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The use of fecal microbiota transplant in sepsis.

Authors
  • Keskey, Robert1
  • Cone, Jennifer T2
  • DeFazio, Jennifer R3
  • Alverdy, John C4
  • 1 Section of General Surgery, Department of Surgery, University of Chicago, Chicago, Illinois.
  • 2 Section of Trauma and Acute Care Surgery, Department of Surgery, University of Chicago, Chicago, Illinois.
  • 3 Division of Pediatric Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York.
  • 4 Section of General Surgery, Department of Surgery, University of Chicago, Chicago, Illinois. Electronic address: [email protected]
Type
Published Article
Journal
Translational research : the journal of laboratory and clinical medicine
Publication Date
Dec 01, 2020
Volume
226
Pages
12–25
Identifiers
DOI: 10.1016/j.trsl.2020.07.002
PMID: 32649987
Source
Medline
Language
English
License
Unknown

Abstract

Sepsis is defined as a dysregulated inflammatory response, which ultimately results from a perturbed interaction of both an altered immune system and the biomass and virulence of involved pathogens. This response has been tied to the intestinal microbiota, as the microbiota and its associated metabolites play an essential role in regulating the host immune response to infection. In turn, critical illness as well as necessary health care treatments result in a collapse of the intestinal microbiota diversity and a subsequent loss of health-promoting short chain fatty acids, such as butyrate, leading to the development of a maladaptive pathobiome. These perturbations of the microbiota contribute to the dysregulated immune response and organ failure associated with sepsis. Several case series have reported the ability of fecal microbiota transplant (FMT) to restore the host immune response and aid in recovery of septic patients. Additionally, animal studies have revealed the mechanism of FMT rescue in sepsis is likely related to the ability of FMT to restore butyrate producing bacteria and alter the innate immune response aiding in pathogen clearance. However, several studies have reported lethal complications associated with FMT, including bacteremia. Therefore, FMT in the treatment of sepsis is and should remain investigational until a more detailed mechanism of how FMT restores the host immune response in sepsis is determined, allowing for the development of more fine-tuned microbiota therapies. Copyright © 2020 Elsevier Inc. All rights reserved.

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