This document provides an overview of faecal microbiota transplantation (FMT). It discusses the history and timeline of FMT, the gut microbiota, common indications for FMT like Clostridium difficile infection, the procedure for FMT including donor screening and administration methods, advantages and disadvantages of FMT, regulatory issues, and areas for future research.
2. ⦿INTRODUCTION
⦿HISTORY AND TIMELINE OF FMT
⦿GUT MICROBIOTA
⦿INDICATIONS
⦿CLOSTRIDIUM DIFFICILE INFECTION
⦿PROCEDURE OF FMT
⦿ADVANTAGES AND DISADVANTAGES
⦿REGULATORY ISSUES
⦿FUTURE RESEARCH
3. ⦿Faecal microbiota transplantation (FMT): It is
the administration of a solution of faecal
matter from a healthy donor into the
intestinal tract of a recipient in order to
directly change the recipient`s gut microbial
composition and confer a health benefit.
4. ⦿Microbiota – bacteria, archaea, microeukaryotes
and viruses that share the human body space.
⦿May function in a commensal, symbiotic or
pathogenic relationship.
⦿Microbiome – collective genomes of these
organisms
⦿Human microbiota – estimated to contain 10-
100 trillion microbial cells.
⦿Intestinal microbiota - largest and most
diverse population.
⦿The gut contains 1100 prevalent species and
atleast 160 species per individual.
5. ⦿Composition of human gut microbiota varies
according to
⦿sex, race/ethnicity and age.
⦿Diet
⦿Location along the GIT
.
⦿Presence of particular group of bacteria –
health advantages.
⦿Enhance metabolism, immune system,
cancer resistance, endocrine signalling, brain
function
6.
7. ⦿Primary Indications:
1. Recurrent or relapsing CDI:
a)3 or more episodes of mild to moderate
CDI and failure to respond to 6 to 8 weeks
taper with vancomycin with or without an
alternative antibiotic (eg- rifaximin,
nitazoxanide or fidaxomicin)
b)Atleast 2 episodes of CDI resulting in
hospitalization and associated with significant
morbidity.
8. ⦿2. Moderate CDI with no response to standard
therapy (vancomycin or fidaxomicin) for
atleast 1 week
⦿3. Severe (even fulminant) CDI with no
response to standard therapy for 48hrs.
10. ⦿Major cause of intestinal infection and
diarrhoea following antibiotic treatment.
⦿Obligate anaerobic, gram positive.
⦿Spore-forming bacillus.
⦿Pseudomembranous colitis – occurs almost
exclusively in association with prolonged
antimicrobial use.
⦿Spores of Clostridium difficile survive for long
periods on inanimate objects.
⦿Resisting heat, acid and antibiotics.
⦿A major problem in healthcare setting.
⦿Spread via faeco-oral route.
11.
12. ⦿Spread via faeco-oral route.
⦿Ingested either as vegetative form or as spores.
⦿Spore germinate into vegetative form in small
intestine.
⦿Normal flora if disrupted by antibiobic-
infection arise.
⦿Once inside GIT, pathogenesis linked to spore
germination and production of toxins.
⦿Pathogenesis of CDI relies on dormant spore
morphotype.
13. ⦿No standardised methodology for FMT
.
⦿Several different methods published.
⦿Little variation in clinical effectiveness
across techniques of delivery.
14. ⦿Universal donor screening:
⦿Detailed history and physical examination.
⦿Donor questionnaire : to identify high risk
behaviour.
⦿T
est should be negative for infections.
⦿Rescreened every 4 months.
15. ⦿Spouse
⦿Friend
⦿Unrelated donor
⦿Children can also be donor (parental consent
should be present)
⦿Donor should be free of diseases.
⦿Those who meet eligibility criteria should
undergo serological and stool testing to screen
for infectious agent.
⦿Preferably within 4 weeks of donation.
16.
17. ⦿A history of antibiotic treatment during the 3
months preceding donation.
⦿ Intrinsic GI illnesses including IBD, IBS,
chronic constipation, GI malignancies or
major GI surgical procedures.
⦿Autoimmune or atopic illnesses or ongoing
immune-modulating therapy.
⦿ A history of chronic pain syndromes
(fibromyalgia, chronic fatigue) or of
neurological or neurodevelopmental
disorders.
⦿Metabolic syndrome, obesity (body mass index
>30kg/m²) or moderate to severe malnutrition.
⦿Malignant illnesses or ongoing oncologic therapy.
18. ⦿The material - diluted and homogenized to a
form – that can be administered.
⦿Homogenized using a blender, manual effort
or other method.
⦿Filter if necessary (eg : guaze,coffee filter
,
strainer).
⦿Processed specimen is then either directly
infused into GIT
.
19. ⦿Some of the published methods of FMT
:
⦿Method A: Blend 50g of stool.
⦿Dilute mixture with saline to 250ml.
⦿Filter with seives.
⦿Administer 250ml.
⦿Method B:
⦿Blend 100g of stool.
⦿Emulsify with wooden spatula.
⦿Add drinking water to 300ml.
⦿Filter with gauze.
⦿Administer only 50 ml
20. ⦿No clear consensus on the best method of
instillation.
⦿Routes of administration are:
⦿1. Upper GI tract via endoscopy
,
nasogastric/nasointestinal tubes or ingestion of
pills.
⦿2. The proximal colon by colonoscopy
.
⦿3. Distal colon by enema, rectal tube or
sigmoidoscopy or a combined approach.
21. ⦿uncomfortable, less appealing to the patient.
⦿May require radiology assistance to confirm
tube placement.
⦿Carry some risk of vomiting and aspiration.
⦿Inexpensive, little procedural risk.
⦿Difficult for some patients to retain donor
material.
⦿May require multiple treatment.
22. ⦿Well tolerated, advantage of examination of
colonic mucosa and exclusion of pathology
like IBD.
⦿Carries some procedural risk.
