By: Dr. Shaina Cahill, Ph.D. (Director Medical Communications & Affairs)
Fecal microbiota transplantation (FMT) is the infusion of specially prepared stool material from a healthy donor(s) into the gut (intestinal tract) of a recipient to restore a healthy and stable microbial community and confer health benefits and/or treat a specific disease or symptom(s) 1–4.
The idea here is that FMT will help re-educate the recipient’s gut microbiome, inducing the re-colonization of the gut, restoring microbial diversity to donor-like proportions 5–10. FMT success is often defined by a shift in the gut microbiome profile towards that of the donor 10. The efficacy of FMT may depend on the donors’ high diversity and composition of the gut microbiota and the ability to provide the necessary microbiota capable of overcoming the gut dysbiosis of the recipient 10,11. While FMT isn’t anything new, it has been around for over 1,700 years in some way, shape or form (see our FMT timeline to learn more). FMT research is still in its infancy, particularly regarding the mechanism of effect, so much is still to be understood.
Several routes of administration are used to perform FMT, including nasogastric and nasoduodenal tube, colonoscopy, retention enemas, and oral capsule 1,10,12. With the comparably high efficacy of FMT capsules, there is a shift toward capsule-based approaches 12–14. FMT capsules create a more patient-friendly alternative with their increased convenience, safety and more tolerable mode of delivery, making them an attractive option for many patients 10,12–14.
FMT and Clostridioides difficile infection (CDI)
FMT has been widely and effectively used to treat recurrent Clostridium difficile infections (rCDI) in patients that are non-responsive to antibiotic therapy 13,15–19. FMT has demonstrated a clinical effect in the treatment, decolonization and prevention of recurrence of CDI with high success rates and favourable safety profiles 5,20–25. A recent analysis found a 92% clinical resolution rate compared to the first choice antibiotics against rCDI, vancomycin 21,26. In addition, another small-scale study showed that FMT leads to higher rates of overall survival, shorter hospital stays, and lower rates of bloodstream infection in patients with rCDI than receiving antibiotics alone 22,27. Overall, FMT has been shown to be effective and has superior long-term efficacy compared to other medical treatments in CDI 3,28,29.
FMT outside of Clostridioides difficile infection (CDI)
In the last ten years, there has been increased scientific and clinical research into how modifications of the gut microbiome using FMT can improve health and tackle areas of unmet medical need. The promising outcomes of FMT to improve symptoms and alter the gut microbiota in patients with CDI have led to the expansion of research evaluating the efficacy of FMT for a wide variety of both gastrointestinal (GI) and non-GI disorders 1,4,15,24,30.
A growing body of literature indicates that FMT may be a useful treatment option for inflammatory bowel disease (IBD) 31–33, irritable bowel syndrome (IBS) 34–36, and other GI disorders 4,15,30. In addition, the therapeutic use of FMT may not be confined to GI diseases, with a growing number of studies on the use of FMT in treating a wide range of non-GI disorders, including metabolic disorders 24,37–41, autism spectrum disorder 42–44, Parkinson’s disease 45–47, and multiple sclerosis 48,49, among others 4,15,30. Overall, there is a lack of large randomized controlled clinical trials, but the number of clinical trials is growing, with more than 300 publicly registered trials exploring FMT in May 2020, compared to less than 30 in 2013 3,15,22.
Our focus at Novel Biome is on supporting autistic children who suffer from digestive symptoms and significant microbiome imbalance to restore their microbiome through Fecal Microbiota Transplantation (FMT).
Team Novel Biome
References: 1. Choi, H. H. & Cho, Y. S. 2016, 2. Gupta, S. et al. 2021, 3. Ser, H. L. et al. 2021, 4. Xu, M. Q. 2015, 5. Kelly, C. R. et al. 2016, 6. Khanna, S. et al. 2017, 7. Shankar, V. et al. 2014, 8. Song, Y. et al. 2013, 9. Staley, C. et al. 2016, 10. Wilson, B. C. et al. 2019, 11. Kump, P. et al. 2018, 12. Ramai, D. 2018, 13. Kao, D. et al. 2017, 14. Zipursky, J. S. et al. 2012, 15. Allegretti, J. R. et al. 2019, 16. Cammarota, G. et al. 2015, 17. Lee, C. H. et al. 2016, 18. Lee, C. H. et al. 2019, 19. van Nood, E. et al. 2013, 20. Austin, M. et al. 2014, 21. Basson, A. R. et al. 2020, 22. Gerardin, Y. et al. 2021, 23. McCune, V. L. et al. 2014, 24. Rinott, E. et al. 2021, 25. Youngster, I. et al. 2014, 26. Quraishi, M. N. et al. 2017, 27. Ianiro, G. et al. 2019, 28. Khan, M. Y. et al. 2018, 29. Moayyedi, P. et al. 2017, 30. Brandt, L. J. & Aroniadis, O. C. 2013, 31. Aldars-García, L. et al. 2021, 32. Anderson, J. L. et al. 2012, 33. Tan, P., Li, X. et al. 2020, 34. Cruz-Aguliar, R. M. et al. 2019, 35. El-Salhy, M. et al. 2022, 36. Ianiro, G. et al. 2019, 37. Allegretti, J. R. et al. 2021, 38. Kootte, R. S. et al. 2017, 39. Proença, I. M. et al. 2020, 40. Rinott, E. et al. 2021, 41. Zhang et al. 2019, 42. Kang, D.-W. et al. 2017, 43. Kang, D.-W. et al. 2019, 44. Li, N. et al.2021, 45. Huang, H. et al. 2019, 46. Segal, A. et al. 2021, 47. Sun, M.-F. et al. 2018, 48. Makkawi, S. et al. 2018, 49. Borody, T.J. et al. 2011.