FAECAL microbiota transplantation (FMT) has been found to be an effective treatment for Clostridium difficile (C. diff) infection.
Of all the forms of transplant currently available, it is safe to say that faecal matter is one of the more unorthodox. However, it could also be one of the most important and represent a solution to the challenge of the increase in antimicrobial resistance.
FMT involves taking a stool sample from a healthy donor, mixing it with a solution, and straining it to remove particulates. The refined solution is then administered by way of enema, endoscopy, colonoscopy, or sigmoidoscopy, depending on the patient’s needs. The intention is to create a diversity of microorganisms within the bowel of the patient in order to fight off disease and prevent future infections.
“These organisms – bacteria, fungi, protozoa – start colonising the bowel in infancy. They appear to be important in training our immune systems and keeping pathogens in check,” said Dr Henning Gerke, Clinical Associate Professor of Internal Medicine – Gastroenterology and Hepatology, University of Iowa, Iowa City, Iowa, USA.
Currently, FMT is most commonly used to treat patients with C. diff infection, which occurs due to a shortage of healthy bacteria in the body and attacks the intestine lining. Antibiotics have previously been used to treat C. diff infection, a practice that Dr Gerke refers to as “fighting fire with fire”; while the antibiotics will destroy some of the pathogenic bacteria, they do not compensate for the loss of good bacteria that may have initially led to infection; failure to replenish the gut balance will often cause the diarrhoea to return within weeks. FMT could offer an effective solution to this challenge; recent studies have shown the process to be well tolerated, inexpensive, and able to achieve success rates greater than 90%.
Considerable strides have been made to legitimise FMT, despite there being several hurdles still to clear, such as achieving full FDA approval. The first human stool bank in the USA became operational in 2012, and the development of synthetic stool and easily consumable gel capsules is underway. In the future, FMT may also be used to treat other conditions such as irritable bowel syndrome, obesity, and Type 2 diabetes following appropriate research. So while FMT may seem like a hard prospect to stomach, it is certainly not to be sniffed at.