Фекалната трансплантация като обещаваща терапия на затлъстяването

Фекалната трансплантация като обещаваща терапия на затлъстяването

Digestive Disease Week (DDW) 2019

This transcript has been edited for clarity.

Alok S. Patel, MD: This is Dr Alok Patel with Medscape. I’m here at Digestive Disease Week 2019 with Dr Jessica Allegretti, the director of the fecal microbiota transplantation (FMT) program at Brigham and Women’s Hospital in Boston, Massachusetts. We’re going to talk about her study of FMT in the treatment of obesity, the results of which were presented here.[1]

Dr Allegretti, I’m fascinated to speak with you about your research, because I feel like everyone is talking about the gut microbiome. Could you tell us a little bit about why you decided to look at FMT as a possible obesity treatment?

Jessica R. Allegretti, MD, MPH: Absolutely. To begin with a little bit of background context, FMT is something I do in my clinical practice all the time for recurrent or refractory Clostridium difficile infections, and we’ve learned a lot from the data we’ve collected in that area. Now with the expansion of the microbiome space, we’re starting to understand that there are many diseases associated with an altered gut microbiome, and that we can really use FMT to try to understand the microbial pathogenesis to some of these diseases.

Obesity seemed like an obvious target. It affects over a third of Americans and has many comorbid conditions associated with it. We wanted to understand if we could come up with some better therapeutic options for these patients.

Patel: I’m not as familiar with the space as you are, but I have seen some previous headlines about how the gut microbiome may affect hormones related to obesity or feelings of satiety. Were there any specific earlier findings that led you to your own study of FMT and obesity?

Allegretti: The impetus for this trial really comes from a few things. As you know, usually before things end up in humans, they’re tested out in mice. It was shown that this obesity phenotype can be essentially transplanted in mice. If you take stool from a lean mouse and place it into an obese mouse, and vice versa, you can actually see weight gain and weight loss. That really got people thinking that maybe this is something that is transmittable via the gut microbiome.

A group in the Netherlands took it a step further and actually used FMT in humans with metabolic syndrome.[2] They were able to show an improvement in insulin sensitivity at 6 weeks after treatment, but it really wasn’t sustained further than that.

We thought these were interesting and promising data, but we really wanted to look at what we call the obese metabolically uncomplicated patient. There are so many patients who are healthy overall but just cannot lose weight. We wanted to try to understand if we could help them. That’s really where our study enters the picture.

Patel: What was the design of your study?

Allegretti: We designed this as a single-center pilot study because, of course, whenever you’re testing a new therapeutic in a new patient population, safety has to be the first thing you confirm. That was really the primary goal, but we also wanted to begin gathering data about the utility of this therapy in this patient population.

Източник: https://www.medscape.com/viewarticle/915387