The gut microbiome dysbiosis and regulation by fecal microbiota transplantation: umbrella review

Xianzhuo Zhang; Xufei Luo; Liang Tian; Ping Yue; Mengyao Li; Kefeng Liu; Daoming Zhu; Chongfei Huang; Qianling Shi; Liping Yang; Zhili Xia; Jinyu Zhao; Zelong Ma; Jianlong Li; Joseph W Leung; Yanyan Lin; Jinqiu Yuan; Wenbo Meng; Xun Li; Yaolong Chen

doi:10.3389/fmicb.2023.1286429

The gut microbiome dysbiosis and regulation by fecal microbiota transplantation: umbrella review

Front Microbiol. 2023 Nov 3:14:1286429. doi: 10.3389/fmicb.2023.1286429. eCollection 2023.

Authors

Xianzhuo Zhang^#¹, Xufei Luo^#², Liang Tian^#¹, Ping Yue^#³, Mengyao Li⁴, Kefeng Liu⁵, Daoming Zhu⁶, Chongfei Huang¹, Qianling Shi¹, Liping Yang³, Zhili Xia¹, Jinyu Zhao¹, Zelong Ma¹, Jianlong Li¹, Joseph W Leung⁷, Yanyan Lin³, Jinqiu Yuan⁸, Wenbo Meng³, Xun Li³, Yaolong Chen^{2

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Affiliations

¹ The First School of Clinical Medicine, Lanzhou University, Lanzhou, China.
² Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
³ Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China.
⁴ The Second Clinical Medical College, Lanzhou University, Lanzhou, China.
⁵ Department of Pharmacy, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁶ Department of Radiology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China.
⁷ Division of Gastroenterology and Hepatology, UC Davis Medical Center and Sacramento VA Medical Center, Sacramento, CA, United States.
⁸ Clinical Research Center, Big Data Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
⁹ Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
¹⁰ Institute of Health Data Science, Lanzhou University, Lanzhou, China.
¹¹ WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.

^# Contributed equally.

Abstract

Background: Gut microbiome dysbiosis has been implicated in various gastrointestinal and extra-gastrointestinal diseases, but evidence on the efficacy and safety of fecal microbiota transplantation (FMT) for therapeutic indications remains unclear.

Methods: The gutMDisorder database was used to summarize the associations between gut microbiome dysbiosis and diseases. We performed an umbrella review of published meta-analyses to determine the evidence synthesis on the efficacy and safety of FMT in treating various diseases. Our study was registered in PROSPERO (CRD42022301226).

Results: Gut microbiome dysbiosis was associated with 117 gastrointestinal and extra-gastrointestinal. Colorectal cancer was associated with 92 dysbiosis. Dysbiosis involving Firmicutes (phylum) was associated with 34 diseases. We identified 62 published meta-analyses of FMT. FMT was found to be effective for 13 diseases, with a 95.56% cure rate (95% CI: 93.88-97.05%) for recurrent Chloridoids difficile infection (rCDI). Evidence was high quality for rCDI and moderate to high quality for ulcerative colitis and Crohn's disease but low to very low quality for other diseases.

Conclusion: Gut microbiome dysbiosis may be implicated in numerous diseases. Substantial evidence suggests FMT improves clinical outcomes for certain indications, but evidence quality varies greatly depending on the specific indication, route of administration, frequency of instillation, fecal preparation, and donor type. This variability should inform clinical, policy, and implementation decisions regarding FMT.

Keywords: dysbiosis; fecal microbiota transplantation; gut microbiome; meta-analyses; umbrella review.

Publication types

Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by National Natural Science Foundation of China (32160255 and 82060551), and the Foundation of The First Hospital of Lanzhou University (ldyyyn2020-102). The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.