Fecal Microbiota Transplants: Challenges in Translating Microbiome Research to Clinical Applications, Volume II

Due to the success of the original Research Topic, we have decided to launch a Volume II of Fecal Microbiota Transplants: challenges in translating microbiome research to clinical applications.Fecal microbiota transplantation (FMT) is a procedure where fecal matter is collected from a healthy donor and transplanted into the gut of a patient, usually with a gastrointestinal disorder. While restoring the balance of gut microbes, the procedure has often shown success in alleviating symptoms and improving overall patient health. Allocoprophagy, or the ingestion of another individual’s feces, was found to be practiced as early as 3000 years ago. In the past decade, the U.S. Food and Drug Administration (FDA) has classified stool as a biological agent that would require an investigational new drug authorization, except for the treatment of the recurrent Clostridium difficile infections. The latter could benefit from the use of FMT with no permit for its evident direct benefit in saving thousands of lives yearly. Since then, more than 500 clinical trials using fecal transplants have been registered worldwide, and explored the use of FMT in the treatment of other gastrointestinal diseases and conditions such as Crohn’s disease, Ulcerative Colitis, Antimicrobial Resistance, bacterial flora disturbance, constipation, irritable bowel syndrome, etc. However, findings from Volume I highlighted the need for a deeper understanding of FMT response variability, long-term resilience of transplanted microbiota, and the influence of host lifestyle and environmental factors on engraftment and clinical outcomes.On the other hand, we witnessed the tremendous advances on the role of gut microbes in health and diseases, with accumulating evidence on the extra-digestive communication between the gut and other organs via short chain fatty acids, the vagus nerve or cytokines. Because of the multiple correlations between gut dysbiosis and various diseases, the gut microbiome and its metabolome became the therapeutic target of the future. Indeed, after the discovery of the gut-brain axis, evidence points to a gut-pancreas axis, gut-liver axis, gut-skin axis, gut-lung axis and many more. As a result, studies have started to investigate the potential role of beneficial microbes in neurodevelopmental disorders, neurological diseases such as Alzheimer’s and Parkinson’s diseases, in metabolic syndrome, pancreatitis, asthma, allergies and more. Data suggest that an important background is being transferred from the donor, including its susceptibility to antibiotic resistance, diabetes or obesity. Therefore, FMT shall not be taken as a mild intervention. In fact, predicting what other diseases can be transferred by transferring gut microbes is a challenge because several gut microbes are not readily culturable in vitro and therefore not fully characterized. It is necessary to combine the understanding of the microbial interactions within the gut and outside the gut with the current evidence of correlations found between dysbiosis and diseases. Indeed, the first volume highlighted gaps in understanding donor-recipient molecular compatibility, including the potential role of microbiome functional matching, metabolic profiles, and epigenetic interactions that may shape FMT success. Volume I suggested that integrating multi-omics datasets (metagenomics, metabolomics, proteomics) with AI-driven analytical approaches may help clarify mechanistic pathways and improve clinical predictability of FMT.How can the latest advances in gut microbiome studies, animal and clinical observations contribute to the methods for fecal sample screening? Shall the screening only concern the physical stool sample or the entire lifestyle of the donor? In the light of the role of gut microbes on epigenetics, shall the screening include genetic mutations? What ethical considerations should be addressed in FMT? Volume I results emphasized unanswered questions regarding long-term durability of FMT benefits, the resilience of donor strains over time, the role of lifestyle factors in resilience and the differential responses observed across understudied clinical populations such as pediatric, elderly, and immunocompromised patients.We accept submissions of Hypothesis & Theory, Methods, Mini Review, Opinion, Original Research, Case Reports, Clinical Trial Reports, Perspective, Review, Technology and Code on the fundamental microbiology involved in FMT. Examples of questions are: 1. The fecal transplant collection, storage and screening for diseases, antibiotic resistance (CRE).2. Delivery methods of FMT: advantages and risks.3. From dysbiosis to eubiosis: comparing fecal transplants to probiotic ingestion and diet-based control of microbial growth.4. Pathophysiological mechanisms involved in microbiota changes.5. AI-driven multi-omics integration (metabolomics, metagenomics, etc.) to improve prediction of FMT outcomes and identify biomarkers of response or failure.6. Long-term resilience and stability of donor microbiota in the recipient: determinants of sustained engraftment, role of diet, lifestyle, and environmental exposures (exposome) in shaping FMT engraftment.7. Microbial changes induced by FMT in CRE, Autism, ADHD, Crohn, Colitis, Cancer, Obesity, autoimmune diseases, Alzheimer, Parkinson, Multiple Sclerosis, depression, anxiety and more. 8. The ethical considerations surrounding FMT, including issues of informed consent, donor screening, and long-term follow-up.9. FMT in understudied populations (pediatrics, elderly, immunocompromised): safety, adaptation of protocols, and precision-based approaches. Topic editors: Ludovico Abenavoli, Emidio Scarpellini, Nazarii Kobyliak, Tetyana Falalyeyeva Source: https://www.frontiersin.org/research-topics/76767/fecal-microbiota-transplants-challenges-in-translating-microbiome-research-to-clinical-applications-volume-ii