Therapies to modulate gut microbiota:Past,present and future

The human gut microbiota comprises of a complex and diverse array of microorganisms,and over the years the interaction between human diseases and the gut microbiota has become a subject of growing interest.Disturbed microbial milieu in the gastrointestinal tract is central to the pathogenesis of several diseases including antibiotic-associated diarrhea and Clostridioides difficile infection(CDI).Manipulation of this microbial milieu to restore balance by microbial replacement therapies has proven to be a safe and effective treatment for recurrent CDI.There is considerable heterogeneity in various aspects of stool processing and administration for fecal microbiota transplantation(FMT)across different centers globally,and standardized microbioal replacement therapies offer an attractive alternative.The adverse effects associated with FMT are usually mild.However,there is paucity of data on long term safety of FMT and there is a need for further studies in this regard.With our increasing understanding of the host-microbiome interaction,there is immense potential for microbial replacement therapies to emerge as a treatment option for several diseases.The role of microbioal replacement therapies in diseases other than CDI is being extensively studied in ongoing clinical trials and it may be a potential treatment option for inflammatory bowel disease,irritable bowel syndrome,obesity,multidrug resistant infections,and neuropsychiatric illnesses.Fecal microbiota transplantation for non-CDI disease states should currently be limited only to research settings.

Parkinson’s disease and gut microbiota:from clinical to mechanistic and therapeutic studies

Parkinson’s disease(PD)is one of the most prevalent neurodegenerative diseases.The typical symptomatology of PD includes motor symptoms;however,a range of nonmotor symptoms,such as intestinal issues,usually occur before the motor symptoms.Various microorganisms inhabiting the gastrointestinal tract can profoundly influence the physiopathology of the central nervous system through neurological,endocrine,and immune system pathways involved in the microbiota-gut-brain axis.In addition,extensive evidence suggests that the gut microbiota is strongly associated with PD.This review summarizes the latest findings on microbial changes in PD and their clinical relevance,describes the underlying mechanisms through which intestinal bacteria may mediate PD,and discusses the correlations between gut microbes and anti-PD drugs.In addition,this review outlines the status of research on microbial therapies for PD and the future directions of PD-gut microbiota research.