Fecal Microbiota Transplantation: Screening and Selection to Choose the Optimal Donor

Abstract

In the past decade, fecal microbiota transplantation (FMT) has rapidly spread worldwide in clinical practice as a highly effective treatment option against recurrent Clostridioides difficile infection. Moreover, new evidence also supports a role for FMT in other conditions, such as inflammatory bowel disease, functional gastrointestinal disorders, or metabolic disorders. Recently, some studies have identified specific microbial characteristics associated with clinical improvement after FMT, in different disorders, paving the way for a microbiota-based precision medicine approach. Moreover, donor screening has become increasingly more complex over years, along with standardization of FMT and the increasing number of stool banks. In this narrative review, we discuss most recent evidence on the screening and selection of the stool donor, with reference to recent studies that have identified specific microbiological features for clinical conditions such as Clostridioides difficile infection, irritable bowel syndrome, inflammatory bowel disease, and metabolic disorders.

Personalized Clinical Phenotyping through Systems Medicine and Artificial Intelligence

“…This might probably be attributable to the fact that donor selection is less important in Clostridium difficile colitis, as it is caused by the uncontrolled overgrowth of a single pathobiont that can be tackled by simply replacing a dysbiotic microbial flora. When it comes to more complex diseases, it is likely that an accurate donor selection will play a more important role [ 126 ], as the transferred microbiota has to struggle against more intricate alterations sustained by a chronic trigger (such as the constant over activation of inflammatory response in IBD, for instance). Extensive characterizations of gut microbiota composition and functions, as well as their interplay with the immune system, have been a major focus of study for our group [ 127 ].…”

What Makes a Successful Donor? Fecal Transplant from Anxious-Like Rats Does Not Prevent Spinal Cord Injury-Induced Dysbiosis

“…Critically, the FMT donor rats in the present study were uninjured, free of pathogens and are genetically compatible to the recipients and would likely have passed screening criteria used clinically for FMT donors. In FMT trials, potential donors undergo a preliminary interview to rule out potential risk factors such as drug use and medical history [ 15 , 19 , 49 , 50 , 51 ]. Individuals who pass the preliminary interview then undergo blood and stool testing to exclude the risk for transferring infectious diseases [ 15 , 19 , 50 , 51 ].…”

“…Individuals who pass the preliminary interview then undergo blood and stool testing to exclude the risk for transferring infectious diseases [ 15 , 19 , 50 , 51 ]. Although a history of psychiatric conditions is a risk factor for potential FMT donors [ 52 ], it is often not considered for donor screening [ 15 , 19 , 49 , 50 , 51 ]. This is particularly relevant for studies on the efficacy of FMT for depression and anxiety.…”

Evolving Technologies in Gastrointestinal Microbiome Era and Their Potential Clinical Applications

“…FMT therapy has been extended to the treatment of lifestyle and other diseases, such as diabetes, metabolic syndrome, Parkinson’s disease, obesity and cancer. FMT entails transfer of gut microbiota in feces of a healthy donor to recipient patient to correct/treat a disorder or gastrointestinal disease [ 35 , 36 , 37 ]. Although the level of success of this procedure, is yet to be wide spread due to some constraints identified by Cammarota et al [ 38 ], including difficulties with donor recruitment, lack of dedicated centers and issues pertaining to safety monitoring and regulation, hence, the proposal for the provision of stool banks to bridge the gap of FMT in clinical practice.…”