분변 미생물 이식의 현재와 미래

초록

Purpose: Fecal microbiota transplantation (FMT) has emerged as one of the most effective interventions for restoring gut microbial balance through the reintroduction of a healthy donor microbiome. The established clinical indication for FMT currently remains limited to recurrent Clostridioides difficile infection (rCDI).This review aims to summarize the current understanding, evidence-based recommendations, and future perspectives regarding the clinical application of FMT. Current concepts: The 2024 American Gastroenterological Association guideline conditionally recommends microbiota-based therapies for adults with rCDI after completion of standard antibiotic treatment and suggests that conventional FMT may be considered in mildly to moderately immunocompromised patients. In contrast, its use is discouraged in severely immunocompromised individuals, and not recommended for conditions such as inflammatory bowel disease or irritable bowel syndrome because of insufficient evidence. Increasing evidence implicates the gut microbiota in the pathogenesis of various diseases, including neurologic and metabolic disorders. In parallel, advances in standardized preparations and the development of next-generation microbiota-based therapeutics underscore the broader therapeutic potential of FMT. However, outside the context of rCDI, both clinical effectiveness and long-term safety remain uncertain, and substantial challenges persist with respect to donor selection, product standardization, and procedural consistency. Discussion and conclusion: With an improved understanding of the mechanisms underlying dysbiosis and the accumulation of validated safety data, microbiota-based therapies are expected to evolve into additional therapeutic options for a variety of diseases. However, at present, clinical use should remain restricted to C. difficile infection, particularly rCDI, and should be limited to clinical settings supported by evidence-based guidelines.

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