthetics. Therefore, the recent coined name, selective microbiota transplantation(SMT) for partially replacing FMT has gained more attention than FMT from the researchers in microbiology and clinical medicine in the recent years. SMT could transplant the selective microbiota in the digestive tract, reproductive tract, nasal cavity, skin and others. The range of therapeutic indications for SMT used in gastrointestinal tract exceeds FMT, but its efficacy for serious diseases may be inferior to FMT. Microbiota transplantation, including FMT and SMT will be promising to be used for the treatment of various diseases in the future. According to the published reports and our experience based on more than 4000 cases of diseases we have treated, many patients complicated with pneumonia, asthma, liver disease, diabetes, skin diseases, hematopoietic dysfunction, epilepsy, autism, sleep disorders, sexual dysfunction and other comorbidities can be alleviated or even cured by microbiota transplantation. The real-world study for microbiota transplantation in long term will be critical research to answer the efficacy and the safety in short term and long term. This paper commented the prominent understanding and the latest progress of microbiota transplantation in the recent years.
作者
张发明
张婷
Faming Zhang;Ting Zhang(Medical Center for Digestive Diseases,the Second Affiliated Hospital,Nanjing Medical University,Nanjing 210011,China;Key Lab of Holistic Integrative Enterology,Nanjing Medical University,Nanjing 210011,China)
出处
《科学通报》
EI
CAS
CSCD
北大核心
2019年第3期285-290,共6页
Chinese Science Bulletin
关键词
粪菌移植
选择性菌群移植
益生菌
难辨梭状芽孢杆菌
安全性
fecal microbiota transplantation
selective microbiota transplantation
probiotics
Clostridium difficile
safety
作者简介
联系人:张发明,E-mail:fzhang@njmu.edu.cn.
