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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Cell. Infect. Microbiol.</journal-id>
<journal-title>Frontiers in Cellular and Infection Microbiology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Cell. Infect. Microbiol.</abbrev-journal-title>
<issn pub-type="epub">2235-2988</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fcimb.2025.1644187</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Cellular and Infection Microbiology</subject>
<subj-group>
<subject>Review</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Human microbiota-associated animal models: a review</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" equal-contrib="yes">
<name>
<surname>Huang</surname>
<given-names>Xiangning</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/3020136/overview"/>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
</contrib>
<contrib contrib-type="author" equal-contrib="yes">
<name>
<surname>Yu</surname>
<given-names>Yunfeng</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="author-notes" rid="fn003">
<sup>&#x2020;</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1823978/overview"/>
<role content-type="https://credit.niso.org/contributor-roles/supervision/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Tian</surname>
<given-names>Na</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<role content-type="https://credit.niso.org/contributor-roles/investigation/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Huang</surname>
<given-names>Jiawang</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Zhang</surname>
<given-names>Xiaoqin</given-names>
</name>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Yu</surname>
<given-names>Rong</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>*</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2842145/overview"/>
<role content-type="https://credit.niso.org/contributor-roles/supervision/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>School of Traditional Chinese Medicine, Hunan University of Chinese Medicine</institution>, <addr-line>Changsha</addr-line>,&#xa0;<country>China</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>Department of Endocrine, The First Hospital of Hunan University of Chinese Medicine</institution>, <addr-line>Changsha</addr-line>,&#xa0;<country>China</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>Department of Rehabilitation, Hunan Provincial People&#x2019;s Hospital</institution>, <addr-line>Changsha</addr-line>,&#xa0;<country>China</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: Aabid Hussain, Cleveland Clinic, United States</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1112084/overview">Jordy Evan Sulaiman</ext-link>, Hong Kong Polytechnic University, Hong Kong SAR, China</p>
<p>
<ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/2325066/overview">Awatif Abid Al-Judaibi</ext-link>, Jeddah University, Saudi Arabia</p>
<p>
<ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/2515577/overview">Qiwen Cheng</ext-link>, Shandong University, China</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Rong Yu, <email xlink:href="mailto:yurong196905@163.com">yurong196905@163.com</email>
</p>
</fn>
<fn fn-type="equal" id="fn003">
<p>&#x2020;These authors have contributed equally to this work</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>27</day>
<month>08</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="collection">
<year>2025</year>
</pub-date>
<volume>15</volume>
<elocation-id>1644187</elocation-id>
<history>
<date date-type="received">
<day>10</day>
<month>06</month>
<year>2025</year>
</date>
<date date-type="accepted">
<day>14</day>
<month>08</month>
<year>2025</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2025 Huang, Yu, Tian, Huang, Zhang and Yu.</copyright-statement>
<copyright-year>2025</copyright-year>
<copyright-holder>Huang, Yu, Tian, Huang, Zhang and Yu</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>Human microbiota-associated (HMA) animal models have become indispensable tools for investigating microbe-host interactions and disease pathogenesis. However, standardization challenges persist across different research groups when such models are used in fecal microbiota transplantation (FMT) protocols. Establishing a successful HMA model involves multiple stages, including donor screening, fecal suspension preparation, recipient preparation, and FMT. The outcomes of these stages are influenced by donor characteristics, recipient type, microbial viability, and dietary factors. This review examined the critical components of HMA model production, including the inclusion and exclusion criteria for human donors, collection time and processing methodology for fecal samples, recipient animal preparation strategies, and FMT regimens with engraftment validation. The key findings revealed that short-term antibiotic, probiotic, or laxative use constitutes an essential donor exclusion criterion. The time and method of fecal collection should be standardized as much as possible. Fecal samples should be processed as soon as possible, in anaerobic environments, with the addition of suitable protectants if they must be preserved at low temperatures. Microbial community profiling via 16S rRNA gene sequencing represents the primary method for analyzing microbiome composition and verifying microbiota engraftment efficacy throughout FMT procedures. The most commonly used recipients for HMA modeling included germ-free and pseudo-germ-free animals generated through antibiotic-mediated microbiota depletion. Although FMT with a single gavage of fecal suspension proved sufficient for model establishment, multiple frequencies and longer FMT durations significantly improved the efficiency of donor microbiota colonization. Overall, these findings are expected to aid the establishment of a standardized and reproducible protocol for preparing HMA models.</p>
</abstract>
<kwd-group>
<kwd>human microbiota-associated animal models</kwd>
<kwd>fecal microbiota transplantation</kwd>
<kwd>gut microbe-host interactions</kwd>
<kwd>microbiome</kwd>
<kwd>engraftment</kwd>
<kwd>procedure</kwd>
</kwd-group>
<counts>
<fig-count count="2"/>
<table-count count="4"/>
<equation-count count="0"/>
<ref-count count="186"/>
<page-count count="26"/>
<word-count count="12464"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-in-acceptance</meta-name>
<meta-value>Intestinal Microbiome</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<label>1</label>
<title>Introduction</title>
<p>The microbiota constitutes a complex ecosystem of microorganisms that encompasses bacterial, archaeal, eukaryotic, and viral taxa, each occupying specific ecological niches (<xref ref-type="bibr" rid="B106">Marchesi and Ravel, 2015</xref>). These microorganisms demonstrate a ubiquitous natural distribution, with humans serving as one of their primary hosts. Long-term coevolution has cultivated mutualism between humans and their microbiota&#x2014;particularly within the gastrointestinal tract, where ~95% of endogenous microbes reside. A 2010 metagenomic sequencing analysis revealed that the total human gut microbiome genome exceeds its genomic content by ~150&#xd7; (<xref ref-type="bibr" rid="B115">Qin et&#xa0;al., 2010</xref>). As of 2019, researchers have identified nearly 2,000 novel microbial species in the human intestine (<xref ref-type="bibr" rid="B3">Almeida et&#xa0;al., 2019</xref>). Subsequent studies have estimated that the ratio of bacterial to human cells in the adult human body is approximately 1.3:1 (<xref ref-type="bibr" rid="B139">Sender et&#xa0;al., 2016</xref>). Recent advancements in multi-omics assay profiling have elucidated the important impact of the microbiome on host health and disease (<xref ref-type="bibr" rid="B73">Integrative HMP (iHMP) Research Network Consortium, 2014</xref>). The gut microbial consortium mediates essential physiological functions such as immunological homeostasis, colonization resistance against pathogens, energy metabolism, endocrine regulation, and even certain neurological functions (<xref ref-type="bibr" rid="B103">Lynch and Pedersen, 2016</xref>). Dysregulation of the microbial community and abnormalities involving its metabolites have been closely associated with a variety of chronic diseases, including inflammatory bowel disease (<xref ref-type="bibr" rid="B108">Mousa and Al Ali, 2024</xref>), certain neuromuscular pathologies (e.g., Alzheimer&#x2019;s disease (<xref ref-type="bibr" rid="B174">Yang et&#xa0;al., 2024</xref>), certain muscular dystrophies (<xref ref-type="bibr" rid="B125">Russo et&#xa0;al., 2024</xref>)), metabolic syndromes (e.g., obesity and type 2 diabetes) (<xref ref-type="bibr" rid="B7">Aron-Wisnewsky et&#xa0;al., 2021</xref>), and dermatosis (e.g., acne and atopic dermatitis) (<xref ref-type="bibr" rid="B16">Borrego-Ruiz and Borrego, 2024</xref>).</p>
<p>The investigation of gut microbe-host interactions offers dual scientific value: elucidating disease mechanisms and pioneering novel diagnostic-therapeutic paradigms. Human microbiota-associated (HMA) animal models have emerged as crucial tools for elucidating the mechanisms underlying microbe-host interactions (<xref ref-type="bibr" rid="B62">Hirayama, 1999</xref>; <xref ref-type="bibr" rid="B72">Imaoka et&#xa0;al., 2004</xref>; <xref ref-type="bibr" rid="B81">Kibe et&#xa0;al., 2005</xref>). Through the transplantation of human microbial communities into recipient animals, HMA models facilitate the longitudinal observation of microbial dynamics or examination of the efficacy of specific therapeutic targets involved in certain interventions (<xref ref-type="bibr" rid="B123">Ridaura et&#xa0;al., 2013</xref>). Evidence has demonstrated that HMA models can effectively reconstruct donor microbial signatures and metabolomic profiles (<xref ref-type="bibr" rid="B107">Marcobal et&#xa0;al., 2013</xref>). Current applications span four key research domains: the composition of gut microbial consortia, the regulation of gut microbiota in host development, the causal associations between microbes and diseases, and the evaluation of targeted microbiota therapeutic strategies (<xref ref-type="bibr" rid="B140">Sharon et&#xa0;al., 2019</xref>). These findings solidify the functional centrality of intestinal microbiomes in terms of maintaining good health. They also provide a scientific basis for microbial interventions that target health benefits across human, animal, and ecological domains.</p>
<p>Despite their scientific utility, HMA animal models derived through fecal microbiota transplantation (FMT) face persistent methodological controversies. The engraftment efficiency of human-derived microbial communities in animal recipients is influenced by several factors. These include the host&#x2019;s genetic background, gastrointestinal architecture, and behavioral differences&#x2014;all of which impose certain constraints on HMA animal models (<xref ref-type="bibr" rid="B8">Arrieta et&#xa0;al., 2016</xref>). Evidence has indicated that these models risk overestimating the causal associations between microbiomes and disease phenotypes (<xref ref-type="bibr" rid="B165">Walter et&#xa0;al., 2020</xref>). Nevertheless, HMA models remain the best choice for investigating host-microbe crosstalk. It remains unclear precisely which methodological refinements in HMA model generation via FMT are required to establish standardized workflows that improve reproducibility and scientific validity. This review highlights key considerations in donor screening, recipient preparation, transplantation protocols, and microbiota validation to enhance HMA model development, experimental reproducibility, and standardization (<xref ref-type="fig" rid="f1">
<bold>Figure&#xa0;1</bold>
</xref>).</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>The General procedures of human microbiota-associated (HMA) mice models. Using mice as an example, the general procedures of HMA models primarily involves three steps. Donor Preparation: select human donors with balanced diet who meet predefined inclusion and exclusion criteria. Preservation and Processing of Donor Fecal: collect and transport fecal samples and store them under low-temperature conditions. Standardized fecal suspensions are prepared by diluting, homogenizing, filtering, and pooling fecal samples from multiple donors. Fecal Microbiota Transplantation (FMT): recipient mice are adult germ-free animals or antibiotic-induced pseudo-germ-free models. Following FMT, next-generation sequencing (NGS) is utilized as an effective method to quantify microbial engraftment efficiency.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-15-1644187-g001.tif">
<alt-text content-type="machine-generated">Illustration depicting the process of fecal microbiota transplantation (FMT). It includes elements such as balanced diet, fecal collection, cryopreservation, donor preparation, multiple donor mixture, homogenization, fecal suspension, Next-Generation Sequencing (NGS), and 16S rRNA sequencing. A human figure and mouse represent donors and recipients. The process involves oral-gastric gavage for transplantation.</alt-text>
</graphic>
</fig>
</sec>
<sec id="s2">
<label>2</label>
<title>Donor preparation</title>
<sec id="s2_1">
<label>2.1</label>
<title>Inclusion and exclusion criteria for human donors</title>
<p>The 2017 European Consensus Conference established donor inclusion and exclusion criteria for clinical fecal microbiota transplantation (FMT), specifying evaluation parameters that included comprehensive medical histories, same-day donation, clinical signs and symptoms, dietary profiling, and laboratory tests (<xref ref-type="bibr" rid="B21">Cammarota et&#xa0;al., 2017</xref>). However, standardized protocols for selecting human fecal donors in animal experiments remain undefined, with significant differences remaining in terms of inclusion and exclusion criteria across studies. Current FMT-based human microbiota-associated (HMA) models predominantly use two donor cohorts: healthy individuals, and patients with the diseases being investigated by the study. The inclusion criteria for healthy individuals reported in existing studies mainly included the following aspects: (1) a minimum of 2&#x2013;12 months without antibiotic exposure (<xref ref-type="bibr" rid="B23">Cherbuy et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B82">Kim et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B88">Le Bihan et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B5">Aluthge et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B26">Chung et&#xa0;al., 2012</xref>); (2) the elimination of laxative agents for &#x2265;3 months (<xref ref-type="bibr" rid="B17">Brandi et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B47">G&#xe9;rard et&#xa0;al., 2004</xref>; <xref ref-type="bibr" rid="B121">Respondek et&#xa0;al., 2013</xref>); (3) a omnivorous diet that includes both vegetarian and meat component (<xref ref-type="bibr" rid="B23">Cherbuy et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B34">Dong et&#xa0;al., 2021</xref>); and (4) the absence of gastrointestinal disorders (<xref ref-type="bibr" rid="B122">Reygner et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B151">Tamura et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B49">Gobert et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B126">Saint-Cyr et&#xa0;al., 2013</xref>), recent pathogen (bacterial or parasitic) infection (<xref ref-type="bibr" rid="B87">Lauko et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B109">Nagao-Kitamoto et&#xa0;al., 2020</xref>, <xref ref-type="bibr" rid="B110">2016</xref>), and acute or chronic illnesses that can alter gut microbe composition (<xref ref-type="bibr" rid="B127">Salandre et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B176">Zabolotneva et&#xa0;al., 2023</xref>). The most common exclusion criteria included the following: (1) recent (within 1&#x2013;2 months) exposure to antimicrobials, prebiotics, or probiotics (<xref ref-type="bibr" rid="B182">Zhang et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B22">Chen et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B171">Xia et&#xa0;al., 2019</xref>); (2) active neuropsychiatric disorders including major depression (<xref ref-type="bibr" rid="B49">Gobert et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B77">Kaiser et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B176">Zabolotneva et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B178">Zhan et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B179">Zhang et&#xa0;al., 2020</xref>); (3) excessive alcoholism or smoking habits (<xref ref-type="bibr" rid="B176">Zabolotneva et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B51">Grabrucker et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B49">Gobert et&#xa0;al., 2016</xref>); and (4) pregnant or lactating (<xref ref-type="bibr" rid="B176">Zabolotneva et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B31">Demir et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B179">Zhang et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B49">Gobert et&#xa0;al., 2016</xref>). The inclusion criteria for disease donors typically add the following requirements: clinical manifestations, laboratory tests, and pathological findings that collectively satisfy the diagnostic criteria for the disease (<xref ref-type="bibr" rid="B182">Zhang et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B66">Hsu et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B41">Fan et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B31">Demir et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B179">Zhang et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B22">Chen et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B37">Duan et&#xa0;al., 2019</xref>). Exclusion criteria often include: (1) incomplete information (<xref ref-type="bibr" rid="B183">Zhong et&#xa0;al., 2024</xref>); (2) the use of medications that could interfere with the experiment (<xref ref-type="bibr" rid="B71">Hutchison et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B178">Zhan et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B183">Zhong et&#xa0;al., 2024</xref>); and (3) comorbidities of chronic or infectious diseases that could affect the study (<xref ref-type="bibr" rid="B66">Hsu et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B41">Fan et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B22">Chen et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B37">Duan et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B171">Xia et&#xa0;al., 2019</xref>).</p>
<p>Antibiotic exposure and dietary patterns critically influence gut microbiota composition (<xref ref-type="bibr" rid="B38">Dudek-Wicher et&#xa0;al., 2018</xref>). Clinical trials have demonstrated that antibiotic administration reduces microbial diversity. It typically takes &#x2265;1.5 months for the intestinal flora of healthy adults to return to near-baseline levels&#x2014;with a few common taxa remaining undetectable even after 6 months (<xref ref-type="bibr" rid="B111">Palleja et&#xa0;al., 2018</xref>). Diet serves as the substrate for the energy used by microbes, with different microbial species differing in their ability to utilize different foods, resulting in different microbial compositions (<xref ref-type="bibr" rid="B44">Flint et&#xa0;al., 2015</xref>). Pharmacological interventions such as laxatives induce clearance of intestinal contents, directly altering the microbial community structure (<xref ref-type="bibr" rid="B35">Drago et&#xa0;al., 2019</xref>). Probiotic and prebiotic interventions selectively modulate enteric microbial populations, affecting their health-promoting effects (<xref ref-type="bibr" rid="B130">Sanders et&#xa0;al., 2019</xref>). Although evidence regarding the impact of alcohol and tobacco on the gut microbiota remains limited, current findings indicate that excessive alcohol consumption compromises intestinal barrier function and induces dysbiosis (<xref ref-type="bibr" rid="B39">Engen et&#xa0;al., 2015</xref>). Cigarette smoking can alter gut microbial composition and diversity through mechanisms involving oxidative stress modulation, the disruption of intestinal tight junctions, and changes in mucin composition (<xref ref-type="bibr" rid="B133">Savin et&#xa0;al., 2018</xref>). Current studies report significant variations in donor cohort sizes for FMT, ranging from single donors to multi-donor cohorts (n=1&#x2013;10) across published protocols (<xref ref-type="bibr" rid="B87">Lauko et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B66">Hsu et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B55">Hanske et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B129">S&#xe1;nchez-Quintero et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B28">Crouzet et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B127">Salandre et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B105">Mao et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B24">Chiu et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B171">Xia et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B150">Sun et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B98">Liu et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B162">von Klitzing et&#xa0;al., 2017a</xref>; <xref ref-type="bibr" rid="B175">Ye et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B181">Zhang et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B5">Aluthge et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B122">Reygner et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B41">Fan et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B120">Renu et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B176">Zabolotneva et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B23">Cherbuy et&#xa0;al., 2019</xref>) (<xref ref-type="table" rid="T1">
<bold>Table&#xa0;1</bold>
</xref>). Research from the Human Microbiome Project has confirmed that significant heterogeneity exists in gut microbial compositions and relative abundances between individuals, even among healthy populations (<xref ref-type="bibr" rid="B68">Human Microbiome Project Consortium, 2012a</xref>). Although single-donor FMT ensures traceable microbial origins, it does not adequately address population-level microbial diversity. Conversely, multi-donor strategies enhance ecological validity through sample pooling but increase operational complexity in terms of specimen collection and processing.</p>
<table-wrap id="T1" position="float">
<label>Table&#xa0;1</label>
<caption>
<p>Summary of methodological parameters for fecal sample cohort, collection, transport and storage in human microbiota-associated (HMA) studies.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="middle" rowspan="2" align="center">Donor cohort sizes</th>
<th valign="middle" rowspan="2" align="center">Fecal collection methodologies</th>
<th valign="middle" rowspan="2" align="center">Time interval/storage conditions before processing</th>
<th valign="middle" rowspan="2" align="center">Fecal transport</th>
<th valign="middle" colspan="2" align="center">Fecal storage</th>
<th valign="middle" rowspan="2" align="center">References</th>
</tr>
<tr>
<th valign="middle" align="center">Cryoprotective agents</th>
<th valign="middle" align="center">Temperature</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="middle" align="center">A healthy adult donor</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Stored at 4&#xb0;C under anaerobic conditions and processed within 12 h</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B88">Le Bihan et&#xa0;al., 2015</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">3 patients with acute stroke</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Frozen at &#x2212;80&#xb0;C immediately</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B171">Xia et&#xa0;al., 2019</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">2 cohorts of 6 donors</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2264;2h</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B98">Liu et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">5 healthy donors</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B162">von Klitzing et&#xa0;al., 2017a</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">2 cohorts of 1 donors</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Transferred to an anaerobic cabinet immediately</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">20% glycerol</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B175">Ye et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">6 essential tremor patients and 6 healthy controls</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2264;4h</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">50% sterile glycerol</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B182">Zhang et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">5</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">With dry ice</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B161">Van Den Ham et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">4 female donors</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">50% glycerol</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B5">Aluthge et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">6 healthy donors</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2264;2h</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">The maltodextrin-trehalose cocktail, 10% glycerol or 80% glycerol</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B122">Reygner et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">3 females patients with anorexia nervosa and 3 healthy controls</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">20% glycerol</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B41">Fan et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">5 obese and 5 healthy lean children</td>
<td valign="middle" align="center">A sterile glass bottle</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">15% glycerol</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B120">Renu et&#xa0;al., 2022</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">2 cohorts of 5 donors</td>
<td valign="middle" align="center">A terile screwcap bottle with a sterile anaerobic medium</td>
<td valign="middle" align="center">&#x2264;0.5h</td>
<td valign="middle" align="center">With ice</td>
<td valign="middle" align="center">15% glycerol</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B32">Dhakal et&#xa0;al., 2019</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">10 adult human donors (5 males and 5 females) and a 3-mo old healthy baby</td>
<td valign="middle" align="center">A completely filled airtight containers</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">10% glycerol</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B181">Zhang et&#xa0;al., 2013</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">1</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2264;6h</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">10% sterile glycerol</td>
<td valign="middle" align="center">&#x2013;70&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B87">Lauko et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">10</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2264;2h</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">10% glycerol</td>
<td valign="middle" align="center">&#x2013;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B127">Salandre et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">A healthy male</td>
<td valign="middle" align="center">An anaerobic box</td>
<td valign="middle" align="center">&#x2264;1h</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B17">Brandi et&#xa0;al., 2024</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="center">A sterile plastic cup</td>
<td valign="middle" align="center">Storage at &#x2212;20&#xb0;C before processing</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">20% glycerol</td>
<td valign="middle" align="center">&#x2013;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B51">Grabrucker et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="center">An stool sampler</td>
<td valign="middle" align="center">Immediately transported to the laboratory and frozen at &#x2212;&#x2009;80&#x2009;&#xb0;C before processing.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B100">Liu et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">4 female healthy donors</td>
<td valign="middle" align="center">Paper sheets</td>
<td valign="middle" align="center">Immediately transferred into sterilized containers, placed in an AnaeroPouch with a CO<sub>2</sub> generator, and stored at &#x2212;80&#xb0;C before processing.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B151">Tamura et&#xa0;al., 2019</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">3</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Immediately transferred into an anaerobic chamber</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B99">Liu et&#xa0;al., 2022</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2264;2h</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B144">Sj&#xf6;land et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">3 constipated-predominant irritable bowel syndrome patients and 3 healthy controls</td>
<td valign="middle" align="center">With Anaerocult A sachet</td>
<td valign="middle" align="center">&#x2264;3h</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B49">Gobert et&#xa0;al., 2016</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2264;2h</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">10% glycerol</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B147">Staley et&#xa0;al., 2017</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">3</td>
<td valign="middle" align="center">Sterile plastic boxes</td>
<td valign="middle" align="center">Kept under anoxic conditions by using Anaerocult A and stored at 4&#xb0;C for a maximum of 6 h before processing.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B70">Humblot et&#xa0;al., 2005</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Stored at 4&#xb0;C in an anaerobiosis generator within 24 h before processing</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B146">Spatz et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">2 cohorts of 4 donors</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Stored at 4&#xb0;C before transport</td>
<td valign="middle" align="center">With ice packs</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80 &#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B48">Glenny et&#xa0;al., 2021</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Stored at &#x2212;80&#xb0;C immediately</td>
<td valign="middle" align="center">In containers cooled by dry ice</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B156">Togao et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Immediately frozen before being stored in liquid nitrogen within 15 min.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B110">Nagao-Kitamoto et&#xa0;al., 2016</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">5</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B163">von Klitzing et&#xa0;al., 2017b</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">A female healthy donors</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Stored at 4&#x2009;&#xb0;C in an anaerobiosis generator immediately, and processed within 24&#x2009;h.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">-80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Sterile tubes</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Dry ice</td>
<td valign="middle" align="center">30% glycerol</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B42">Feehley et&#xa0;al., 2019</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">5 healthy donors</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B58">Heimesaat et&#xa0;al., 2019</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Tubes without any additive</td>
<td valign="middle" align="center">&#x2264;4h</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">20% glycerol</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B154">Tintelnot et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Immediately frozen at -20&#xb0;C</td>
<td valign="middle" align="center">Frozen</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B123">Ridaura et&#xa0;al., 2013</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">3</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">10% glycerol</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B129">S&#xe1;nchez-Quintero et&#xa0;al., 2022</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">2</td>
<td valign="middle" align="center">Disposable coffee filter-like fecal collection devices</td>
<td valign="middle" align="center">Immediately frozen at -80&#xb0;C</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B61">Hintze et&#xa0;al., 2014</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">2 cohorts of 3 donors</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">50% glycerol</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B77">Kaiser et&#xa0;al., 2021</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Frozen at &#x2013;80&#xb0;C before processing</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">15% glycerol</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B18">Britton et&#xa0;al., 2019</xref>)</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>Optimal donor selection for microbiota studies requires stringent criteria. Based on the above evidence, we believe that healthy donors must demonstrate at least: (1) A &#x2265;3-month abstinence from antibiotics, laxatives, and probiotic or prebiotic supplements (<xref ref-type="bibr" rid="B88">Le Bihan et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B5">Aluthge et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B26">Chung et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B17">Brandi et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B47">G&#xe9;rard et&#xa0;al., 2004</xref>; <xref ref-type="bibr" rid="B121">Respondek et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B182">Zhang et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B22">Chen et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B171">Xia et&#xa0;al., 2019</xref>); (2) the absence of gastrointestinal disorders or active infections (<xref ref-type="bibr" rid="B122">Reygner et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B151">Tamura et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B49">Gobert et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B126">Saint-Cyr et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B87">Lauko et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B110">Nagao-Kitamoto et&#xa0;al., 2016</xref>, <xref ref-type="bibr" rid="B109">2020</xref>; <xref ref-type="bibr" rid="B127">Salandre et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B176">Zabolotneva et&#xa0;al., 2023</xref>); (3) adherence to a nutritionally balanced diet (<xref ref-type="bibr" rid="B23">Cherbuy et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B34">Dong et&#xa0;al., 2021</xref>); (4) A preference for non-smokers and non-drinkers (<xref ref-type="bibr" rid="B176">Zabolotneva et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B51">Grabrucker et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B49">Gobert et&#xa0;al., 2016</xref>); and (5) compliance with fecal collection protocols. Disease cohort donors require additional validation that includes: (1) diagnostic confirmation per established clinical criteria (<xref ref-type="bibr" rid="B182">Zhang et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B66">Hsu et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B41">Fan et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B31">Demir et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B179">Zhang et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B22">Chen et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B37">Duan et&#xa0;al., 2019</xref>); (2) the exclusion of confounding comorbidities that could affect gut microbiota (<xref ref-type="bibr" rid="B66">Hsu et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B41">Fan et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B22">Chen et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B37">Duan et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B171">Xia et&#xa0;al., 2019</xref>); (3) the absence of active infectious diseases (<xref ref-type="bibr" rid="B147">Staley et&#xa0;al., 2017</xref>). Fecal samples could be initially collected from multiple donors, after which a suitable number of optimal and representative specimens could be selected for downstream experiments (<xref ref-type="bibr" rid="B41">Fan et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B49">Gobert et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B171">Xia et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B182">Zhang et&#xa0;al., 2023</xref>).</p>
</sec>
<sec id="s2_2">
<label>2.2</label>
<title>Fecal collection</title>
<sec id="s2_2_1">
<label>2.2.1</label>
<title>The time of fecal collection</title>
<p>Both humans and animals, along with their gut microbiotas, are affected by temporal rhythms. Research has demonstrated that 10% of the bacterial operational taxonomic units (OTUs) in humans and 15% of those in mice show significant circadian fluctuations in terms of relative abundance (<xref ref-type="bibr" rid="B153">Thaiss et&#xa0;al., 2014</xref>). Reitmeier et&#xa0;al. analyzed fecal samples from 1,943 participants with recorded collection times and revealed that 70% exhibited defecation patterns concentrated between the hours of 5:00&#x2013;11:00 (<xref ref-type="bibr" rid="B119">Reitmeier et&#xa0;al., 2020</xref>). Throughout the day, distinct taxonomic groups dominate the gut microbiota. <italic>Firmicutes</italic> prevail during daylight hours, for example, whereas <italic>Bacteroidetes</italic> predominate nocturnally (<xref ref-type="bibr" rid="B119">Reitmeier et&#xa0;al., 2020</xref>). Current clinical FMT protocols lack standardized stool collection timing. In the preparation of animal models for FMT-based HMA animal model preparation, certain studies have utilized stool samples obtained from donors&#x2019; first morning bowel movements (<xref ref-type="bibr" rid="B179">Zhang et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B105">Mao et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B150">Sun et&#xa0;al., 2022</xref>).</p>
</sec>
<sec id="s2_2_2">
<label>2.2.2</label>
<title>The methodology of fecal collection</title>
<p>Current methodologies for fecal sample collection exhibit significant heterogeneity. Certain protocols require donors to defecate directly into an anaerobic box (<xref ref-type="bibr" rid="B17">Brandi et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B49">Gobert et&#xa0;al., 2016</xref>), while others use sterile containers or specialized stool collection kits (<xref ref-type="bibr" rid="B61">Hintze et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B51">Grabrucker et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B100">Liu et&#xa0;al., 2020</xref>). Alternative approaches involve paper sheets and immediately transferring them into sterilized containers (<xref ref-type="bibr" rid="B151">Tamura et&#xa0;al., 2019</xref>). Standardized collection tools, exemplified by stool collection kits, present three primary advantages. First, they minimize oxygen exposure to protect anaerobic taxa. Second, they prevent environmental contamination, such as from toilet water and urine. Third, they enhance donor compliance through improved hygienic handling and sensory acceptability. The commode kit has gained widespread adoption in large-scale cohort studies such as the Human Microbiome Project, owing to its user-friendly design (<xref ref-type="bibr" rid="B46">Franzosa et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B69">Human Microbiome Project Consortium, 2012b</xref>). Despite achieving operational simplicity and cost optimization, these systems require detailed instructional protocols and incur additional research expenditures. Conversely, evidence demonstrates that paper-based collection methods preserve fecal microbial diversity and community structure without significant alteration (<xref ref-type="bibr" rid="B2">Al et&#xa0;al., 2018</xref>), offering a viable alternative for resource-constrained investigations.</p>
</sec>
<sec id="s2_2_3">
<label>2.2.3</label>
<title>Time interval and storage conditions before processing</title>
<p>For fresh samples, the clinical FMT protocols emphasize that the primary recommendation is to process them within 6 h (<xref ref-type="bibr" rid="B21">Cammarota et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B102">Lopetuso et&#xa0;al., 2023</xref>). Fecal samples should be stored at a temperature of 20&#xb0;C&#x2013;30&#xb0;C (<xref ref-type="bibr" rid="B21">Cammarota et&#xa0;al., 2017</xref>) or at &#x2264;4&#xb0;C prior to processing (<xref ref-type="bibr" rid="B102">Lopetuso et&#xa0;al., 2023</xref>). If feasible, anaerobic storage and processing should be utilized (<xref ref-type="bibr" rid="B21">Cammarota et&#xa0;al., 2017</xref>). Similar protocols apply to FMT-based HMA animal model preparation: in some studies, samples were required to be processed in an anaerobic chamber immediately after defecation (<xref ref-type="bibr" rid="B151">Tamura et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B175">Ye et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B99">Liu et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>). Consistent with clinical FMT protocols, some studies require microbial slurry extraction and FMT administration to be completed within 2&#x2013;6 hours post-collection (<xref ref-type="bibr" rid="B144">Sj&#xf6;land et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B49">Gobert et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B147">Staley et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B182">Zhang et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B87">Lauko et&#xa0;al., 2023</xref>). When immediate processing is unfeasible, stool samples were stored under anoxic conditions at 4&#xb0;C for a maximum 6&#x2013;24 h (<xref ref-type="bibr" rid="B70">Humblot et&#xa0;al., 2005</xref>; <xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B88">Le Bihan et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B146">Spatz et&#xa0;al., 2023</xref>)(<xref ref-type="table" rid="T1">
<bold>Table&#xa0;1</bold>
</xref>). These preservation measures aim to maintain donor microbial viability (MV) and protect obligate anaerobes, which outnumber aerobic bacteria by 100&#x2013;1000&#xd7; in the human gut (<xref ref-type="bibr" rid="B167">Widjaja and Rietjens, 2023</xref>). Lower anaerobe abundance has been reported to correlate with dysbiosis-associated pathologies such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) (<xref ref-type="bibr" rid="B116">Rajili&#x107;-Stojanovi&#x107; et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B145">Sokol et&#xa0;al., 2009</xref>). Insufficient anaerobic protection may therefore compromise experimental outcomes through microbial community variation. However, clinical evidence demonstrates comparable efficacy between anaerobic and aerobic FMT preparations when treating <italic>Clostridioides difficile</italic> infections (<xref ref-type="bibr" rid="B89">Lee et&#xa0;al., 2016</xref>). This equivalence may stem from spore-forming bacterial genera, which constitute 50&#x2013;60% of healthy gut microbiota and exhibit oxygen-resistant sporulation capabilities and thus facilitate inter-host transmission (<xref ref-type="bibr" rid="B19">Browne et&#xa0;al., 2016</xref>).</p>
<p>In summary, it is imperative for researchers to meticulously record the precise defecation times of participants and to prioritize the collection of fecal samples from the same timeframe in order to mitigate potential confounding variables associated with circadian rhythms (<xref ref-type="bibr" rid="B153">Thaiss et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B119">Reitmeier et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B179">Zhang et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B105">Mao et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B150">Sun et&#xa0;al., 2022</xref>). The optimal collection methodology should be selected based on donor cohort size and degree of cooperation, with a standardized sampling methodology maintained to minimize technical variability. Ideally, fresh fecal samples should be processed within 2 h of collection, with a maximum allowable delay of 6 h (<xref ref-type="bibr" rid="B144">Sj&#xf6;land et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B49">Gobert et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B147">Staley et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B182">Zhang et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B87">Lauko et&#xa0;al., 2023</xref>). In instances where immediate processing is not feasible, it is advisable to refrigerate the samples at 4&#xb0;C (<xref ref-type="bibr" rid="B70">Humblot et&#xa0;al., 2005</xref>; <xref ref-type="bibr" rid="B146">Spatz et&#xa0;al., 2023</xref>). The adoption of anaerobic preservation and processing protocols should be guided by the available laboratory resources and the specific aims of the research. These findings provide preliminary insights into fecal collection and processing methods, but further research is needed for validation.</p>
</sec>
</sec>
<sec id="s2_3">
<label>2.3</label>
<title>Fecal transport and storage protocols</title>
<p>The standardized handling of fresh fecal samples requires predefined transport and storage solutions when immediate processing is not feasible. Current methodologies demonstrate variations in the transportation and preservation of stool samples(<xref ref-type="table" rid="T1">
<bold>Table&#xa0;1</bold>
</xref>): some studies advocate for ice-based transportation without defined temperature parameters (<xref ref-type="bibr" rid="B32">Dhakal et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B48">Glenny et&#xa0;al., 2021</xref>), while others recommend using dry ice for cryopreservation prior to shipping (<xref ref-type="bibr" rid="B161">Van Den Ham et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B156">Togao et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B42">Feehley et&#xa0;al., 2019</xref>). A broad consensus exists among researchers regarding &#x2013;80&#xb0;C as the optimal long-term storage temperature for fecal specimens (<xref ref-type="bibr" rid="B110">Nagao-Kitamoto et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B163">von Klitzing et&#xa0;al., 2017b</xref>; <xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B42">Feehley et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B58">Heimesaat et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B146">Spatz et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B154">Tintelnot et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B156">Togao et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B182">Zhang et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B171">Xia et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B98">Liu et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B175">Ye et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B182">Zhang et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B161">Van Den Ham et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B5">Aluthge et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B122">Reygner et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B41">Fan et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B120">Renu et&#xa0;al., 2022</xref>). Although pragmatic protocols permit short-term preservation at &#x2013;20&#xb0;C before inoculum preparation (<xref ref-type="bibr" rid="B51">Grabrucker et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B123">Ridaura et&#xa0;al., 2013</xref>). Alternatively, storage and transportation at 4&#xb0;C is permitted within a strict &#x2264;24 h limit (<xref ref-type="bibr" rid="B146">Spatz et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>).</p>
<p>Current research has not explored how different storage conditions of fecal samples may influence the outcomes of FMT. Nevertheless, multiple studies have reported the finite effects of storage conditions on fecal microbiota. Fouhy et&#xa0;al. observed no significant compositional differences between fresh, dry ice flash-frozen, and &#x2013;80&#xb0;C-stored (for 7 days) fecal samples (<xref ref-type="bibr" rid="B45">Fouhy et&#xa0;al., 2015</xref>). Tedjo et&#xa0;al. confirmed microbiota stability following 24 h storage at 4&#xb0;C, and 1-week storage at &#x2013;20&#xb0;C preservation whether for healthy, IBS, and IBD cohorts (<xref ref-type="bibr" rid="B152">Tedjo et&#xa0;al., 2015</xref>). Similarly, Choo et&#xa0;al. demonstrated that healthy donor fecal samples stored at 4&#xb0;C for 72 h exhibited no statistically significant differences regarding microbial composition and diversity compared to their &#x2013;80&#xb0;C cryopreserved counterparts (<xref ref-type="bibr" rid="B25">Choo et&#xa0;al., 2015</xref>). Therefore, 4&#xb0;C refrigeration and &#x2013;20&#xb0;C freezing are recommended as short-term transportation and preservation conditions, while &#x2013;80&#xb0;C cryopreservation is reserved for long - term storage.</p>
<p>In the context of cryopreservation, methods encompass direct freezing (<xref ref-type="bibr" rid="B123">Ridaura et&#xa0;al., 2013</xref>) as well as the incorporation of various cryoprotective agents like 10&#x2013;50% glycerol solutions (<xref ref-type="bibr" rid="B87">Lauko et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B175">Ye et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B42">Feehley et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B129">S&#xe1;nchez-Quintero et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B5">Aluthge et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B182">Zhang et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B41">Fan et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B120">Renu et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B32">Dhakal et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B181">Zhang et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B87">Lauko et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B127">Salandre et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B51">Grabrucker et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B42">Feehley et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B154">Tintelnot et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B77">Kaiser et&#xa0;al., 2021</xref>).The academic community remains divided concerning cryoprotectant. Advocates posit that freeze-thaw cycles (FTCs) compromise bacterial viability (<xref ref-type="bibr" rid="B112">Postgate and Hunter, 1961</xref>), necessitating the use of protective agents. Due to the uncertainties surrounding the effects of glycerol&#x2019;s cellular permeation on bacterial viability, novel formulations such as maltodextrin-trehalose have been developed. The maltodextrin-trehalose have been validated through multi-phase assays to optimally preserve fecal microbial vitality during both freezing and thawing (<xref ref-type="bibr" rid="B20">Burz et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B122">Reygner et&#xa0;al., 2020</xref>). Conversely, some researchers suggest that direct ultra-low-temperature (&#x2212;80&#xb0;C) preservation without additives can maintain microbial composition without significant alteration (<xref ref-type="bibr" rid="B152">Tedjo et&#xa0;al., 2015</xref>). Three clinical studies provide evidence that the therapeutic effects of fresh and cryopreserved FMT preparations are comparable (<xref ref-type="bibr" rid="B89">Lee et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B132">Satokari et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B143">Sintes et&#xa0;al., 2024</xref>). However, a comparative trial indicated that fecal samples frozen without cryoprotectants showed changes in composition, viability, and cultivability upon thawing compared to fresh feces (<xref ref-type="bibr" rid="B13">Bilinski et&#xa0;al., 2022</xref>). Therefore, cryopreservation method should consider the use of cryoprotectants to maintain MV and composition, especially when samples undergo multiple FTCs. For short-term fecal sample storage, direct freezing at ultra-low temperatures without additives may be sufficient for preserving microbial integrity in certain contexts.</p>
</sec>
<sec id="s2_4">
<label>2.4</label>
<title>Fecal suspensions preparation</title>
<p>Fresh fecal specimens are typically reconstituted using phosphate-buffered saline (PBS) (<xref ref-type="bibr" rid="B105">Mao et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B24">Chiu et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B34">Dong et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B150">Sun et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B129">S&#xe1;nchez-Quintero et&#xa0;al., 2022</xref>, <xref ref-type="bibr" rid="B129">2023</xref>; <xref ref-type="bibr" rid="B164">Wahlstr&#xf6;m et&#xa0;al., 2017</xref>) or brain heart infusion (BHI) culture medium (<xref ref-type="bibr" rid="B146">Spatz et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>) before FMT administration, as shown in <xref ref-type="table" rid="T2">
<bold>Table&#xa0;2</bold>
</xref>. During the post-thaw processing of cryopreserved fecal samples, common dilution vehicles include sterile saline (<xref ref-type="bibr" rid="B61">Hintze et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B67">Huang et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B161">Van Den Ham et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B176">Zabolotneva et&#xa0;al., 2023</xref>), PBS buffer (<xref ref-type="bibr" rid="B51">Grabrucker et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B77">Kaiser et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B171">Xia et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B175">Ye et&#xa0;al., 2023</xref>), media contain glycerol (<xref ref-type="bibr" rid="B18">Britton et&#xa0;al., 2019</xref>), and BHI medium (<xref ref-type="bibr" rid="B154">Tintelnot et&#xa0;al., 2023</xref>). The standard dilution ratios range from 1:10 to 1:1000 (w/v) (<xref ref-type="bibr" rid="B88">Le Bihan et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B110">Nagao-Kitamoto et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B28">Crouzet et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B156">Togao et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B176">Zabolotneva et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B164">Wahlstr&#xf6;m et&#xa0;al., 2017</xref>)(<xref ref-type="table" rid="T2">
<bold>Table&#xa0;2</bold>
</xref>). Sample preparation strategies include donor-specific retention through individual processing (<xref ref-type="bibr" rid="B110">Nagao-Kitamoto et&#xa0;al., 2016</xref>) and homogenized aliquots via pooled sample blending (<xref ref-type="bibr" rid="B128">S&#xe1;nchez-Quintero et&#xa0;al., 2023</xref>). Clinical guidelines explicitly discourage the pooling of fecal samples from multiple donors during processing, to maintain donor traceability and mitigate the potential for pathogen dissemination (<xref ref-type="bibr" rid="B79">Keller et&#xa0;al., 2021</xref>). However, HMA model development strategies often involve compositing donor material to achieve a uniform distribution of human-derived gut microbiota across recipient animals (<xref ref-type="bibr" rid="B128">S&#xe1;nchez-Quintero et&#xa0;al., 2023</xref>), thereby minimizing inter-individual variability. Fecal homogenization tools include traditional mortar-pestle grinding (<xref ref-type="bibr" rid="B159">Turnbaugh et&#xa0;al., 2009</xref>), dedicated blenders (<xref ref-type="bibr" rid="B87">Lauko et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B122">Reygner et&#xa0;al., 2020</xref>), the Ultra-Turrax blender (<xref ref-type="bibr" rid="B70">Humblot et&#xa0;al., 2005</xref>), and the Nanogenizer-Titanium High-Pressure Homogenizer (<xref ref-type="bibr" rid="B147">Staley et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B77">Kaiser et&#xa0;al., 2021</xref>). At present, there is a deficiency of comparative research examining the effects of various homogenization instruments on FMT. The available evidence suggests that following the blending process using either a blender or a pneumatic mixer, high-throughput DNA sequencing reveals a notable decrease in intra-sample heterogeneity (<xref ref-type="bibr" rid="B65">Hsieh et&#xa0;al., 2016</xref>). Dilution and filtration are common procedures during suspension preparation (<xref ref-type="bibr" rid="B51">Grabrucker et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B176">Zabolotneva et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B182">Zhang et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B53">Han et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B122">Reygner et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B179">Zhang et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B147">Staley et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B181">Zhang et&#xa0;al., 2013</xref>), which may help remove food debris, reduce the viscosity of the suspension, and prevent catheter occlusion during administration. Drawing from the aforementioned information, we recommend blending fecal samples followed by sequential dilution, homogenization, and filtration to obtain representative suspensions. Researchers should explicitly document their procedural details during such experiments&#x2014;particularly the diluent composition and dilution ratio&#x2014;to enhance experimental reproducibility.</p>
<table-wrap id="T2" position="float">
<label>Table&#xa0;2</label>
<caption>
<p>Preparation and storage conditions of fecal suspensions.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="middle" colspan="2" align="center">Fecal sample</th>
<th valign="middle" rowspan="2" align="center">Condition</th>
<th valign="middle" colspan="2" align="center">Dilution</th>
<th valign="middle" rowspan="2" align="center">Storage</th>
<th valign="middle" rowspan="2" align="center">References</th>
</tr>
<tr>
<th valign="middle" align="center">Fresh/frozen</th>
<th valign="middle" align="center">Dosage(g)</th>
<th valign="middle" align="center">Solution</th>
<th valign="middle" align="center">Concentration</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center">1</td>
<td valign="middle" align="center">Anaerobic</td>
<td valign="middle" align="center">Anaerobic mineral solution containing 5 g/l NaCl, 2 g/l glucose and 0.3 g/l cysteine&#x2013;HCl</td>
<td valign="middle" align="center">1:10(wt:v)</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B88">Le Bihan et&#xa0;al., 2015</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Anaerobic</td>
<td valign="middle" align="center">Anaerobic mineral solution</td>
<td valign="middle" align="center">1:1000(wt:v)</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B28">Crouzet et&#xa0;al., 2013</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">0.1 M phosphate-buffered saline (PBS) buffer (pH 7.2)</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B105">Mao et&#xa0;al., 2021</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Anaerobic</td>
<td valign="middle" align="center">0.85% saline</td>
<td valign="middle" align="center">1:50(wt:v)</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B55">Hanske et&#xa0;al., 2009</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Frozen</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Sterile PBS containing 20% glycerol</td>
<td valign="middle" align="center">100 mg/mL</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B51">Grabrucker et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Frozen</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Sterile saline</td>
<td valign="middle" align="center">100 mg/mL</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B61">Hintze et&#xa0;al., 2014</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center">1</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">PBS</td>
<td valign="middle" align="center">1:9</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B24">Chiu et&#xa0;al., 2017</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Frozen</td>
<td valign="middle" align="center">0.2-0.5</td>
<td valign="middle" align="center">Anaerobic</td>
<td valign="middle" align="center">Anaerobic Mega Media</td>
<td valign="middle" align="center">100 mg/mL</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B71">Hutchison et&#xa0;al., 2024</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="center">1</td>
<td valign="middle" align="center">Anaerobic</td>
<td valign="middle" align="center">LuriaBertani medium containing 15% glycerol</td>
<td valign="middle" align="center">1g:30 mL</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B66">Hsu et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Frozen</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Sterile PBS</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B171">Xia et&#xa0;al., 2019</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">PBS</td>
<td valign="middle" align="center">1:9(wt:v)</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B150">Sun et&#xa0;al., 2022</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Anaerobic</td>
<td valign="middle" align="center">Brain-Heart Infusion (BHI) supplemented with 0.5 mg/mL L-cysteine and 20% skim milk</td>
<td valign="middle" align="center">1:100(wt:v)</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B146">Spatz et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="center">0.5</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">PBS buffer containing 0.5 g/L cysteine</td>
<td valign="middle" align="center">100 mg/mL</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B98">Liu et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">BHI supplemented with 0.5&#x2009;mg/mL L-cysteine and 20% skim milk (vol/vol)</td>
<td valign="middle" align="center">1:100(wt:v)</td>
<td valign="middle" align="center">&#x2212;80&#x2009;&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Frozen</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Sterile PBS</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#x2009;&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B163">von Klitzing et&#xa0;al., 2017b</xref>, <xref ref-type="bibr" rid="B162">2017a</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Frozen</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Sterile saline</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B67">Huang et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Anaerobic</td>
<td valign="middle" align="center">Sterile PBS with 20% glycerol</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B175">Ye et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Frozen</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">BHI</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B154">Tintelnot et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Saline with 50% sterile glycerol</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B182">Zhang et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Frozen</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Sterile saline</td>
<td valign="middle" align="center">1:10(wt:v)</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B161">Van Den Ham et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="center">0.1</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Sterile PBS</td>
<td valign="middle" align="center">1g:15mL</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B96">Lin et&#xa0;al., 2021</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="center">1</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Saline</td>
<td valign="middle" align="center">1:10(wt:v)</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B156">Togao et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Frozen</td>
<td valign="middle" align="center">0.1</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Saline</td>
<td valign="middle" align="center">1:10(wt:v)</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B176">Zabolotneva et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Frozen</td>
<td valign="middle" align="center">2.5</td>
<td valign="middle" align="center">Anaerobic</td>
<td valign="middle" align="center">Sterile Similac<sup>&#xae;</sup> infant formula</td>
<td valign="middle" align="center">1g:20mL</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B5">Aluthge et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Frozen</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">The maltodextrin-trehalose cocktail, 10% glycerol or 80% glycerol</td>
<td valign="middle" align="center">1:6 (v:v)</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B122">Reygner et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Sterile PBS</td>
<td valign="middle" align="center">1:10 (v:v)</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B128">S&#xe1;nchez-Quintero et&#xa0;al., 2023</xref>, <xref ref-type="bibr" rid="B129">2022</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center">50&#x2009;</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Sterile normal saline, 0.1&#x2009;M PBS containing 10% sterile medical glycerin</td>
<td valign="middle" align="center">1:50(wt:v)</td>
<td valign="middle" align="center">&#x2212;80&#x2009;&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B53">Han et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B179">Zhang et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Frozen</td>
<td valign="middle" align="center">10</td>
<td valign="middle" align="center">Anaerobic</td>
<td valign="middle" align="center">0.1 M PBS</td>
<td valign="middle" align="center">1:10(wt:v)</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B34">Dong et&#xa0;al., 2021</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Anaerobic</td>
<td valign="middle" align="center">Sterile pre-reduced PBS</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B99">Liu et&#xa0;al., 2022</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center">0.25</td>
<td valign="middle" align="center">Anaerobic</td>
<td valign="middle" align="center">LYBHI medium (containing 0.05% cysteine and 0.2% hemin) with 20% glycerol</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#x2009;&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B41">Fan et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center">0.5</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">PBS</td>
<td valign="middle" align="center">1:10</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B164">Wahlstr&#xf6;m et&#xa0;al., 2017</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">0.1&#x2009;M PBS with 15% glycerol</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B120">Renu et&#xa0;al., 2022</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Sterile glycerol 15% (v/v)</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B32">Dhakal et&#xa0;al., 2019</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Reduced PBS containing 10% glycerol</td>
<td valign="middle" align="center">1:10</td>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B181">Zhang et&#xa0;al., 2013</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fresh</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">PBS containing 10% glycerol</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">&#x2212;80&#xb0;C</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B147">Staley et&#xa0;al., 2017</xref>)</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="s2_5">
<label>2.5</label>
<title>Fecal microbiota assessment methodologies</title>
<p>Before FMT implementation, fecal suspensions are typically assessed via culturing-based methods (<xref ref-type="bibr" rid="B11">Bereswill et&#xa0;al., 2011</xref>), flow cytometry (<xref ref-type="bibr" rid="B12">Bilinski et&#xa0;al., 2020</xref>), 16S rRNA sequencing (<xref ref-type="bibr" rid="B11">Bereswill et&#xa0;al., 2011</xref>), shotgun metagenomic sequencing (<xref ref-type="bibr" rid="B98">Liu et&#xa0;al., 2023</xref>), or agar spot assays (<xref ref-type="bibr" rid="B122">Reygner et&#xa0;al., 2020</xref>). These analytical modalities collectively evaluate MV, composition, quantitation, and antagonistic capacity against specific bacterial strains. Conventional culturing methods typically detect only ~30&#x2013;50% of viable gut microbes (<xref ref-type="bibr" rid="B1">Adak and Khan, 2019</xref>). Bilinski et&#xa0;al. demonstrated that flow cytometry with fluorochromes provides superior bacterial viability validation (<xref ref-type="bibr" rid="B12">Bilinski et&#xa0;al., 2020</xref>). The next-generation sequencing (NGS)&#x2014;including 16S rRNA gene sequencing and shotgun metagenomics represent the common methodologies used in microbial studies, both of which carry distinct advantages. The 16S rRNA gene sequencing is well-suited to large-scale cohort analyses. However, it suffers from reduced accuracy in terms of species-level classification and functional profiling capacity&#x2014;thus precluding the detection of strain-level variations (<xref ref-type="bibr" rid="B76">Jovel et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B166">Wensel et&#xa0;al., 2022</xref>). Conversely, the shotgun metagenomics facilitates strain identification and functional prediction but carries substantially higher costs (<xref ref-type="bibr" rid="B76">Jovel et&#xa0;al., 2016</xref>; <xref ref-type="bibr" rid="B166">Wensel et&#xa0;al., 2022</xref>). The agar spot test serves as a simple and effective preliminary screening tool for selecting antagonistic fecal samples in FMT-bacterial infection therapy, thus reducing downstream experimental expenditures (<xref ref-type="bibr" rid="B127">Salandre et&#xa0;al., 2023</xref>). In summary, shotgun metagenomic sequencing and agar spot assays are considered more suitable analytical methods for conducting detailed characterizations of specific bacterial strains or for selecting functionally specialized samples. However, the viable microbial number and 16S rRNA gene sequencing are recommended for initial community profiling due to its cost-effectiveness, ease of use, and suitability for large-scale or routine analyses.</p>
</sec>
</sec>
<sec id="s3">
<label>3</label>
<title>Recipient selection</title>
<sec id="s3_1">
<label>3.1</label>
<title>Recipient types</title>
<sec id="s3_1_1">
<label>3.1.1</label>
<title>Germ-free animals</title>
<p>Germ-free (GF) animals are born and maintained in isolators throughout their lifespans, thus having minimal or no microbial exposure (<xref ref-type="bibr" rid="B36">Dremova et&#xa0;al., 2023</xref>). GF mice are still the most extensively used model organisms of this type&#x2014;although axenic pig, dog, and chicken systems have been successfully generated through the progressive development of various technologies (<xref ref-type="bibr" rid="B32">Dhakal et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B160">Uzbay, 2019</xref>; <xref ref-type="bibr" rid="B181">Zhang et&#xa0;al., 2013</xref>). The establishment of gnotobiotic models through the colonization of GF animals with defined microbial consortia can provide controllable platforms for investigating host-microbe interactions (<xref ref-type="bibr" rid="B36">Dremova et&#xa0;al., 2023</xref>). Excluding the confounding effects of indigenous microbiota and antibiotics, this approach is widely regarded as an optimal strategy for generating human microbiota-associated (HMA) models. The applications of GF animals primarily include the following aspects: (1) elucidating the relationship between microbes and diseases to explore pathogenic mechanisms (<xref ref-type="bibr" rid="B67">Huang et&#xa0;al., 2020</xref>); (2) investigating the protective roles of microbes, such as resistance to the pathogen <italic>Clostridioides difficile</italic> (<xref ref-type="bibr" rid="B148">Sulaiman et&#xa0;al., 2025</xref>, <xref ref-type="bibr" rid="B149">2024</xref>), mitigation of obesity (<xref ref-type="bibr" rid="B105">Mao et&#xa0;al., 2021</xref>), and alleviation of gastrointestinal discomfort (<xref ref-type="bibr" rid="B124">Rocha Martin et&#xa0;al., 2022</xref>); (3) studying metabolites produced by gut microbial communities, such as short-chain fatty acids (<xref ref-type="bibr" rid="B97">Liu et&#xa0;al., 2025</xref>), bile acids (<xref ref-type="bibr" rid="B173">Xue et&#xa0;al., 2025</xref>), and lactate (<xref ref-type="bibr" rid="B93">Li et&#xa0;al., 2022</xref>); (4) examining factors influencing microbial communities, including responses and functional outputs to dietary fibers and different types of diets (<xref ref-type="bibr" rid="B43">Feng et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B159">Turnbaugh et&#xa0;al., 2009</xref>); and (5) exploring the mechanisms by which drugs target the gut microbiota for therapeutic effects (<xref ref-type="bibr" rid="B94">Li et&#xa0;al., 2023</xref>). However, the utility of axenic models is constrained by three intrinsic barriers: first, the operational costs of isolator-based husbandry and sterile maintenance are prohibitive (<xref ref-type="bibr" rid="B80">Kennedy et&#xa0;al., 2018</xref>); second, open-environment behavioral assays and coinfection studies cannot be implemented (<xref ref-type="bibr" rid="B80">Kennedy et&#xa0;al., 2018</xref>); and third, immuno-developmental deficits inevitably arise because of the absence of gut microbiota (<xref ref-type="bibr" rid="B80">Kennedy et&#xa0;al., 2018</xref>). Collectively, these limitations have reduced the applicability of such models in terms of sophisticated pathophysiological research.</p>
</sec>
<sec id="s3_1_2">
<label>3.1.2</label>
<title>Altered Schaedler&#x2019;s flora animals</title>
<p>To circumvent the immunological and developmental deficits of GF animals while maintaining controlled microbial status, altered Schaedler&#x2019;s flora (ASF) animals were developed as well-defined microbiota models. Originating from Schaedler&#x2019;s 1965 longitudinal tracking of gut microbiota succession in Nelson-Collins Swiss mice from birth to weaning, this model incorporates a standardized bacterial consortium that has been designated Schaedler&#x2019;s flora (<xref ref-type="bibr" rid="B134">Schaedler et&#xa0;al., 1965</xref>). In 1978, Orcutt et&#xa0;al. refined and standardized this microbial consortium for stable intestinal colonization in murine hosts, and formally designated it ASF (<xref ref-type="bibr" rid="B157">Trexler and Orcutt, 1999</xref>). ASF serves as a representation of conventional murine gut microbiota (<xref ref-type="bibr" rid="B30">Deloris Alexander et&#xa0;al., 2006</xref>), demonstrating heritable stability through transgenerational propagation after colonization (<xref ref-type="bibr" rid="B131">Sarma-Rupavtarm et&#xa0;al., 2004</xref>). Compared to GF mice, ASF mice exhibit normal gastrointestinal architecture and physiological functions, along with fully developed immune systems (<xref ref-type="bibr" rid="B113">Proctor et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B131">Sarma-Rupavtarm et&#xa0;al., 2004</xref>). These animals are preferentially used to investigate specific microbial influences, intestinal mucosal responses, and the development of the enteric nervous system (<xref ref-type="bibr" rid="B170">Wymore Brand et&#xa0;al., 2015</xref>). However, the use of ASF mice in HMA studies remains scarce. Staley et&#xa0;al. demonstrated separate human donor microbiota transferability to ASF mice but revealed divergent outcomes. One cage exhibited significant microbial divergence from the donors (<italic>P</italic>=0.002), while another maintained no detectable divergence (<italic>P</italic>=0.012) (<xref ref-type="bibr" rid="B147">Staley et&#xa0;al., 2017</xref>). This heterogeneity suggests a potential niche competition between native ASF and humanized microbiomes (<xref ref-type="bibr" rid="B147">Staley et&#xa0;al., 2017</xref>), though the specific mechanisms underlying this phenomenon merit further investigation. The current evidence in the field is insufficient in terms of clearly defining the utility of ASF systems regarding humanized microbiota transfer, thus demanding expanded experimental validation.</p>
</sec>
<sec id="s3_1_3">
<label>3.1.3</label>
<title>Antibiotic administration-induced pseudo-germ-free animals</title>
<p>Although rodent and human gut microbiomes share taxonomic similarities, 85% of the microbial genera present in rodents are absent in humans (<xref ref-type="bibr" rid="B91">Ley et&#xa0;al., 2005</xref>). Thus, pre-FMT preparation must maximize the depletion of native microbiota to enhance the engraftment efficiency of transplanted communities. Specific pathogen-free (SPF) animals are those maintained in barrier-controlled environments, with certification confirming the absence of a defined set of common pathogens to which the species is typically exposed in a natural setting (<xref ref-type="bibr" rid="B33">Dobson et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B86">Lane-Petter, 1962</xref>). The establishment of pseudo-GF animals using various antibiotic regimens (<xref ref-type="table" rid="T3">
<bold>Table&#xa0;3</bold>
</xref>) constitutes the primary preparatory phase for establishing HMAs based on SPF animals. This strategy originated in 1954 with Bohnhoff&#x2019;s seminal discovery that the oral administration of high-dose streptomycin (50 mg) significantly increased the susceptibility to <italic>Salmonella enteritidis</italic> infection in mice (<xref ref-type="bibr" rid="B14">Bohnhoff et&#xa0;al., 1954</xref>). This discovery revealed that antibiotics disrupt gut microbiota homeostasis. It also established an experimental approach that leverages the antimicrobial suppression of native microbiota to enhance colonization potential. Subsequent studies demonstrated a 10&#xd7; reduction in fecal 16S rDNA load and drastic structural alterations in microbial communities by day 10 of antibiotic treatment (<xref ref-type="bibr" rid="B60">Hill et&#xa0;al., 2010</xref>). This significantly increased the probability of effective donor microbiota colonization via FMT.</p>
<table-wrap id="T3" position="float">
<label>Table&#xa0;3</label>
<caption>
<p>Exemplary intestinal preparation strategies for recipient cohorts.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="middle" align="center">Administration techniques</th>
<th valign="middle" align="center">Gut decontamination Strategy</th>
<th valign="middle" align="center">Add-ons</th>
<th valign="middle" align="center">Detection methods and depletion status of intestinal microbiome</th>
<th valign="middle" align="center">Antibiotic washout period</th>
<th valign="middle" align="center">References</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="middle" align="center">Oral gavage</td>
<td valign="middle" align="left">Vancomycin (100 mg/kg), Neomycin Sulfate (200 mg/kg), Metronidazole (200 mg/kg), and Ampicillin (200 mg/kg), Qd, 5 consecutive days.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left">16S rRNA gene sequencing</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B22">Chen et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B85">Kong et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Vancomycin (100 mg/kg), Neomycin Sulfate (200 mg/kg), Metronidazole (200 mg/kg), and Ampicillin (200 mg/kg), Qd, 3 consecutive weeks.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left">16S rRNA gene sequencing</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B95">Liang et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Vancomycin (400 mg/kg), Neomycin (400 mg/kg), and Metronidazole (200 mg/kg), 3 consecutive days.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left">16S rRNA gene sequencing</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B150">Sun et&#xa0;al., 2022</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Vancomycin (10 g/L), Metronidazole <break/>(20 g/L), Gentamicin (4 g/L), and Ampicillin (20 g/L), 0.2mL/Qd, 3 consecutive days.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B171">Xia et&#xa0;al., 2019</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Oral gavage+ subcutaneous injection</td>
<td valign="middle" align="left">Amoksiklav (2 &#xd7; 457 mg/5 mL) 0.2 mL/d + Ciprinol con infusion (5 &#xd7; 10 mL/100 mg), 0.1 mL/Q12h, 5 consecutive days.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B87">Lauko et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">
<italic>Ad libitum</italic> antibiotic solution</td>
<td valign="middle" align="left">Phase 1: Ertapenem Sodium (1 g/L), Neomycin Sulfate (1 g/L), and Vancomycin Hydrochloride (1 g/L) administered for 7 consecutive days;<break/>Transition: Standard drinking water <italic>ad libitum</italic> for 2 days;<break/>Phase 2: Ampicillin (1 g/L), Cefoperazone Sodium salt (1 g/L), and Clindamycin Hydrochloride (1 g/L) administered for 7 days;<break/>Transition: Standard drinking water <italic>ad libitum</italic> for 2 days;<break/>Phase 3: Repeat phase 1 for 7 consecutive days.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left"/>
<td valign="middle" align="center">48h</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B77">Kaiser et&#xa0;al., 2021</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Amoxicillin (0.5 g/L) for 8 consecutive days.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left"/>
<td valign="middle" align="center">24h</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B127">Salandre et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Ampicillin (1 g/L), Vancomycin (500 mg/L), Ciprofloxacin HCL (200 mg/L), and Imipenem (250 mg/L) for 7 consecutive days</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left">16S rRNA gene sequencing</td>
<td valign="middle" align="center">72h</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B51">Grabrucker et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Ampicillin (1 g/L), Vancomycin (500 mg/L), Ciprofloxacin (200 mg/L), Imipenem (250 mg/L) and Metronidazole(1 g/L) for 6 consecutive weeks</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left">16S rRNA gene sequencing confirmed bacterial absence in the generated secondary abiotic mice fecal samples</td>
<td valign="middle" align="center">72h</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B57">Heimesaat et&#xa0;al., 2018</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Ampicillin (1 g/L), Vancomycin (500 mg/L), Ciprofloxacin (200 mg/l), Imipenem (250 mg/L) and Metronidazole(1 g/L) <break/>for 6&#x2013;8 consecutive weeks</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B11">Bereswill et&#xa0;al., 2011</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Ampicillin (1 g/L), Vancomycin (500 mg/L), Neomycin (100 mg/l) and Metronidazole (1 g/L) for 6 consecutive weeks</td>
<td valign="middle" align="center">10% sucrose</td>
<td valign="middle" align="left">Bacterial culture, Quantitative PCR, and Fluorescent <italic>in-situ</italic> Hybridization (FISH): 96% stool DNA reduction at day 3 of antibiotic treatment compared to baseline (<italic>P</italic> &lt; 0.00001).</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B6">Amorim et&#xa0;al., 2022</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Ampicillin (2 g/L) plus Sulbactam (1 g/L) for 8 consecutive weeks.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left"/>
<td valign="middle" align="center">48h</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B59">Heimesaat et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B141">Shayya et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Ampicillin plus sulbactam (1 g/L), Vancomycin (500 mg/L), Ciprofloxacin (200 mg/L), Imipenem (250 mg/L), and Metronidazole (1 g/L) for 6&#x2013;8 consecutive weeks.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left"/>
<td valign="middle" align="center">72h</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B163">von Klitzing et&#xa0;al., 2017b</xref>, <xref ref-type="bibr" rid="B162">2017a</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Ampicillin plus sulbactam (1 g/L), Vancomycin (500 mg/L), Ciprofloxacin <break/>(200 mg/L), Imipenem (250 mg/L) and Metronidazole (1 g/L) for 8 consecutive weeks.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left"/>
<td valign="middle" align="center">72h</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B83">Kl&#xf8;ve et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Ampicillin (1 g/L), Neomycin Sulfate (1 g/L), Metronidazole (1 g/L), and Vancomycin Hydrochloride (1 g/L) for 4 consecutive weeks.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left"/>
<td valign="middle" align="center">48h</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B178">Zhan et&#xa0;al., 2024</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Ampicillin (1 g/L), Cefoperazone Sodium salt (1 g/L), and Clindamycin Hydrochloride <break/>(1 g/L) administered for 7 days.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left">16S rRNA gene sequencing: antibiotic treatments significantly reduced Shannon community diversity indices relative to those before antibiotic exposure or among donor samples (Tukey&#x2019;s <italic>post hoc</italic> test <italic>P</italic> &lt; 0.0001).</td>
<td valign="middle" align="center">48h</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B147">Staley et&#xa0;al., 2017</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Ampicillin (1 g/L), Vancomycin (500 mg/L), Neomycin (500 mg/L), Gentamicin <break/>(100 mg/L) and Erythromycin (10 mg/L) for 2 consecutive weeks.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left"/>
<td valign="middle" align="center">48h</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B182">Zhang et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Ampicillin (1 g/L), Neomycin (1 g/L), Metronidazole (1 g/L) and Vancomycin Hydrochloride (1 g/L) administered for 7 days.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left"/>
<td valign="middle" align="center">96h</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B98">Liu et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Ciprofloxacin (30 mg/kg) administered for 4 days.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left">16S rRNA gene sequencing: antibiotic treatment reduced the mouse&#x2019;s autochthonous gut microbial load by 1&#x2013;2 orders of magnitude.</td>
<td valign="middle" align="center">3h</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B168">Wos-Oxley et&#xa0;al., 2012</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">
<italic>Ad libitum</italic> antibiotic solution + Intraperitoneal injection</td>
<td valign="middle" align="left">Phase 1: Drinking water containing Kanamycin (0.4 mg/mL), Gentamicin <break/>(0.035 mg/mL), Colistin (850 U/mL), Metronidazole (0.215 mg/mL), and Vancomycin (0.045 mg/mL) for 3 consecutive days Washout: Standard <break/>water ad libitum for 1 day;<break/>Phase 2: Single intraperitoneal injection of Clindamycin (10 mg/kg).</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B122">Reygner et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">
<italic>Ad libitum</italic> antibiotic solution+ Oral gavage</td>
<td valign="middle" align="left">Phase 1: Drinking water containing Ampicillin (1 g/L) During the period;<break/>Phase 2: Orally gavage Vancomycin <break/>(5 mg/mL), Neomycin (10 mg/mL), and Metronidazole (10 mg/mL), 10 mL/kg/Q12h for 10 consecutive days.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B129">S&#xe1;nchez-Quintero et&#xa0;al., 2022</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Phase 1: Drinking water containing Ampicillin (1 g/L) During the period;<break/>Phase 2: Orally gavage Amphotericin B <break/>(1 mg/kg), Q12h for 3 consecutive days;<break/>Phase 3: Orally gavage Vancomycin <break/>(500 mg/L), Neomycin (100 mg/l), and Metronidazole(1 g/L)and Amphotericin B <break/>(1 mg/kg), Q12h for 14 consecutive days.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left"/>
<td valign="middle" align="center">12h</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B61">Hintze et&#xa0;al., 2014</xref>; <xref ref-type="bibr" rid="B82">Kim et&#xa0;al., 2024</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Oral gavage</td>
<td valign="middle" align="left">After 1-hour fasting, oral gavage administration of polyethylene glycol 4000 (PEG4000)</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left"/>
<td valign="middle" align="center">4h</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B146">Spatz et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center"/>
<td valign="middle" align="left">After 1-hour fasting, 200 &#x3bc;L of polyethylene glycol 4000 (PEG4000; 425 g/L) was administered via oral gavage at 20-minute intervals, with the cycle repeated 2&#x2013;6 times.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="left">Real-time qPCR analysis of the 16S rRNA gene sequencing: a significant 1-Log decrease (90% of the total bacteria), and reaching the plateau phase.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>)</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>The administration routes include <italic>ad libitum</italic> antibiotic solution (<xref ref-type="bibr" rid="B6">Amorim et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B11">Bereswill et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B51">Grabrucker et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B59">Heimesaat et&#xa0;al., 2024</xref>, <xref ref-type="bibr" rid="B57">2018</xref>; <xref ref-type="bibr" rid="B77">Kaiser et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B127">Salandre et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B141">Shayya et&#xa0;al., 2023</xref>), oral gavage (<xref ref-type="bibr" rid="B22">Chen et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B85">Kong et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B95">Liang et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B150">Sun et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B171">Xia et&#xa0;al., 2019</xref>), and injection (<xref ref-type="bibr" rid="B87">Lauko et&#xa0;al., 2023</xref>). Among these, drinking antibiotic solutions offers maximal technical simplicity.However, it carries a risk of dehydration, which may result from animals avoiding water due to the taste of the antibiotic or from antibiotic-associated diarrhea caused by prolonged exposure to the solution (<xref ref-type="bibr" rid="B60">Hill et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B117">Reikvam et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B172">Xu et&#xa0;al., 2023</xref>). Modified regimens, such as removing gentamicin or supplementing with sweeteners, have failed to mitigate this issue (<xref ref-type="bibr" rid="B60">Hill et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B117">Reikvam et&#xa0;al., 2011</xref>). By contrast, gavage delivery circumvents the dehydration trap while displaying microbiota depletion-associated phenotypes (<xref ref-type="bibr" rid="B60">Hill et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B117">Reikvam et&#xa0;al., 2011</xref>).Furthermore, several investigators have combined various delivery modalities like &#x201c;oral gavage + subcutaneous injection&#x201d; (<xref ref-type="bibr" rid="B87">Lauko et&#xa0;al., 2023</xref>), &#x201c;<italic>ad libitum</italic>antibiotic solution + intraperitoneal injection&#x201d; (<xref ref-type="bibr" rid="B122">Reygner et&#xa0;al., 2020</xref>), and &#x201c;<italic>ad libitum</italic>antibiotic solution + oral gavage&#x201d; (<xref ref-type="bibr" rid="B129">S&#xe1;nchez-Quintero et&#xa0;al., 2022</xref>) to achieve superior methodological outcomes.</p>
<p>Different antimicrobial agents exhibit different targeting mechanisms. Metronidazole selectively impacts anaerobes, vancomycin targets gram-positive bacteria, and ampicillin and ciprofloxacin act against both gram-positive and gram-negative species (<xref ref-type="bibr" rid="B137">Schubert et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B177">Zackular et&#xa0;al., 2016</xref>). Consequently, antibiotic cocktails (including dual or multiple antibiotics and antifungals) are essential for comprehensive microbial eradication (<xref ref-type="bibr" rid="B163">von Klitzing et&#xa0;al., 2017b</xref>, <xref ref-type="bibr" rid="B162">2017a</xref>; <xref ref-type="bibr" rid="B178">Zhan et&#xa0;al., 2024</xref>).</p>
<p>In pseudo-GF animal models generation, different types of antibiotics exhibit varying dosages depending on the administration route. For example, the commonly used oral gavage dose of vancomycin is 100 mg/kg (<xref ref-type="bibr" rid="B22">Chen et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B85">Kong et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B95">Liang et&#xa0;al., 2020</xref>), while the dose via drinking water is 500 mg/L (<xref ref-type="bibr" rid="B51">Grabrucker et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B6">Amorim et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B83">Kl&#xf8;ve et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B57">Heimesaat et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B163">von Klitzing et&#xa0;al., 2017b</xref>, <xref ref-type="bibr" rid="B162">2017a</xref>; <xref ref-type="bibr" rid="B11">Bereswill et&#xa0;al., 2011</xref>). The typical gavage dose of ampicillin is 200 mg/kg (<xref ref-type="bibr" rid="B85">Kong et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B22">Chen et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B95">Liang et&#xa0;al., 2020</xref>), whereas the dose in drinking water is 1 g/L (<xref ref-type="bibr" rid="B51">Grabrucker et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B6">Amorim et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B77">Kaiser et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B83">Kl&#xf8;ve et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B57">Heimesaat et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B163">von Klitzing et&#xa0;al., 2017b</xref>, <xref ref-type="bibr" rid="B162">2017a</xref>; <xref ref-type="bibr" rid="B11">Bereswill et&#xa0;al., 2011</xref>). For metronidazole, the gavage dose is 200 mg/kg (<xref ref-type="bibr" rid="B85">Kong et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B150">Sun et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B22">Chen et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B95">Liang et&#xa0;al., 2020</xref>), while the drinking water concentration is 1 g/L (<xref ref-type="bibr" rid="B6">Amorim et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B83">Kl&#xf8;ve et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B57">Heimesaat et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B163">von Klitzing et&#xa0;al., 2017b</xref>, <xref ref-type="bibr" rid="B162">2017a</xref>; <xref ref-type="bibr" rid="B11">Bereswill et&#xa0;al., 2011</xref>). Treatment timeframes also vary significantly. Gavage persists for 3&#x2013;21 days (<xref ref-type="bibr" rid="B95">Liang et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B150">Sun et&#xa0;al., 2022</xref>), whereas aqueous delivery via the drinking of antibiotic solutions lasts between 3&#x2013;56 days (<xref ref-type="bibr" rid="B59">Heimesaat et&#xa0;al., 2024</xref>, <xref ref-type="bibr" rid="B57">2018</xref>; <xref ref-type="bibr" rid="B98">Liu et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B122">Reygner et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B141">Shayya et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B168">Wos-Oxley et&#xa0;al., 2012</xref>). Amorim et&#xa0;al. administered broad-spectrum antibiotics (ampicillin 1 g/L, vancomycin 0.5 g/L, neomycin 1 g/L, and metronidazole 1 g/L) through drinking an antibiotic solution and subsequently quantified the depletion of gut microbiota (<xref ref-type="bibr" rid="B6">Amorim et&#xa0;al., 2022</xref>). They demonstrated a 96% reduction by day 3, progressive declines through days 7&#x2013;14, and stabilization by day 21 (<xref ref-type="bibr" rid="B6">Amorim et&#xa0;al., 2022</xref>). Tirelle et&#xa0;al. compared administration routes across temporal fecal bacterial density profiles and reported that twice-daily gavage (amphotericin-B 0.1&#x2009;g/L, ampicillin 10&#x2009;g/L, neomycin trisulfate salt hydrate 10&#x2009;g/L, metronidazole 10&#x2009;g/L, and vancomycin hydrochloride 5&#x2009;g/L) achieved a bacterial depletion efficiency comparable to that of drinking water (amphotericin-B 0.01&#x2009;g/L, ampicillin 1&#x2009;g/L, neomycin trisulfate salt hydrate 1&#x2009;g/L, metronidazole 1&#x2009;g/L, and vancomycin hydrochloride 0.5&#x2009;g/L). They demonstrated significant depletion by day 4, which was sustained until day 12 without additional clearance effects (<xref ref-type="bibr" rid="B155">Tirelle et&#xa0;al., 2020</xref>). These findings indicate that 3-day administration achieves fundamental microbiota eradication regardless of the delivery method, whereas optimized durations maintain persistent effects. Prolonged treatment regimens risk inducing antibiotic-resistant strains and compromising the health of the model animals, altering their phenotypes and increasing their mortality rates (<xref ref-type="bibr" rid="B60">Hill et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B155">Tirelle et&#xa0;al., 2020</xref>).</p>
<p>Additionally, animal studies from rat donors have demonstrated that transplantation of homologous microbiota on the second day following antibiotic administration leads to novel microbial reorganization (<xref ref-type="bibr" rid="B104">Manichanh et&#xa0;al., 2010</xref>). This phenomenon may be attributed to collateral damage caused by antibiotic residues, which can adversely affect both native and transplanted microbial communities (<xref ref-type="bibr" rid="B104">Manichanh et&#xa0;al., 2010</xref>). Therefore, restoring sterile water for a certain period prior to FMT could help mitigate the interference caused by antibiotic residues. According to existing evidence, this period typically ranges from 48 to 72 hours (<xref ref-type="bibr" rid="B51">Grabrucker et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B59">Heimesaat et&#xa0;al., 2024</xref>, <xref ref-type="bibr" rid="B57">2018</xref>; <xref ref-type="bibr" rid="B77">Kaiser et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B83">Kl&#xf8;ve et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B141">Shayya et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B147">Staley et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B163">von Klitzing et&#xa0;al., 2017b</xref>, <xref ref-type="bibr" rid="B162">2017a</xref>; <xref ref-type="bibr" rid="B178">Zhan et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B182">Zhang et&#xa0;al., 2023</xref>).</p>
</sec>
<sec id="s3_1_4">
<label>3.1.4</label>
<title>Bowel cleansing-induced pseudo-germ-free animals</title>
<p>Laxative-based bowel-cleansing agents provide another effective microbiota-depleting strategy. Polyethylene glycol (PEG), a standard colonic preparation agent for colonoscopy procedures, has been used in many clinical studies to reduce microbial biomass and diversity when administered via split-dose regimens (<xref ref-type="bibr" rid="B56">Harrell et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B75">Jalanka et&#xa0;al., 2015</xref>; <xref ref-type="bibr" rid="B184">Zhou et&#xa0;al., 2025</xref>). Current clinical FMT guidelines rank PEG enemas as the optimal secondary preparatory intervention following antibiotic pretreatment (<xref ref-type="bibr" rid="B21">Cammarota et&#xa0;al., 2017</xref>). Wrzosek et&#xa0;al. demonstrated the applicability of PEG in animal bowel preparation protocols (<xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>). Murine models that received four cycles of intragastric 425 g/L PEG 4000 (200 &#xb5;L per dose at 20 min intervals) achieved complete gastrointestinal evacuation with 90% reductions in microbial biomass (<xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>). Experimental data from mouse donor studies also indicated that 4-week regimens of PEG 400 or PEG 4000 (40% concentration, 100 &#xb5;L oral gavage delivered 5 times weekly) significantly reduced gut microbial diversity in mice, with the 40% PEG 4000 cohort showing superior efficacy (<xref ref-type="bibr" rid="B74">Ishibashi et&#xa0;al., 2023</xref>). This approach preserves intestinal immune function and gut microbiome stability vs antibiotic-mediated depletion protocols (<xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>). In complex HMA models that require concurrent antibiotic therapy because of coinfection (<xref ref-type="bibr" rid="B146">Spatz et&#xa0;al., 2023</xref>), PEG lavage prevents antibiotic-associated carryover effects. However, as an osmotic cathartic, PEG requires elevated concentrations and substantial dosages to achieve effective intestinal clearance (<xref ref-type="bibr" rid="B74">Ishibashi et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B90">Le Roy et&#xa0;al., 2018</xref>)&#x2014;which can induce electrolyte disturbances and dehydration. PEG-induced osmotic diarrhea disrupts the protective colonic mucus barrier, potentially influencing host immunocompetence (<xref ref-type="bibr" rid="B158">Tropini et&#xa0;al., 2018</xref>).</p>
<p>Overall, since antibiotic administration and bowel cleansing-induced pseudo-germ-free animals both retain residual native microbiota, these microbes may compete with the transplanted microbes or potentially develop into new ecological structures. Such models may not accurately represent a truly germ-free environment (<xref ref-type="bibr" rid="B6">Amorim et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B60">Hill et&#xa0;al., 2010</xref>; <xref ref-type="bibr" rid="B155">Tirelle et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>). Therefore, GF animals may be the optimal research model for exploring the causal relationships between microbiota and phenotypes. However, antibiotic-mediated pseudo-axenic models exhibit methodological superiority in studies focused on immunological regulation, developmental research, or targeted pathogen challenges. PEG bowel-cleansing protocols merit primary consideration if required to circumvent antibiotic-induced microbiota remodeling or residual impacts.</p>
</sec>
</sec>
<sec id="s3_2">
<label>3.2</label>
<title>Recipient age</title>
<p>Human microbiota-associated (HMA) animal models common receptor types and ages include: (1) Fischer 344 rat, 8 -week-old (<xref ref-type="bibr" rid="B28">Crouzet et&#xa0;al., 2013</xref>); (2) Sprague dawley (SD) Rat, with various starting ages including 8 -week-old (<xref ref-type="bibr" rid="B105">Mao et&#xa0;al., 2021</xref>), 10 -week-old (<xref ref-type="bibr" rid="B55">Hanske et&#xa0;al., 2009</xref>), and 13-week-old (<xref ref-type="bibr" rid="B51">Grabrucker et&#xa0;al., 2023</xref>); (3) C57BL/6 mouse, with a range of starting ages from 3 to 8-week-old (<xref ref-type="bibr" rid="B24">Chiu et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B71">Hutchison et&#xa0;al., 2024</xref>; <xref ref-type="bibr" rid="B66">Hsu et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B171">Xia et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B150">Sun et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B146">Spatz et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B127">Salandre et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B98">Liu et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B67">Huang et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B162">von Klitzing et&#xa0;al., 2017a</xref>); (4) BALB/c mouse, with various starting ages including 4,6,8-week-old (<xref ref-type="bibr" rid="B81">Kibe et&#xa0;al., 2005</xref>; <xref ref-type="bibr" rid="B96">Lin et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B156">Togao et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B176">Zabolotneva et&#xa0;al., 2023</xref>); as shown in <xref ref-type="table" rid="T4">
<bold>Table&#xa0;4</bold>
</xref>. Due to the lack of humanized microbiota animal studies across different age groups, a study describing FMT from animal donors to same-species recipients of varying ages was selected as an indirect reference for analysis. In this study, age significantly influenced the efficacy of gut microbiota colonization (<xref ref-type="bibr" rid="B90">Le Roy et&#xa0;al., 2018</xref>).Comparative analyses by Le Roy demonstrated superior donor microbiota engraftment in 3-week-old weaned SPF micecompared to 8-week-old adults (<xref ref-type="bibr" rid="B90">Le Roy et&#xa0;al., 2018</xref>). This may be because animals with low gut microbiota richness exhibit superior engraftment efficacy (<xref ref-type="bibr" rid="B40">Ericsson et&#xa0;al., 2017</xref>), as microbial diversity naturally increases with age (<xref ref-type="bibr" rid="B180">Zhang et&#xa0;al., 2015</xref>). By contrast, the dietary transition to solid food during weaning generates transient microbial instability (<xref ref-type="bibr" rid="B180">Zhang et&#xa0;al., 2015</xref>) that requires 11&#x2013;15 days to achieve full community stabilization (<xref ref-type="bibr" rid="B135">Schloss et&#xa0;al., 2012</xref>). Other compelling evidence has demonstrated that microbiota alterations established during juvenile stages are sustained into adulthood and induce phenotypic convergence between host organisms and donor profiles (<xref ref-type="bibr" rid="B27">Cox et&#xa0;al., 2014</xref>). Collectively, these findings suggest that&#xa0;3-week-old or weaning-stage juvenile animals may represent the optimal candidates for FMT selection. However, given the critical role of microbiota-immune crosstalk in host immunological maturation (<xref ref-type="bibr" rid="B4">Al Nabhani et&#xa0;al., 2019</xref>), studies advocate using 6&#x2013;8-week-old adult animals with fully developed immune systems (<xref ref-type="bibr" rid="B28">Crouzet et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B163">von Klitzing et&#xa0;al., 2017b</xref>; <xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>; <xref ref-type="bibr" rid="B29">Daharsh et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B171">Xia et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B5">Aluthge et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B9">Basson et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B179">Zhang et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B67">Huang et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B96">Lin et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B105">Mao et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B53">Han et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B150">Sun et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B127">Salandre et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B146">Spatz et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B98">Liu et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B156">Togao&#xa0;et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B41">Fan&#xa0;et&#xa0;al., 2023</xref>). Although this age-specific model better&#xa0;recapitulates microbiota-mature immune system interactions, it may compromise the efficiency of colonization. Therefore, in HMA model, we recommend strategic selection based on research priorities: juvenile models for microbiota colonization dynamics, and adult animals when investigating immunomodulatory mechanisms.</p>
<table-wrap id="T4" position="float">
<label>Table&#xa0;4</label>
<caption>
<p>Fecal microbiota transplantation (FMT) regimens and colonization efficacy.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="middle" rowspan="2" align="center">Recipient</th>
<th valign="middle" rowspan="2" align="center">Age</th>
<th valign="middle" rowspan="2" align="center">Gender</th>
<th valign="middle" rowspan="2" align="center">Recipient preparation</th>
<th valign="middle" colspan="3" align="center">FMT regimen</th>
<th valign="middle" rowspan="2" align="center">Observation time and colonization efficacy</th>
<th valign="middle" rowspan="2" align="center">References</th>
</tr>
<tr>
<th valign="middle" align="center">Method</th>
<th valign="middle" align="center">Dose</th>
<th valign="middle" align="center">Duration</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="middle" align="center">Fischer 344 Rat</td>
<td valign="middle" align="center">Adult</td>
<td valign="middle" align="center">Male</td>
<td valign="middle" align="center">Germ-free(GF)</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">1 mL</td>
<td valign="middle" align="center">Single-dose</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B88">Le Bihan et&#xa0;al., 2015</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Fischer 344 Rat</td>
<td valign="middle" align="center">8w</td>
<td valign="middle" align="center">Male</td>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">2 mL (10<sup>9</sup> CFU/mL)</td>
<td valign="middle" align="center">Single-dose</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B28">Crouzet et&#xa0;al., 2013</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Wistar Rat</td>
<td valign="middle" align="center">7w</td>
<td valign="middle" align="center">Male</td>
<td valign="middle" align="center">Antibiotic-induced intestinal microbiota depletion</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">2 mL</td>
<td valign="middle" align="center">Once daily for 21 consecutive days</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B178">Zhan et&#xa0;al., 2024</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Sprague Dawley (SD) Rat</td>
<td valign="middle" align="center">8w</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Every 2 days for 3 times</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B105">Mao et&#xa0;al., 2021</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">SD Rat</td>
<td valign="middle" align="center">10w</td>
<td valign="middle" align="center">Male</td>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">1 mL<break/>(2.7&#x2013;5.5 &#xd7; 10<sup>9</sup> cells)</td>
<td valign="middle" align="center">Single-dose</td>
<td valign="middle" align="center">PCR-coupled denaturing gradient gel electrophoresis: 55.8&#x2013;64.5% during 2-12w.</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B55">Hanske et&#xa0;al., 2009</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">SD Rat</td>
<td valign="middle" align="center">13w</td>
<td valign="middle" align="center">Male</td>
<td valign="middle" align="center">Antibiotic-induced intestinal microbiota depletion</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.3 mL<break/>(100mg/ml)</td>
<td valign="middle" align="center">Once daily for 3 consecutive days, and twice weekly during the subsequent study period</td>
<td valign="middle" align="center">16S rRNA gene sequencing: at the end of the study (59 days after FMT), 40% of the taxa from human donors engrafted into recipient rats.</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B51">Grabrucker et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">A/J strain Mouse</td>
<td valign="middle" align="center">7 w</td>
<td valign="middle" align="center">Male</td>
<td valign="middle" align="center">Antibiotic-induced intestinal microbiota depletion</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Once a week for12 weeks</td>
<td valign="middle" align="center">16S rRNA gene sequencing:76% and 66% of the mouse sequence mass was reflected in the corresponding human donor sample after 12w.</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B61">Hintze et&#xa0;al., 2014</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C57BL/6JMouse</td>
<td valign="middle" align="center">3-4w</td>
<td valign="middle" align="center">Male</td>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.5 mL</td>
<td valign="middle" align="center">Single-dose</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B24">Chiu et&#xa0;al., 2017</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C57BL/6 Mouse</td>
<td valign="middle" align="center">5w</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.1 mL<break/>(100 mg/mL)</td>
<td valign="middle" align="center">First dose, 1-week interval repeat</td>
<td valign="middle" align="center">16S rRNA gene sequencing: after 8 weeks, the amplicon sequence variant (ASV) colonization efficiencies were 52%, 52%, 49%, and 49%. The colonization efficiencies at the genus level were 58%, 68%, 66%, and 66%.</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B71">Hutchison et&#xa0;al., 2024</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C57BL/6 Mouse</td>
<td valign="middle" align="center">5-6w</td>
<td valign="middle" align="center">Female and Male</td>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.1 mL</td>
<td valign="middle" align="center">First dose, 2-week interval repeat</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B66">Hsu et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C57BL/6 Mouse</td>
<td valign="middle" align="center">6w</td>
<td valign="middle" align="center">Male</td>
<td valign="middle" align="center">Antibiotic-induced intestinal microbiota depletion</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2 mL</td>
<td valign="middle" align="center">Once daily for 14 consecutive days</td>
<td valign="middle" align="center">16S rRNA gene sequencing:4 genera (i.e., <italic>Oscillospira</italic>, <italic>Enterobacteriaceae</italic>, <italic>Bacteroides</italic>, and <italic>Bacteroidaceae</italic>) enriched in donor feces were successfully transplanted to recipient mice after 2w.</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B171">Xia et&#xa0;al., 2019</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C57BL/6J Mouse</td>
<td valign="middle" align="center">6w</td>
<td valign="middle" align="center">Female</td>
<td valign="middle" align="center">Antibiotic-induced intestinal microbiota depletion</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.3 mL</td>
<td valign="middle" align="center">Once every other day, for 3 weeks</td>
<td valign="middle" align="center">16S rDNA Amplicon Pyrosequencing: at 3 weeks post-transplantation, the Bacteroidetes/Firmicutes ratio (B/F ratio) was measured as an indicator of gut microbiota composition. The values for the control group, HMA mice group, and human donor feces were 0.968, 0.482, and 0.267, respectively, indicating that the gut microbiota of transplanted mice closely resembled that of the human donor samples.</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B150">Sun et&#xa0;al., 2022</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C57BL/6J Mouse</td>
<td valign="middle" align="center">6w</td>
<td valign="middle" align="center">Female</td>
<td valign="middle" align="center">Polyethylene glycol-mediated gut decontamination</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.35 mL</td>
<td valign="middle" align="center">Once a week for 3 weeks</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B146">Spatz et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C57BL/6 Mouse</td>
<td valign="middle" align="center">6-8w</td>
<td valign="middle" align="center">Female</td>
<td valign="middle" align="center">Antibiotic-induced intestinal microbiota depletion</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2 mL</td>
<td valign="middle" align="center">Once daily for 3 consecutive days</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B127">Salandre et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C57BL/6 Mouse</td>
<td valign="middle" align="center">8w</td>
<td valign="middle" align="center">Male</td>
<td valign="middle" align="center">Antibiotic-induced intestinal microbiota depletion</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2 mL</td>
<td valign="middle" align="center">Once daily for 3 consecutive days in the first week, and every other day to reinforce colonization for the remaining 7 weeks.</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B98">Liu et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C57BL/6J Mouse</td>
<td valign="middle" align="center">8w</td>
<td valign="middle" align="center">Female</td>
<td valign="middle" align="center">Polyethylene glycol-mediated gut decontamination</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2 mL</td>
<td valign="middle" align="center">Twice weekly for 4 weeks</td>
<td valign="middle" align="center">16S rDNA Amplicon Pyrosequencing: human bacteria are detected in recipient mice four weeks after FMT.</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C57BL/6J Mouse</td>
<td valign="middle" align="center">8w</td>
<td valign="middle" align="center">Female</td>
<td valign="middle" align="center">Antibiotic-induced intestinal microbiota depletion</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.3 mL</td>
<td valign="middle" align="center">Once daily for 2 consecutive days</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B162">von Klitzing et&#xa0;al., 2017a</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C57BL/6J Mouse</td>
<td valign="middle" align="center">8w</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2 mL</td>
<td valign="middle" align="center">Twice daily for 14 consecutive days</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B67">Huang et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C57BL/6 Mouse</td>
<td valign="middle" align="center">6 m</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2 mL<break/>(10<sup>9</sup> CFU/ml)</td>
<td valign="middle" align="center">Single-dose</td>
<td valign="middle" align="center">16S rRNA gene sequencing: 66% (76/115) and 65% (75/115) of healthy donor genus-level taxa were detected in the recipient mice at weeks 1 and 5, respectively.</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B175">Ye et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C57BL/6 Mouse</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2 mL</td>
<td valign="middle" align="center">Single-dose</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B154">Tintelnot et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C57BL/6J Mouse</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Male</td>
<td valign="middle" align="center">Antibiotic-induced intestinal microbiota depletion</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2 mL</td>
<td valign="middle" align="center">3 times per week for 21 consecutive days</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B182">Zhang et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C57BL/6N Mouse</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Female</td>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2 mL</td>
<td valign="middle" align="center">Single-dose/Once daily for 4 consecutive days/Once weekly for 4 weeks</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B161">Van Den Ham et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">BALB/c Mouse</td>
<td valign="middle" align="center">4w</td>
<td valign="middle" align="center">Female and Male</td>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.5 ml</td>
<td valign="middle" align="center">Single-dose</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B81">Kibe et&#xa0;al., 2005</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">BALB/c Mouse</td>
<td valign="middle" align="center">6w</td>
<td valign="middle" align="center">Male</td>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2 mL</td>
<td valign="middle" align="center">Twice a week</td>
<td valign="middle" align="center">16S rRNA gene sequencing: 70% of genera detected in the human fecal samples were also found in the recipient mice.</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B96">Lin et&#xa0;al., 2021</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">BALB/c Mouse</td>
<td valign="middle" align="center">6w</td>
<td valign="middle" align="center">Male</td>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2 mL</td>
<td valign="middle" align="center">Single-dose</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B156">Togao et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">BALB/c Mouse</td>
<td valign="middle" align="center">8-10w</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.1 mL</td>
<td valign="middle" align="center">three times a day, at least 4 days</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B176">Zabolotneva et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C3H/HeN Mouse</td>
<td valign="middle" align="center">3w</td>
<td valign="middle" align="center">Female and Male</td>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2 mL</td>
<td valign="middle" align="center">First dose, 1-week interval repeat</td>
<td valign="middle" align="center">16S rRNA gene sequencing: only 9 (33%), 15 (55%), and 10 (37%) of the 27 shared core ASVs from all donors colonized in the HMA mice.</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B5">Aluthge et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">C3H/HeN Mouse</td>
<td valign="middle" align="center">13w</td>
<td valign="middle" align="center">Female</td>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">0.1 mL<break/>(10<sup>7</sup> bacteria)</td>
<td valign="middle" align="center">Single-dose</td>
<td valign="middle" align="center">16S rRNA gene sequencing: fecal samples remained recoverable after 12-month cryostorage and successfully colonized the gastrointestinal tract of germ-free recipient mice.</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B122">Reygner et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">CD1 Mouse</td>
<td valign="middle" align="center">18w</td>
<td valign="middle" align="center">Female</td>
<td valign="middle" align="center">Antibiotic-induced intestinal microbiota depletion</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2 mL</td>
<td valign="middle" align="center">Once daily for 3 consecutive days</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B128">S&#xe1;nchez-Quintero et&#xa0;al., 2023</xref>, <xref ref-type="bibr" rid="B129">2022</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">db/db Mouse</td>
<td valign="middle" align="center">8w</td>
<td valign="middle" align="center">Male</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2&#x2009;mL</td>
<td valign="middle" align="center">Once daily for 14 consecutive days</td>
<td valign="middle" align="center">Fluorescence microscopy of Detection: The fecal bacteria solution was stained with the fluorescent dye, and fluorescent signals in the fecal bacteria solution of mice on day 14 confirmed successful colonization.</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B53">Han et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B179">Zhang et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">KM Mouse</td>
<td valign="middle" align="center">3-4w</td>
<td valign="middle" align="center">Male</td>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.3 mL</td>
<td valign="middle" align="center">Single-dose</td>
<td valign="middle" align="center">16S rRNA gene sequencing: Evaluated by OTUs overlap between HMA mice and human donor (reference normalized to 100%):67.50, 69.61, and 70.00% for the coarse-feed diet-fed mice and 74.42, 85.96, and 72.69% for the purified feed diet-fed mice at 1, 2, and 4 weeks, respectively.</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B34">Dong et&#xa0;al., 2021</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">NSG Mouse</td>
<td valign="middle" align="center">6&#x2013;8 w</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Antibiotic-induced intestinal microbiota depletion</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2 mL</td>
<td valign="middle" align="center">First dose,24-hour interval repeat</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B29">Daharsh et&#xa0;al., 2019</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">SAMP Mouse</td>
<td valign="middle" align="center">7w</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.20 mL/10 g<break/>(10<sup>8&#x2013;9</sup> CFU/mouse)</td>
<td valign="middle" align="center">Once weekly for 60 days</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B9">Basson et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Swiss-Webster Mouse</td>
<td valign="middle" align="center">5-9w</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.1 mL</td>
<td valign="middle" align="center">Single-dose</td>
<td valign="middle" align="center">16S rRNA gene sequencing: 59% to 81% of human-associated bacterial phylotypes (OTUs) were successfully transplanted in mice.</td>
<td valign="middle" align="center">(L. <xref ref-type="bibr" rid="B99">Liu et&#xa0;al., 2022</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Swiss-Webster Mouse</td>
<td valign="middle" align="center">6W</td>
<td valign="middle" align="center">Female</td>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2 mL</td>
<td valign="middle" align="center">First dose, 3 days after the second gavage</td>
<td valign="middle" align="center">16S rRNA gene sequencing:45 donor-ASVs (53%) were successfully engrafted in recipients.</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B41">Fan et&#xa0;al., 2023</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Swiss-Webster Mouse</td>
<td valign="middle" align="center">8-15w</td>
<td valign="middle" align="center">Female</td>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.2 mL</td>
<td valign="middle" align="center">Single-dose</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B164">Wahlstr&#xf6;m et&#xa0;al., 2017</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Germ-free gnotobiotic (Gn) pigs</td>
<td valign="middle" align="center">2w</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">1 mL Fecal inoculation blended with 40 mL sterile infant milk formula</td>
<td valign="middle" align="center">Single-dose</td>
<td valign="middle" align="center">16S metagenomic: a similar microbiota composition (&gt;99%) was observed in HMA pigs, at the genus level.</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B120">Renu et&#xa0;al., 2022</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Piglets</td>
<td valign="middle" align="center">6w</td>
<td valign="middle" align="center">Female and Male</td>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral via feed bowl admixture</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">First dose, 14 days after the second gavage</td>
<td valign="middle" align="center">16S rRNA gene sequencing: 24 (89%), 25 (93%) and 19 (70%) of the 27 shared core ASVs from all donors colonized in the HMA piglets.</td>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B5">Aluthge et&#xa0;al., 2020</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Piglets</td>
<td valign="middle" align="center">2w</td>
<td valign="middle" align="center">Female and Male</td>
<td valign="middle" align="center">GF</td>
<td valign="middle" align="center">Oral</td>
<td valign="middle" align="center">5mL Fecal inoculation blended with 40 mL sterile infant milk formula</td>
<td valign="middle" align="center">Once weekly for 3 consecutive weeks</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B32">Dhakal et&#xa0;al., 2019</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Piglets</td>
<td valign="middle" align="center">5d/8d/23d/30d</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">First 10 mL of 0.2 M carbonate buffer pH 9.5 orally, followed by 3 mL of stool homogenate.</td>
<td valign="middle" align="center">Single-dose</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B181">Zhang et&#xa0;al., 2013</xref>)</td>
</tr>
<tr>
<td valign="middle" align="center">Altered Schaedler Flora (ASF)<break/>C57BL/6 Mouse</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">Male</td>
<td valign="middle" align="center">ASF</td>
<td valign="middle" align="center">Oral-gastric gavage</td>
<td valign="middle" align="center">0.1 mL<break/>(10<sup>10</sup> cells)</td>
<td valign="middle" align="center">Single-dose</td>
<td valign="middle" align="center"/>
<td valign="middle" align="center">(<xref ref-type="bibr" rid="B147">Staley et&#xa0;al., 2017</xref>)</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="s3_3">
<label>3.3</label>
<title>Dietary impact</title>
<p>Dietary modulation plays a pivotal role in shaping the gut microbiome (<xref ref-type="bibr" rid="B186">Zmora et&#xa0;al., 2019</xref>). Empirical evidence has confirmed that different diets influence both the composition and function of intestinal microorganisms in humans as well as animals (<xref ref-type="bibr" rid="B10">Beam et&#xa0;al., 2021</xref>). This principle is equally applicable to HMA animals. Turnbaugh et&#xa0;al. proved that high-fat high-sugar diets rapidly remodeled the microbiota architectures of HMAs, impaired donor microbiota engraftment, and induced phenotypes associated with metabolic obesity (<xref ref-type="bibr" rid="B159">Turnbaugh et&#xa0;al., 2009</xref>). Dietary heterogeneity constitutes a critical determinant that prevents HMA animals from fully replicating the gut microbial profiles of their donors (<xref ref-type="bibr" rid="B142">Silley, 2009</xref>). Comparative studies have revealed that donor-matched diets fail to enhance gut microbial engraftment efficiency in HMA mice vs fixed-formula grain-based chows (<xref ref-type="bibr" rid="B161">Van Den Ham et&#xa0;al., 2023</xref>). By contrast, Schoeler et&#xa0;al. demonstrated superior microbiota transfer success rates in HMA mice that received analog diets identical to those of their human donors (<xref ref-type="bibr" rid="B136">Schoeler et&#xa0;al., 2024</xref>). In a 28-day dietary intervention study, Dong et&#xa0;al. observed equivalent microbial colonization rates between coarse-feed diet (CFD) and purified-feed diet groups (70.00% vs. 72.69%) in HMA mice (<xref ref-type="bibr" rid="B34">Dong et&#xa0;al., 2021</xref>). In particular, the CFD-fed mice exhibited gut microbial diversity profiles and functional signatures that demonstrated close proximities to those of their human donors (<xref ref-type="bibr" rid="B34">Dong et&#xa0;al., 2021</xref>). Although the effects of standardized feeds on HMA animals remain unclear, current evidence demonstrates that donor-aligned dietary formulations may reduce enteric microbiota discrepancies between donor and recipient ecosystems.</p>
</sec>
</sec>
<sec id="s4">
<label>4</label>
<title>Experimental administration protocols and treatment duration</title>
<p>Common methods for administering fecal microbiota transplantation (FMT) include rectal enema, co-housing, and oral-gastric gavage. Rectal administration requires anesthetizing the animals, gently inserting a tube into the colon, and slowly injecting a fecal bacteria suspension (<xref ref-type="bibr" rid="B185">Zhou et&#xa0;al., 2019</xref>). Nevertheless, this procedure presents technical challenges such as mucosal damage, infection, and uncontrollable absorption efficacy (<xref ref-type="bibr" rid="B15">Bokoliya et&#xa0;al., 2021</xref>). Co-housing protocols, which let germ-free (GF) mice be co-housed with colonized mice, are effective for microbiota transfer between conspecifics (<xref ref-type="bibr" rid="B54">Hansen et&#xa0;al., 2012</xref>; <xref ref-type="bibr" rid="B138">Seedorf et&#xa0;al., 2014</xref>). However, it is not suitable for the establishment of human microbiota-associated (HMA) models (<xref ref-type="bibr" rid="B15">Bokoliya et&#xa0;al., 2021</xref>). Oral gastric gavage is a method that involves using a stainless-steel or flexible cannula to a syringe to deliver the fecal suspension directly into the stomach (<xref ref-type="bibr" rid="B15">Bokoliya et&#xa0;al., 2021</xref>). This method carries potential complications, including respiratory tract injury, gastric rupture, and weight loss (<xref ref-type="bibr" rid="B15">Bokoliya et&#xa0;al., 2021</xref>). Nonetheless, empirical evidence has confirmed that single-dose FMT delivery via gavage reliably induces human microbial colonization in experimental animals (<xref ref-type="bibr" rid="B55">Hanske et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B122">Reygner et&#xa0;al., 2020</xref>). This approach therefore remains the preferred methodology for establishing HMA models.</p>
<p>Notably, emerging nanotechnology applications have introduced single-cell nanocapsules as a novel delivery vehicle for FMT (<xref ref-type="bibr" rid="B64">Hou et&#xa0;al., 2025</xref>). This innovative approach utilizes silk fibroin and phosphatidylcholine to form reinforced nanoshells around intestinal microbiota within 1 hour, achieving microbial encapsulation without compromising viability. Experimental trials involving oral administration of these nanocapsules to GF mice and colitis murine models demonstrated superior performance compared to conventional FMT through three key advantages: (1) protecting microbial communities from gastric acid and pepsin degradation; (2) significantly enhancing microbial engraftment efficiency; and (3) providing additional anti-inflammatory benefits while preserving intestinal epithelial integrity (<xref ref-type="bibr" rid="B64">Hou et&#xa0;al., 2025</xref>).</p>
<p>Another critical aspect that merits attention is the dosage and frequency of fecal suspension administration (<xref ref-type="table" rid="T1">
<bold>Table&#xa0;1</bold>
</xref>). The typical standard gavage volumes are 1&#x2013;2 mL for rats (<xref ref-type="bibr" rid="B55">Hanske et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B28">Crouzet et&#xa0;al., 2013</xref>; <xref ref-type="bibr" rid="B88">Le Bihan et&#xa0;al., 2015</xref>) and 0.1&#x2013;0.5 mL for mice (<xref ref-type="bibr" rid="B24">Chiu et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B53">Han et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B99">Liu et&#xa0;al., 2022</xref>). For developing pig HMA models, the sparse existing literature on the subject suggests an ideal inoculum volume of 1 mL (<xref ref-type="bibr" rid="B32">Dhakal et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B120">Renu et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B181">Zhang et&#xa0;al., 2013</xref>). Furthermore, some studies have characterized the total number of cells administered within these volumes, reporting, for instance, 1 mL (2.7&#x2013;5.5 &#xd7; 10<sup>9</sup> cells) for SD rats (<xref ref-type="bibr" rid="B55">Hanske et&#xa0;al., 2009</xref>), 0.2 mL (10<sup>9</sup> CFU/ml) for C57BL/6 mice (<xref ref-type="bibr" rid="B175">Ye et&#xa0;al., 2023</xref>), 0.1 mL (10<sup>7</sup> bacteria) for C3H/HeN mice (<xref ref-type="bibr" rid="B122">Reygner et&#xa0;al., 2020</xref>), and 0.20 mL/10 g (10<sup>8&#x2013;9</sup> CFU/mouse) for SAMP mice (<xref ref-type="bibr" rid="B9">Basson et&#xa0;al., 2020</xref>). Administration frequencies vary widely, ranging from single-bolus delivery to daily regimens (1&#x2013;3 doses/day) spanning 2&#x2013;60 days, or periodic administration at 2&#x2013;7-day intervals (<xref ref-type="bibr" rid="B9">Basson et&#xa0;al., 2020</xref>; <xref ref-type="bibr" rid="B29">Daharsh et&#xa0;al., 2019</xref>; <xref ref-type="bibr" rid="B41">Fan et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B164">Wahlstr&#xf6;m et&#xa0;al., 2017</xref>; <xref ref-type="bibr" rid="B176">Zabolotneva et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B178">Zhan et&#xa0;al., 2024</xref>). Hanke et&#xa0;al. demonstrated that HMA rats exhibited 55.8&#x2013;64.5% gut microbial similarity to their human donors at 2&#x2013;12 weeks post-FMT, with no significant differences observed between time points (<xref ref-type="bibr" rid="B55">Hanske et&#xa0;al., 2009</xref>). Despite the variations present in murine strains, studies by (<xref ref-type="bibr" rid="B99">Liu et&#xa0;al., 2022</xref>) (<xref ref-type="bibr" rid="B175">Ye et&#xa0;al., 2023</xref>), and (<xref ref-type="bibr" rid="B34">Dong et&#xa0;al., 2021</xref>) demonstrated that fecal suspension doses of 0.1, 0.2, and 0.3 mL achieved colonization efficiencies of 59&#x2013;81% (operational taxonomic unit, OTU level), 65&#x2013;66% (genus level), and 67.5&#x2013;85.96% (OTU level), respectively. The relationship between dosage and engraftment efficiency has yet to be elucidated. Nevertheless, current studies consistently demonstrate &#x2265;50% donor microbiota retention in HMA models following single-dose FMT following adequate intestinal preparation, regardless of the volume administered (<xref ref-type="bibr" rid="B34">Dong et&#xa0;al., 2021</xref>; <xref ref-type="bibr" rid="B55">Hanske et&#xa0;al., 2009</xref>; <xref ref-type="bibr" rid="B101">Liu et&#xa0;al., 2022</xref>; <xref ref-type="bibr" rid="B175">Ye et&#xa0;al., 2023</xref>).</p>
<p>Thus, the question has arisen of whether chronic FMT protocols with increased frequency can optimize colonization success has garnered significant attention. Experimental protocols by Aluthge et&#xa0;al. revealed that a secondary 0.2 mL fecal transplant in C3H/HeN mice (delivered at a 2-week interval) induced &gt;96% amplicon sequence variant (ASV)-level microbial retention (<xref ref-type="bibr" rid="B5">Aluthge et&#xa0;al., 2020</xref>). By contrast, Hutchison et&#xa0;al.&#x2019;s cohort of C57BL/6 mice, who received multiple 0.1 mL doses at 7-day intervals, exhibited 49&#x2013;52% ASV and 58&#x2013;68% genus-level colonization fidelity (<xref ref-type="bibr" rid="B71">Hutchison et&#xa0;al., 2024</xref>). The twice-weekly administration of a 0.2 mL fecal suspension to BALB/c mice revealed 70% genus-level colonization efficiency via 16S rRNA gene sequencing (<xref ref-type="bibr" rid="B96">Lin et&#xa0;al., 2021</xref>). Although FMT protocols with increased administration frequency appear to improve colonization success, experimental outcomes varied substantially across the above study. A comprehensive study by Van Den Ham et&#xa0;al. evaluated three fecal transplant schedules (single-dose, 4-day consecutively, and once a week for 4 weeks) using 0.2 mL inocula administered to GF mice (<xref ref-type="bibr" rid="B161">Van Den Ham et&#xa0;al., 2023</xref>). The once a week for 4 weeks protocol demonstrated superior colonization efficiency vs the other interventions, which was attributed to its capacity to establish a stabilized intestinal condition that minimized pre-engraftment microbial fluctuations, thereby narrowing the donor-recipient microbiota divergence (<xref ref-type="bibr" rid="B161">Van Den Ham et&#xa0;al., 2023</xref>). Another comparative study evaluated four FMT strategies in Polyethylene glycol (PEG)-cleansed C57BL/6J mice: (1) a single round during the first week; (2) two rounds of FMT in the first week; (3) once a week for four weeks; and (4) twice a week for four weeks (<xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>). After four weeks, the results showed that: (1) a single FMT enabled the observation of human-derived microorganisms; (2) two rounds of FMT in the first week allowed for the engraftment of sub-dominant human bacteria; (3) once-weekly regimen for four weeks was sufficient to establish dominant bacterial populations; (4) in contrast, FMT twice weekly for four weeks disrupted the stability of the newly established microbial ecosystem (<xref ref-type="bibr" rid="B169">Wrzosek et&#xa0;al., 2018</xref>). Therefore, the above evidence supports administering multiple FMT doses (cumulatively &#x2265;2 doses) over a 2&#x2013;4weeks period during the HMA model preparation to optimize the efficacy of donor microbiota engraftment.</p>
</sec>
<sec id="s5">
<label>5</label>
<title>Microbial colonization assessment strategies</title>
<p>The assessment of donor microbiota engraftment efficiency is performed through diverse detection modalities. These modalities include conventional culturing (<xref ref-type="bibr" rid="B63">Hirayama et&#xa0;al., 1995</xref>), next-generation sequencing (NGS) (<xref ref-type="bibr" rid="B85">Kong et&#xa0;al., 2023</xref>; <xref ref-type="bibr" rid="B166">Wensel et&#xa0;al., 2022</xref>), selective culturing (<xref ref-type="bibr" rid="B24">Chiu et&#xa0;al., 2017</xref>), fluorescence <italic>in situ</italic> hybridization (<xref ref-type="bibr" rid="B47">G&#xe9;rard et&#xa0;al., 2004</xref>), and temporal-temperature gradient gel electrophoresis (<xref ref-type="bibr" rid="B121">Respondek et&#xa0;al., 2013</xref>). Cultivation and isolation represent conventional approaches wherein microbiota are taxonomically enumerated post-development on selective media. Intrinsic limitations persist as slow-growing or fastidious bacteria, which are subject to microbial competition and stringent nutrient requirements, often resist <italic>in vitro</italic> isolation and cultivation (<xref ref-type="bibr" rid="B78">Kato et&#xa0;al., 2018</xref>). Strategies such as oligotrophic media, extended incubation periods, and anaerobic culturing conditions have been implemented to address these limitations (<xref ref-type="bibr" rid="B50">Goodman et&#xa0;al., 2011</xref>; <xref ref-type="bibr" rid="B114">Pulschen et&#xa0;al., 2017</xref>). Nevertheless, their high level of technical demand exacerbates in the challenges inherent to culturing gut microbiota. The advent of culture-independent NGS has resolved these obstacles by facilitating the direct sequencing of microbial DNA and RNA, thereby facilitating the detection of unculturable bacterial taxa. The emergence of culture-independent NGS has addressed these challenges by enabling the amplification and direct sequencing of microbial DNA and RNA, which in turn enhances the identification of unculturable bacterial taxa (<xref ref-type="bibr" rid="B166">Wensel et&#xa0;al., 2022</xref>). Microbial colonization efficacy can be quantified using three principal approaches derived from sequencing data. The first is donor-specific retention percentages calculated using operational taxonomic unit (OTU) (<xref ref-type="bibr" rid="B84">Knights et&#xa0;al., 2011</xref>) or amplicon sequence variant (ASV) (<xref ref-type="bibr" rid="B52">Gray et&#xa0;al., 2024</xref>) classification systems. Studies have revealed that OTU-based calculations systematically overestimate colonization efficiency vs ASV-resolution analyses (<xref ref-type="bibr" rid="B52">Gray et&#xa0;al., 2024</xref>). This might be because OTU analysis provides more spurious taxa (<xref ref-type="bibr" rid="B118">Reitmeier et&#xa0;al., 2021</xref>). Consequently, the assessment of colonization efficiency at this tier&#xa0;remains contentious, warranting genus-level analysis (<xref ref-type="bibr" rid="B175">Ye et&#xa0;al., 2023</xref>) or the implementation of alternative assessment methodologies. The second approach comprises monitoring the emergence of donor-enriched or species-specific bacterial taxa in recipient microbiota (<xref ref-type="bibr" rid="B171">Xia et&#xa0;al., 2019</xref>). This approach faces validity challenges related to interspecies microbial overlap (e.g., <italic>Prevotella</italic>, <italic>Bacteroides</italic>, <italic>Clostridium</italic>, and <italic>Eubacterium</italic>-dominant genera across human, murine, and porcine gut communities) (<xref ref-type="bibr" rid="B92">Li et&#xa0;al., 2018</xref>), rendering FMT-dependent colonization indistinguishable from native microbiota. The third approach involves assessing microbial transfer via abundance ratios (e.g., the <italic>Bacteroidetes</italic>/<italic>Firmicutes</italic> ratio) (<xref ref-type="bibr" rid="B150">Sun et&#xa0;al., 2022</xref>). However, such evaluations lack diagnostic precision, owing to multifactorial influences on microbial abundance and pre-existing microbial overlap between donors and recipients.</p>
</sec>
<sec id="s6">
<label>6</label>
<title>Conclusion and prospects</title>
<p>HMA animal models serve as indispensable tools for deciphering the roles of microbes in states of both health and disease, by simulating humanized gut microbiomes. The core technical aspects underlying the construction of HMA models remain under investigation. This review of the critical elements involved in the development of HMA models has delineated the following key findings(<xref ref-type="fig" rid="f2">
<bold>Figure&#xa0;2</bold>
</xref>): (1) Donor screening necessitates rigorous interviews regarding dietary habits, medication history, and pre-existing pathologies to eliminate a host of factors that can influence gut microbial composition. (2) Fecal preservation mandates immediate refrigeration within a 2&#x2013;6 h window after collection. (3) Fecal suspension preparation should employ multi-donor blending strategies coupled with 16S rRNA sequencing to verify microbial composition. (4) Recipient selection should preferentially utilize adult germ-free (GF) or antibiotic-induced pseudo-GF animals that are fed diets matching their human donors. (5) Oral gavage represents the ideal route for FMT, with protocols utilizing high administration frequencies (cumulatively &#x2265;2 doses) and extended durations (2&#x2013;4 weeks) demonstrating significantly higher engraftment rates. (6) Next-generation sequencing (NGS) represents an efficient methodology for quantifying microbial engraftment. Metrics used include retention rates of operational taxonomic unit (OTU)/amplicon sequence variant (ASV) between donor and recipient microbiomes. Other metrics involve the detection of donor-specific bacterial strains, and phylum-level abundance ratios. These findings establish a methodological foundation for standardizing HMA model generation protocols. The development of HMA models faces persistent challenges that include objective microbial disparities between donors, unstable colonization of human microbiota in animal recipients, methodological variations in recipient animal preparations, and various dietary influences on microbial colonization. Moreover, a rational method for assessing the efficiency of colonization is needed to maximize the preparation of reproducible and representative HMA models.</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p>Optimal protocol for establishing human microbiota-associated (HMA) animal models.</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fcimb-15-1644187-g002.tif">
<alt-text content-type="machine-generated">Flowchart illustrating the process of fecal microbiota transplantation. It breaks down into several sections: donor preparation, fecal collection, and fecal suspension preparation. Donor preparation requires a balanced diet and absence of substances like antibiotics. Fecal collection involves timely processing and specific storage conditions. Fecal suspensions are prepared through blending, dilution, and sequencing. Recipient types include germ-free or antibiotic-induced pseudo-germ-free animals. Fecal microbiota transplantation is followed by microbial colonization assessment using next-generation sequencing. Parameters such as dosing frequency and duration are highlighted.</alt-text>
</graphic>
</fig>
</sec>
</body>
<back>
<sec id="s7" sec-type="author-contributions">
<title>Author contributions</title>
<p>XH: Conceptualization, Writing &#x2013; original draft. YY: Supervision, Writing &#x2013; original draft. NT: Investigation, Writing &#x2013; original draft. JH: Writing &#x2013; original draft. XZ: Writing &#x2013; original draft. RY:&#xa0;Supervision, Writing &#x2013; review &amp; editing.</p>
</sec>
<sec id="s8" sec-type="funding-information">
<title>Funding</title>
<p>The author(s) declare financial support was received for the research and/or publication of this article. This study was supported by the National Natural Science Foundation of China (U21A20411), Natural Science Foundation of Hunan Province of China (2024JJ1007), and Hunan University of Chinese Medicine Disciplinary Construction &#x201c;Revealing the List and Appointing Leaders&#x201d; Project (22JBZ002).</p>
</sec>
<sec id="s9" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s10" sec-type="ai-statement">
<title>Generative AI statement</title>
<p>The author(s) declare that no Generative AI was used in the creation of this manuscript.</p>
<p>Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.</p>
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<sec id="s11" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
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