Efficacy of fecal microbiota transplantation in patients with Crohn's disease

Abstract

Crohn's disease (CD) affects 1.5 million Americans a year. Many patients refractory to standard treatments suffer from life-long detrimental symptoms that reduce quality of life. Chronic inflammation of the gastrointestinal tract, a hallmark of CD, has led to the development of drugs and interventions targeting the immune response. Recent ideology regarding the pathophysiology of CD has implicated a role for the microbiome within the human gut. The advent of metagenomics has allowed for the characterization of the microbiome of both healthy and diseased individuals. The phylogenetic bacterial makeup of the microbiome of patients with CD shows an alteration from that of healthy individuals. Therapeutic methods incorporating the re-establishment of a healthy microbiome are being investigated. Fecal microbiota transplantation (FMT) has become the "gold standard" of care for patients afflicted with Clostridium difficile (C. diff.) infection who do not respond to a standard antibiotic regimen. C. diff.-infection presents with similar symptoms and alterations of the microbiome to that observed in patients diagnosed with CD. To date, only studies of three case and two cohorts utilizing FMT in patients with CD have been reported. Results from these studies show potential usefulness for fecal microbiota transplantation as a therapy for CD. This review offers insight for improved clinical trials in which FMT and immune response therapies are adjunctively utilized to improve CD treatment.