Das gastrointestinale Mikrobiom – Vision und Mission

Das gastrointestinale Mikrobiom beeinflusst physiologische Funktionen und ist bei einer Vielzahl von Erkrankungen verändert. Bei Patienten mit entzündlichen Darmerkrankungen zeigen Bakterien, Pilze, Bakteriophagen und Archaeen krankheitstypische Muster, die mit Störungen im Metabolom einhergehen. Der fäkale Mikrobiomtransfer (FMT) ist die einschneidendste Methode zur Therapie einer Dysbiose.

Abstract

The gastrointestinal microbiome influences physiological functions and is altered in a variety of diseases. The causality of “dysbiosis” in the pathogenesis is not always proven; association studies are often involved. Patients with IBD, bacteria, fungi, bacteriophages, and archaea show disease-typical patterns associated with metabolome disturbances. Fecal microbiome transfer (FMT) for treating various diseases is the subject of numerous clinical studies. Currently, recurrent Clostridioides difficile infection (rCDI) is the only confirmed indication recommended in medical guidelines. In Germany, the FMT is subject to the Medicines Act and may only be carried out as part of individual healing attempts or clinical studies. For patient safety, repeated donor screening, ideally with the construction of a chair bench, is necessary. This significantly limits the nationwide availability of the FMT in Germany. Microbiota-based therapeutics prepared from the stool of tested donors have recently been approved by the US Food and Drug Administration (FDA) for the prevention of rCDI. More microbiome-based medicines can be expected in the future.

Kernaussagen

• Die Kausalität eines „dysbiotischen Mikrobioms“ in der Pathogenese verschiedenster Erkrankungen ist nicht immer ausreichend belegt.

• Kommerzielle Mikrobiomanalysen haben zurzeit für den individuellen Patienten keine praktische Bedeutung.

• Wichtiger als Analysen zur Zusammensetzung des Mikrobioms sind gute Charakterisierungen des Metaboloms.

• Der fäkale Mikrobiomtransfer (FMT) ist die drastischste Methode, ein Patientenmikrobiom zu verändern.

• In Deutschland wird der FMT als individueller Heilversuch mit der Verabreichung eines nicht zugelassenen, selbst hergestellten Arzneimittels verstanden.

• Der FMT ist zurzeit die effektivste Behandlung einer rekurrenten Clostridioides-difficile-Infektion.

• Die FDA hat bereits verschiedene „Live Biotherapeutic Products“ (LBPs) zur Prophylaxe der rekurrenten Clostridioides-difficile-Infektion zugelassen.

Schlüsselwörter

Mikrobiota - Mikrobiotatransplantation - fäkal - LBP - Clostridioides-difficile-Infektion

Keywords

microbiota - microbiota-transplantation - fecal - live-biotherapeutic-product - clostridioides-difficile-infection

Publication History

Article published online:
29 January 2025

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