Definition:
Fecal microbiota transplantation or FMT is the transfer of fecal material containing bacteria and natural anti-bacterials from a healthy individual into a diseased recipient. Previous terms for the procedure include fecal bacteriotherapy, fecal transfusion, fecal transplant, stool transplant, fecal enema, and human probiotic infusion (HPI). Because the procedure involves the complete restoration of the entire fecal microbiota, not just a single agent or combination of agents, these terms have now been replaced by the new term fecal microbiota transplantation. FMT is transfusion or transplant of fecal material.
The human body contains 10 bacterial cells for every human cell. Our bodies have 10 times more bacteria than human cells. This vast, largely unexplored bacterial community, known as the microbiome, has been linked to many aspects of human health, from gastrointestinal dis-eases to obesity. Importantly, disrupting the microbiome with antibiotics can cause disease by wiping out the helpful bacteria in our guts. Fortunately, a promising therapy called Fecal Microbiota Transplantation may help patients suffering from microbiome-related conditions.
Medical Use
Clostridium difficile infection
Fecal bacteriotherapy is approximately 85% to 90% effective in those for whom antibiotics have not worked or in whom the disease recurs following antibiotics.
Most people with CDI recover after just one treatment.
A 2009 study found that fecal bacteriotherapy was an effective and simple procedure that was more cost-effective than continued antibiotic administration and reduced the incidence of antibiotic resistance.
Once considered to be “last resort therapy” by some medical professionals due to its unusual nature and ‘invasiveness’ compared with antibiotics, perceived potential risk of infection transmission, and lack of Medicare coverage for donor stool, position statements by specialists in infectious diseases and other societies have been moving toward acceptance of FMT as standard therapy for relapsing CDI and also Medi-care coverage in the United States.
It has been recommended that endoscopic FMT be elevated to first-line treatment for people with clinical deterioration and severe relapsing C. difficile infection.
Ulcerative colitis and other gastrointestinal conditions
While C. difficile is easily eradicated with a single FMT infusion, this generally appears to not be the case with ulcerative colitis. Published experience of ulcerative colitis treatment with FMT largely shows that multiple and recurrent infusions are required to achieve prolonged remission or ‘cure’.
Autoimmune and neurologic conditions
The therapeutic potential of FMT in non-gastroenterologic conditions, including autoimmune disorders, neurological conditions,[11] obesity, metabolic syndrome and diabetes, multiple sclerosis, and Parkinson’s disease are now being explored. As of May 2008, studies had shown that FMT can have a positive effect on devastating neurological diseases such as Parkinson’s disease.[13] While Dr. Thomas Borody was experimenting with patients who were afflicted by both CDI and Parkin-son’s disease, he realized that after fecal therapy the symptoms of Parkinson’s in his patients began to de-crease; some to the point that the Parkinson’s could not be detected by other neurologists. The hypothesis for future studies is that the fluctuation in the body’s microbiome done by FMT can also be recreated by adding anti–Clostridium-difficile antibodies to the patient’s body, a technique intended to be used in Borody’s future case studies involving Parkinson’s disease.
Technique
A team of international gastroenterologists and infectious disease specialists have published formal standard practice guidelines for performing FMT which outline in detail the FMT procedure, including preparation of material, donor selection and screening, and FMT administration. There is preliminary evidence that the fecal transplant may also be delivered in the form of a pill.
Donor selection
Preparing for the procedure requires careful selection and screening of the donor and excluding those who test positive for certain diseases as well as any donor carrying any pathogenic gastrointestinal infectious agent.[vague][citation needed] Although a close relative is often the easiest donor to obtain and have tested, there is no reason to expect this to affect the success of the procedure as genetic similarities or differences do not appear to play a role.[2] Indeed, in some situations, use of a close relative as a donor may be a disadvantage as they may be an asymptomatic carrier of C.difficile. Donors must be tested for a wide array of bacterial and parasitic infections.[2] In more than 370 published reports there has been no reported infection transmission.[12]
Specimen preparation
Approximately 200–300 grams of fecal material is recommended per treatment[which?] for optimum results. Fresh stools have been recommended to be used within six hours, however frozen stool samples can also be used without loss of efficacy to saline as the dilution agent. There is also some evidence that using infusions of greater than 500 ml produces a higher success rate compared to infusions using less than 200 ml of prepared solution] Re-search is needed to determine whether certain mixing methods such as using an electric blender reduce the efficacy of treatment via oxygenating the solution and killing obligate anaerobes. The fecal transplant material is then prepared and administered in a clinical environment to ensure that precautions are taken.
Administration
Numerous techniques have been published, and choice depends on suitability and ease. The procedure involves single or multiple infusions of bacterial fecal flora originating from a healthy donor by enema, through a colonoscope, or through a nasogastric or nasoduodenal tube. There does not appear to be any significant methodological difference in efficacy between the various routes] A recent study has shown that fecal transplant through colonoscopy has a better outcome than transplant performed with a nasogastric or nasoduodenal tube, with a success rate of 90% of patients treated with transplant by colonoscopy vs 81% ] of patients treated with transplant by NG tube.
Autologous restoration of gastrointestinal flora]
A modified form of fecal bacteriotherapy (autologous restoration of gastro-intestinal flora—ARG) commenced development as of 2009. An autologous fecal sample, provided by the patient before anticipated medical treatment with antibiotics, is stored in a refrigerator. Should the patient subsequently develop C. difficile infection the sample is extracted with saline and filtered. There is evidence that the relapse rate is 2 fold greater when water is used as opposed to saline as the dilution agent. There is also some evidence that using infusions of greater than 500 ml produces a higher success rate compared to infusions using less than 200 ml of prepared solution] Research is needed to determine whether certain mixing methods such as using an electric blender reduce the efficacy of treatment via oxygenating the solution and killing obligate an-aerobes. The fecal transplant material is then prepared and administered in a clinical environment to ensure that precautions are taken.
Administration
Numerous techniques have been published, and choice depends on suitability and ease. The procedure involves single or multiple infusions of bacterial fecal flora originating from a healthy donor by enema, through a colonoscope, or through a nasogastric or nasoduodenal tube. There does not appear to be any significant methodological difference in efficacy between the various routes] A recent study has shown that fecal transplant through colonoscopy has a better outcome than than transplant performed with a nasogastric or nasoduodenal tube, with a success rate of 90% of patients treated with transplant by colonoscopy vs 81% ] of patients treated with transplant by NG tube.
Autologous restoration of gastrointestinal flora]
A modified form of fecal bacteriotherapy (autologous restoration of gastro-intestinal flora—ARG) commenced development as of 2009. An autologous fecal sample, provided by the patient before anticipated medical treatment with antibiotics, is stored in a refrigerator. Should the patient subsequently develop C. difficile infection the sample is extracted with saline and filtered. The filtrate is freeze-dried and the resulting solid enclosed in enteric-coated capsules. Administration of the capsules is hypothesized to restore the patient’s original colonic flora and combat C. difficile. However using one’s own original colonic flora which made them susceptible to the CDI infection in the first place obviously holds a foresee-able disadvantage. As such, it is likely that following treatment the patient will still remain susceptible to C. difficile colonisation. In comparison, the introduction of donor flora facilitates colonisation with a more robust, C. difficile-resistant flora.
Standardized filtrate
Researchers have also produced a standardized filtrate composed of viable fecal bacteria in a colorless, odorless form The preparation has been shown to be as effective at re-storing missing and deficient bacterial constituents as crude homogenized FMT.
Public stool bank in the United States
In 2012, a team of researchers from the Massachusetts Institute of Technology founded OpenBiome, the first public stool bank in the United States OpenBiome provides clinicians with frozen, ready-to-administer stool samples for use in treating C. difficile, and supports clinical research into the use of fecal transfer for other indications.
References:
https://en.wikipedia.org/wiki/Fecal_bacteriotherapy
thepowerofpoop.com
www.openbiome.org/about-fmt
thefecaltransplantfounda-tion.org/what-is-f
Articles Researched and collected By Liz Dequinia
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