Update on Fecal Microbiota Transplantation 2015: Indications, Methodologies, Mechanisms, and Outlook

Abstract

The community of microorganisms within the human gut (or microbiota) is critical to health and functions with a level of complexity comparable to an organ system. Alterations of this ecology (or dysbiosis) has been implicated in a number of disease states, the prototypical example being Clostridium difficile infection (CDI). Fecal microbiota transplantation (FMT) has been demonstrated to durably alter the gut microbiota of the recipient and has shown efficacy in the treatment of recurrent CDI. There is hope that FMT may eventually prove beneficial for treatment of other disease associated with alterations in gut microbiota, such as inflammatory bowel disease, irritable bowel syndrome and the metabolic syndrome, to name a few. Although the basic principles that underlie the mechanisms by which FMT demonstrates therapeutic efficacy in CDI are becoming apparent, further research is needed to understand the possible role of FMT in these other conditions. Though relatively simple to perform, questions regarding both short- and long-term safety, as well as the complex and rapidly evolving regulatory landscape has limited widespread utilization. Future work will focus on establishing best practices and more robust safety data than exist currently, as well as refining FMT beyond current “whole stool” transplants to increase safety and tolerability. Encapsulated formulations, full spectrum stool-based products and defined microbial consortia are all in the immediate future.

Successful Therapy of Clostridium Difficile Infection with Fecal Microbiota Transplantation

“…FMT is an emerging therapy for CDI that offers the potential for a rapid and lasting elimination of the infection through restoration of healthy microbiota. FMT is a process of stool transfer from one or multiple healthy donors to the gut of the sick person (9).…”

Challenges in fecal donor selection and screening for fecal microbiota transplantation: A review

“…These recommendations and subsequent updates have used blood donor screening as a robust medicolegal analogy to fecal donor screening with donor questionnaires and laboratory testing. 16,17,19 This informs much of current published guidance to use questionnaires to identify risk for diseases for which there are no valid laboratory tests (or for which there may be an undetectable early-stage or windowperiod) and to use appropriate diagnostics for diseases which can be tested. 15 Since the FDA's announcement in 2013, there has been incremental revision in donor selection and screening practices with input from experts and donor screening data from public stool banking organizations.…”

Fecal microbiota transplantation in recurrent Clostridium difficile infection in a patient with concomitant inflammatory bowel disease

“…The role of Clostridium difficile in IBD pathogenesis as a cause or consequence is still unknown (2). The standard antibiotic therapy is frequently ineffective in recurrent CDI in IBD patients (5). Fecal microbiota transplantation (FMT) can be an alternative treatment, likely due to the restoration of a disrupted microbiome, thereby breaking the cycle of recurrent CDI (1,3,5).…”

“…The standard antibiotic therapy is frequently ineffective in recurrent CDI in IBD patients (5). Fecal microbiota transplantation (FMT) can be an alternative treatment, likely due to the restoration of a disrupted microbiome, thereby breaking the cycle of recurrent CDI (1,3,5). Recent studies showed a high efficacy and safety in recurrent or refractory CDI (5).…”

“…Fecal microbiota transplantation (FMT) can be an alternative treatment, likely due to the restoration of a disrupted microbiome, thereby breaking the cycle of recurrent CDI (1,3,5). Recent studies showed a high efficacy and safety in recurrent or refractory CDI (5). Nevertheless, very few data about this procedure in recurrent CDI and concomitant IBD patients have been reported (6).…”