EMERGING research suggests that nasal microbiota transplantation (NMT) could revolutionise the treatment of chronic rhinosinusitis (CRS) and respiratory tract infections, particularly those involving antimicrobial-resistant (AMR) pathogens. Analogous to faecal microbiota transplantation (FMT) for gut health, NMT involves transferring nasal microbiota from healthy donors to patients with dysbiosis, aiming to restore microbial balance and alleviate disease symptoms.
CRS, a chronic inflammation of the paranasal sinuses affecting up to 12% of individuals in Europe and North America, remains challenging to manage with current therapies. Recent studies evaluating NMT’s effectiveness in patients with CRS have yielded promising results. One study administered NMT to 22 patients with CRS without polyps following a 13-day course of antibiotics. Three months after treatment, patients reported significant symptom relief, as measured by a reduced sino-nasal outcome test (SNOT-22) score, along with increased microbial diversity in their nasal passages.
Despite some adverse effects, including transient fever and sinusitis-like symptoms, the findings suggest that NMT could serve as a viable therapeutic strategy. Another case-series study demonstrated that NMT, even without prior antibiotic treatment, resulted in long-term symptom relief for two out of three patients with CRS, further supporting its potential benefits.
Beyond CRS, NMT could play a critical role in combating AMR respiratory tract infections. The human nasopharynx harbours several AMR pathobionts, including Streptococcus pneumoniae and Staphylococcus aureus, which pose significant public health risks. By restoring a healthy nasal microbiota, NMT may help displace AMR microbes, reducing their spread and potentially decreasing reliance on antibiotics. Evidence from FMT studies indicates that microbiota transplantation can effectively decolonise AMR strains in the gut, suggesting that a similar approach could work in the nasal cavity. However, no clinical trials have yet tested NMT’s efficacy in eradicating AMR nasal colonisation.
While NMT shows considerable promise, concerns regarding donor screening, safety, and long-term effects must be addressed. Rigorous screening for pathogens and allergens is essential to minimise risks, particularly in immunocompromised patients. Additionally, research into synthetic microbial communities and nasal microbiota-derived metabolites could pave the way for safer and more targeted therapies.
Ada Enesco, EMJ
Reference
Shekhar S et al. Nasal microbiota transplantation: a gateway to novel treatments. Trends Microbiol. 2025;DOI:10.1016/j.tim.2024.12.010.
