Treating the Metabolic Syndrome by Fecal Transplantation-Current Status

Abstract

The intestinal microbiome (IM) is important for normal gastrointestinal (GI) and other organ systems' functioning. An alteration in the normal IM, dysbiosis, and changes in intestinal motility result in microorganisms' overgrowth and an alteration in intestinal permeability. The gut-brain axis is also of importance in the irritable bowel syndrome (IBS) and associated bowel overgrowth. Secondary to the epidemic of obesity, the metabolic syndrome has become a major health problem. Disturbances in the fecal microbiome are associated with the metabolic syndrome. Metabolic-associated fatty liver disease (MAFLD) is now the current terminology for non-alcoholic fatty liver disease. IM alteration by fecal transplantation is an approved treatment method for recurrent Clostridioides difficile infection. Initially performed by either duodenal infusion or colonoscopy, it is now easily performed by the administration of capsules containing stools. We discuss the intestinal microbiome-its composition, as well as the qualitative changes of microbiome composition leading to inflammation. In addition, we discuss the evidence of the effect of fecal transplantation on the metabolic syndrome and MAFLD, as well as its clinical indications.

Keywords: fecal transplantation; inflammatory mediators; metabolic syndrome; metabolic-associated fatty liver disease; microbiome; non-alcoholic fatty liver disease.

Figure 1

Hepatic sinusoid.

Figure 2

Intestinal microbiota influence the liver cell environment.

Figure 3

Immunohistochemistry (stain—caspase-cleaved K18 (ccK18); Bender MedSystems (Vienna, Austria)). Cytokeratin 18 (arrows) stains the cell death by apoptosis. The hepatocytes present large lipid droplets that occupy 80–90% of the parenchymal cells.