The Future Of Fecal Microbiota Transplantation Method in Neuropsychiatric Disorders
Ceylan, Mehmet Emin
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All microorganisms living in the body and their genetic material is called microbiome, and the community of microorganisms that are present in different ecosystems of human body is called microbiota (i.e. Gut microbiota, skin microbiota) (Evrensel and Ceylan 2015a). Microbiota-gut-brain axis and fecal microbiota transplantation (FMT) has been the focus of attention of the scientific community in recent years. Ninety percent of microbiota-themed articles have been published in recent years (Khanna and Tosh 2014). FMT is the process of transferring stool from a healthy donor to a receiver’s gut in order to recover the impaired intestinal flora (Xu et al. 2015). FMT dates back to 1700 years. First known stool application for treatment has been performed by Chinese physician Ge Hong in the fourth century (Zhang et al. 2012). It has been used orally under the name of “yellow soup” in cases with severe diarrhea. This forgotten treatment method has been put into use again in the last fifty years. It has been implemented in 1958 for the first time in modern medicine. A pseudomembranous enterocolitis case with severe diarrhea related to antibiotics has been treated through fecal enema (Eiseman et al. 1958). Interest in the topic of microbiota-gut-brain axis and FMT is rapidly increasing. New evidence is obtained in the etiopathogenesis of neuropsychiatry disorders. There are numerous experimental and clinical research in the area of gut-brain axis (Evrensel and Ceylan 2015a). Information about FMT is limited. Despite this, initial results are promising. It is commonly used in the treatment of gastrointestinal diseases such as Clostridium difficile infection, Crohn's disease, ulcerative colitis. It is also being tested in the treatment of metabolic and autoimmune diseases. There are case reports indicating the effectiveness of FMT in the treatment of autism, Parkinson's disease, multiple sclerosis, chronic fatigue syndrome and irritable bowel syndrome (Xu et al. 2015). It is easy to implement, and is a cheap and reliable treatment method. However, long-term risks are unknown. Also, standard implementation ways have not yet been formed. Although FMT has a history of 1700 years, modern medical experiences have been obtained in recent years. “In which disorder and in which direction microbiota balance is impaired, whether the transplant material shall be obtained from a donor or shall be produced in the culture, whether fresh feces shall be used or whether feces shall be taken from a stool bank, with what the stool shall be diluted, which dilution material shall be used in different indications, the quantity of the stool to be used, which method shall be used for application, the immunologic response emerging/changing after FMT, whether FMT does have long-term risks” are among the questions to be answered (Vandenplas et al. 2015). In the future, oral application of FMT in the form of capsules to regulate intestinal microbiota is expected to become a routine procedure after antibiotherapy (Borody et al. 2014). Ideal approach shall be to repair the microbiota with probiotics (Evrensel and Ceylan 2015b) In the coming period, the determination of FMT implementation ways and strong evidence with case samples demonstrating its effectiveness in neuropsychiatric disorders are needed.