Fäkaler Mikrobiom-Transfer (FMT) – eine Übersicht

Zusammenfassung

Die humane intestinale Mikrobiota hat wichtige metabolische und immunologische Funktionen für das Individuum und ist Bestandteil der Abwehr gegenüber pathogenen Erregern im Gastrointestinaltrakt. Antibiotika, Probiotika, diätetische Maßnahmen wie Präbiotika sowie als relativ neu etablierte Methode der fäkale Mikrobiom-Transfer (FMT, auch fäkale Mikrobiota-Transplantation) können die Zusammensetzung des intestinalen Mikrobioms beeinflussen. Als FMT wird die Übertragung von Stuhlmikroorganismen, vornehmlich Bakterien, aber auch Bakteriophagen, Pilzen und Viren eines gesunden humanen Spenders in den Gastrointestinaltrakt eines Patienten bezeichnet. Diese Maßnahme soll der Wiederherstellung einer normalen Darmmikrobiota bei Patienten mit einer Dysbiose-assoziierten Erkrankung dienen. Die bislang einzige Indikation für einen FMT ist die multipel rezidivierende Clostridioides difficile-Infektion (CDI). Über 85 % betroffener Patienten können in dieser Situation durch eine „Stuhltransplantation“ erfolgreich und dauerhaft geheilt werden. Als mögliche weitere Anwendungsgebiete werden chronisch-entzündliche und funktionelle Darmerkrankungen, nicht-alkoholisch bedingte Fettlebererkrankung, Insulinresistenz, morbide Adipositas, multiple Sklerose (MS) oder idiopathische thrombozytopenische Purpura (ITP) diskutiert. Die Evaluation in klinischen Studien ist noch unvollständig. Die Durchführung des FMT unterliegt in Deutschland dem Arzneimittelgesetz (AMG) als individuelle Heilmittelzubereitung, an deren Herstellung und Durchführung der behandelnde Arzt verantwortlich und persönlich beteiligt sein muss. Notwendig ist eine sorgfältige Spenderselektion durch genaue Anamnese, klinische Untersuchung, Blut- und Stuhluntersuchungen.

Abstract

The human intestinal microbiota has important metabolic functions for the host, and is part of the defense against pathogens in the gastrointestinal tract. Antibiotics, probiotics, dietary measures such as prebiotics and the relatively newly established method of fecal microbiota transplantation (FMT, also fecal microbiome transfer) all influence the intestinal microbiome. FMT comprises the transmission of fecal microorganisms into the gastrointestinal tract of a patient. The aim of this intervention is to restore a normal microbiota composition in patients with dysbiosis-associated diseases. Until now, the only indication for FMT is multiple recurrence of Clostridioides difficile infection (CDI). About 85 % of affected patients can be treated successfully by FMT. Other possible therapeutic applications are chronic inflammatory and functional bowel diseases, non-alcoholic fatty liver disease, insulin resistance, morbid obesity, multiple sclerosis (MS) or idiopathic thrombocytopenic purpura (ITP). The role of FMT in this condition has to be evaluated further in clinical trials. The implementation of FMT in Germany is subject to the Medicinal Products Act (Arzneimittelgesetz, AMG) with duty of disclosure and personal application by the attending physician. Essential prerequisite is a careful donor selection through accurate history, physical examination, blood and stool tests.

Schlüsselwörter

Intestinale Mikrobiota - fäkaler Mikrobiom-Transfer (FMT) - Clostridium difficile - Insulinresistenz

Key words

Intestinal microbiota - fecal microbiota transplantation (FMT) - Clostridioides difficile - insulin resistance

Publication History

Article published online:
02 December 2019

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