Fäkaler Mikrobiota Transfer (FMT) bei Kindern und Jugendlichen – Review und Stellungnahme der GPGE AG Mikrobiom

Zusammenfassung

Das menschliche Mikrobiom und im speziellen die gastrointestinale Mikrobiota sind mit Gesundheit und Krankheit assoziiert. Eine Störung ihrer Zusammensetzung oder Funktion (Dysbiose) spielen eine Rolle bei der Entstehung von kindergastroenterologischen Krankheitsbildern. Der fäkale Mikrobiota-Transfer (FMT) ist eine spezielle Intervention, bei der intestinale Mikrobiota eines gesunden Spenders transferiert werden.

In diesem Review beschreiben wir die aktuelle Studienlage bezüglich FMT bei pädiatrischen Patient*innen. Für rezidivierende C. difficile-Infektionen bestehen eine gute Datenlage und Empfehlungen der entsprechenden Fachgesellschaften. Bei der Behandlung von chronisch-entzündlichen Darmerkrankungen (CED) mittels FMT liegen erste Daten vor, die auf eine Reduktion der Krankheitsschwere hindeuten.

Nebenwirkungen traten in Studien häufig auf, zeigten sich aber meist milde und transient. Zu in der Pädiatrie besonders bedeutsamen langfristigen Nebenwirkungen eines FMT existieren kaum Daten.

Bei der praktischen Durchführung besteht große Unklarheit, welche Modalitäten und Applikationsrouten angewendet werden sollten. Rechtlich gilt Spenderstuhl im deutschsprachigen Raum als Arzneimittel, für das keine Zulassung vorliegt.

Insgesamt sind die Erkenntnisse zu den physiologischen Zusammenhängen, Wirkungen und Nebenwirkungen noch unzureichend und rechtliche Rahmenbedingungen erschweren die Durchführung. Weitere klinische Studien auf dem Gebiet sind zwingend notwendig.

Abstract

The human microbiome and especially the gastrointestinal microbiota are associated with health and disease. Disturbance in the composition or function of fecal microbiota (dysbiosis) plays a role in the development of pediatric gastrointestinal diseases. Fecal microbiota transfer (FMT) is a special intervention, where microbiota are transferred from a healthy donor.

In this review we describe the current state of knowledge for FMT in pediatric patients. There is satisfactory evidence concerning FMT in patients with recurrent C. difficile infection. For inflammatory bowel disease, few studies show a potential benefit.

Adverse events occurred frequently in clinical studies, but were mostly mild and transient. There are hardly any data on long-term side effects of FMT, which are particularly significant for pediatrics. In practice, there is uncertainty as to which application route, dosage or frequency should be used. Legally, donor stool is considered a drug in German-speaking countries, for which no marketing authorization exists.

In conclusion, knowledge about physiology, efficacy and side effects of FMT is insufficient and legal concerns complicate its implementation. More studies on this topic are needed urgently.

Schlüsselwörter

Mikrobiom - FMT - chronisch entzündliche Darmerkrankung

Keywords

microbiota - fecal microbiota transfer - inflammatory bowel disease

Publication History

Received: 23 February 2022

Accepted: 13 March 2022

Article published online:
09 May 2022

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