Fecal Microbiota Transplantation Techniques, Applications, and Issues

Centre for Digestive Diseases, Level 1, 229 Great North Road, Five Dock, New South Wales 2046, Australia.
Gastroenterology clinics of North America (Impact Factor: 2.82). 12/2012; 41(4):781-803. DOI: 10.1016/j.gtc.2012.08.008
Source: PubMed


Fecal microbiota transplantation (FMT) has gained widespread recognition in light of the recent Clostridium difficile infection (CDI) epidemic, responsible for almost 110,000 deaths per year. The procedure's success rate has caused experts to reflect on what other conditions may benefit. This article provides an overview of (1) description and history of FMT, (2) FMT publications in CDI, (3) the concept of the gut microbiota as a virtual organ, (4) rationale for FMT use, (5) FMT use in inflammatory bowel disease, (6) emerging FMT applications, (7) how FMT is currently performed, and (8) how FMT may be performed in the future.

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    • "In CDI, FMT restores the diversity and composition of the disrupted, dysbiotic intestinal microbiota and subsequently suppresses the pathogen [97] [98] [99]. In IBD, the few case reports on the successful treatment of the disease by FMT suggest that restoration of the normal, regulatory immune effects of microbiota can be achieved [100] [101]. The first randomized placebocontrolled clinical trials on the FMT-treatment of IBD are ongoing and the first results were recently reported in a congress [102]. "
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    ABSTRACT: Abstract Inflammatory bowel diseases (IBDs) are chronic debilitating disorders of unknown etiology, consisting of two main conditions, ulcerative colitis and Crohn's disease. Major advances have recently taken place in human genetic studies of IBD and over 160 risk loci for these two diseases have been uncovered. These genetic data highlight a key role for genes that code for immunological and epithelial barrier functions. Environmental factors also make substantial contributions to the pathogenesis of IBD and account for the growing incidence of the diseases around the world. Intestinal microbiota creates resistance to infection, provides nutrients, and educates the immune system and in many ways has a significant impact on human health. Aberrant microbiota composition and decreased diversity (dysbiotic microbiota) are key etiopathological events in IBD. Dysbiotic microbiota can lead to loss of normal, regulatory immune effects in the gut mucosa. This may play a central role in the development and perpetuation of chronic inflammation. Further, the expression of specific innate immune receptors that recognize microbes is altered in the IBD epithelium. Therefore, the combination of host side epithelial barrier functions and the presence of dysbiotic microbiota in the gut together promote inflammation. New therapeutic options targeting microbiota are currently considered for IBD and they may, in the future, provide means to reverse the pathogenic host-microbiota relationship into a symbiotic one. In this review, the focus is on the intestinal microbiota and host-microbe interactions in IBD.
    Scandinavian Journal of Gastroenterology 01/2015; 50(1):34-42. DOI:10.3109/00365521.2014.966320 · 2.36 Impact Factor
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    • "Finally, the success in faecal transplantation for C. difficile diarrhoea treatment [90, 91] gives promising results for a new era involving transplantation of stools from lean subjects to achieve weight loss. "
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    ABSTRACT: Obesity is a major public health concern, caused by a combination of increased consumption of energy-dense foods and reduced physical activity, with contributions from host genetics, environment, and adipose tissue inflammation. In recent years, the gut microbiome has also been found to be implicated and augmented research in mice and humans have attributed to it both the manifestation and/or exacerbation of this major epidemic and vice versa. At the experimental level, analysis of fecal samples revealed a potential link between obesity and alterations in the gut flora (drop in Bacteroidetes and increase in Firmicutes), the specific gut microbiome being associated with the obese phenotype. Conventionally raised mice were found to have over 40% more total body fat compared with those raised under germ-free conditions, while conventionalization of germ-free mice resulted in a significant increase in total body fat. Similarly, the sparse data in humans supports the fact that fat storage is favoured by the presence of the gut microbiota, through a multifaceted mechanism. Efforts to identify new therapeutic strategies to modulate gut microbiota would be of high priority for public health, and to date, probiotics and/or prebiotics seem to be the most effective tools.
    03/2014; 2014(196):651895. DOI:10.1155/2014/651895
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    • "Ulcerative colitis 6 C Borody et al. (2003) Irritable bowel syndrome 30 C Andrews et al. (1995) Chronic fatigue syndrome 60 C Borody et al. (2012) Multiple sclerosis 4 C Borody et al. (2011) Metabolic acidosis 1 O Schoorel et al. (1980) Recolonization after AD 6 O van der Waaij et al. (1977); Heidt et al. (1983) "
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    ABSTRACT: While practised for over thousand years, there is presently a renaissance in the interest of using of faecal transplantations to modify the intestinal microbiota of patients. This clinical practice consists of delivering large amounts of bowel microbes in various forms into the intestinal tract of the recipient that usually has been cleared previously. The major reason for the popularity of faecal transplantations is their effectiveness in treating a variety of diseases. Hence, there is a need to develop this procedure to the next level. While there are various developments to select, standardize and store the donor microbiota, it is more challenging to understand the intestinal microbial communities and develop ways to deliver these via robust biotechnological processes. The various approaches that have been followed to do so are discussed in this contribution that is also addressing the concept of the minimal microbiome as well as the production of the synthetic communities that can be instrumental in new therapeutic avenues to modify the intestinal microbiota.
    Microbial Biotechnology 04/2013; 6(4). DOI:10.1111/1751-7915.12047 · 3.21 Impact Factor
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