Microbiome restoration

Microbiome restoration is a therapeutic strategy aimed at returning a dysbiotic microbial ecosystem, typically the human gut microbiome, to a healthy and stable state. The microbiome functions as a complex biological system that regulates host immunity, facilitates the metabolism of dietary nutrients, and provides "colonization resistance" against opportunistic pathogens [3, 4]. When this balance is disrupted by factors like antibiotic use or diet, it can lead to chronic conditions such as recurrent Clostridioides difficile infection (CDI) or inflammatory bowel disease [9, 15]. Microbiome-based drugs, such as live biotherapeutic products (LBPs), work by introducing beneficial microbial consortia that outcompete pathogens and restore metabolic pathways, such as the conversion of primary to secondary bile acids [2, 11]. Recent FDA approvals of therapies like Vowst and Rebyota have established this as a validated clinical approach, with ongoing research investigating its role in enhancing cancer immunotherapy and treating metabolic disorders [6, 14].

Other names

Microbiota restorationGut microbiome reconstitutionFecal microbiota transplantation (FMT)Microbial ecosystem restorationLive biotherapeutic products (LBP)

Competitive exclusion of pathogenic species, restoration of microbial diversity and richness, production of antimicrobial peptides (bacteriocins), and modulation of host-microbe metabolic signaling including bile acid and short-chain fatty acid pathways [4, 8, 13].