FECAL-INTESTINAL MICROBIOTA TRANSPLANTATION: STATE OF THE ART AND CLINICAL CHALLENGES

Abstract

The gut microbiota is a complex community of microorganisms that inhabit the human gastrointestinal tract and play essential roles in maintaining health, including participation in nutrient digestion, immune system modulation, metabolite production, and protection against pathogenic microorganisms. However, several factors, such as antibiotic use, dietary changes, environmental conditions, and hygiene practices, can compromise the balance of this microbial ecosystem, leading to dysbiosis. This condition is characterized by an imbalance between beneficial and potentially pathogenic microorganisms and is associated with the development of various diseases, including gastrointestinal disorders, metabolic, inflammatory, autoimmune, and neurological diseases. In this context, fecal microbiota transplantation (FMT) has emerged as a promising therapeutic strategy to restore the balance of the gut microbiota. This technique consists of transferring fecal material from a healthy donor to the gastrointestinal tract of a recipient, with the aim of restoring microbial diversity and functionality. The procedure can be performed via different administration routes, such as colonoscopy, enemas, nasogastric tubes, or oral capsules, with the latter two and colonoscopy being associated with better therapeutic results. MFT (Metabolic Transplantation) shows high efficacy in the treatment of recurrent Clostridioides difficile infections, with high cure rates reported in the literature. Furthermore, recent studies are investigating its therapeutic potential in other conditions associated with dysbiosis, such as irritable bowel syndrome, inflammatory bowel diseases, obesity, type 2 diabetes, and neurodegenerative diseases. Despite advances, the clinical application of MFT still faces challenges related to the standardization of protocols, rigorous donor selection, microbiological safety of the transplanted material, and monitoring of long-term effects. Therefore, more studies are needed to consolidate this approach as a safe and widely applicable therapeutic strategy in clinical practice.