TRANSPLANTATION

1. FECAL TRANSPLANTATIONS
by Mohamed Nasr
Before we go through this topic , there are some definitions we should know to better
understand this subject ;
Microbiota :
The human gut microbiota refers to the trillions of microbes, such as bacteria, viruses, fungi,
etc.. that live in the human gut. The microbiome is the environment they live in. Most
microbes in the body are useful, but they may become harmful when out of balance.( which
called then dysbiosis == dysbacteriosis ) People often use the two terms microbiota and
microbiome interchangeably. However, this is incorrect. The gut microbiota is a vast and
complex collection of microorganisms that profoundly affects human health. Previously,
people referred to the gut microbiota as microflora of the normal healthy gut.
Dysbiosis :
it’s defined as an imbalance in the gut microbial community due to alterations in the body's
natural microbiota especially associated with diseases of the gut resulting in changes in
relative abundance of microbes , by another word , it is disruption of the microbiome
resulting in an imbalance in the microbiota ( increase harmful bacteria over healthy and
beneficial ones ), The most common cause of this changes is excessive using of antibiotics

2. Fecal microbial transplantation :
it’s the process in which stool of a healthy screened donor transfer to a recipient
patient aiming to restore natural balance of the gut microbiota.
Importance of GIT Microbiota
1- Acts as a shield against pathogen that can invade the gut
2- Its fundamental for the immune system and immune tolerance development
3- It plays a fundamental role in digestion and absorption of food components
(minerals & fibers ) and very important in digestion of cellulose
4-Has Important role in synthesis of vitamins and amino acids
5- Production of molecules that regulate immune and metabolic responses
6- In detoxification of potentially dangerous compounds such as ; carcinogenic
molecules

3. Introduction to The Fecal Transplantation (FMT)
• Its first description of use was at 1958 at China , since then interest and
acceptance is rapidly increased for FMT, especially during last 10 yrs
• FMT is defined as the infusion of stool ( microbial contents after preparation )
from a healthy screend individual to a patient with presumed gut dysbiosis
• The most common route of its delivery to the recipient is colonoscopy , but also
can be delivered by naso-enteric tube or endoscopy or even capsule for ingestion
• The purpose of this procedure is to establish new gut microbiota community to
restore the normal gut function and the concept of that process is to repopulate
the gut with a healthy microbiome

4. Several key points should be considered to ensure the
success and safety of FMT:
• Donor Screening: Donors should undergo rigorous screening for infectious
diseases, including tests for bacteria, viruses, parasites, and other pathogens.
They should also have a comprehensive health assessment to rule out any
chronic conditions.
• Recipient Selection: Patients receiving FMT should have specific conditions that
have shown potential benefits from this procedure, such as recurrent Clostridium
difficile infection or certain gastrointestinal disorders. Their health status and
potential risks should be thoroughly evaluated.
• Consent and Ethics: Informed consent is crucial for both the donor and recipient.
They should understand the procedure, potential risks, and expected outcomes.
• Preparation: Before the procedure, recipients may undergo bowel cleansing to
clear out the existing gut bacteria, ensuring a better environment for the
transplanted microbiota.

5. • Administration: FMT can be delivered through various methods, such as
colonoscopy, enema, capsules, or nasogastric/nasoduodenal tubes. The method
chosen depends on the patient's condition and the doctor's recommendation.
• Monitoring and Follow-up: Post-transplantation, patients should be monitored
for any adverse reactions or side effects. Follow-up appointments are essential to
track the effectiveness of the procedure and ensure the patient's well-being.
• Quality Control: Proper handling, processing, and storage of the fecal material
are critical to maintaining the viability and effectiveness of the microbiota.
Standardized protocols and quality control measures should be in place.
• Regulatory Compliance: Adherence to regulatory guidelines and ethical
standards is essential to ensure the safety and legality of the procedure.

6. INDICATIONS OF FMT
Fecal microbiota transplantation (FMT) has shown promise in treating various
conditions primarily associated with disruptions in the gut microbiome. Some of
the key indications for FMT include:
1-Recurrent Clostridium difficile infection (rCDI): FMT has demonstrated high
success rates( 92%) in treating recurrent CDI that has not responded to standard
antibiotic therapy. It helps restore a healthy balance of gut bacteria, thereby
resolving the infection.
2- Inflammatory Bowel Diseases (IBD): While more research is needed, there's
growing interest in FMT as a potential treatment for conditions like Crohn's disease
and ulcerative colitis, which are characterized by inflammation in the
gastrointestinal tract.
3- Antibiotic-Associated Diarrhea: FMT can aid in restoring the disrupted gut
microbiota caused by antibiotic treatment, potentially preventing or resolving
antibiotic-associated diarrhea.

7. 4- Irritable Bowel Syndrome (IBS): Though research is ongoing, some studies
suggest that FMT might have benefits for certain subsets of IBS patients by
restoring gut microbial balance and alleviating symptoms.
5- Metabolic Syndrome and Obesity: Exploratory research indicates a potential
link between gut bacteria and metabolic disorders. FMT might have implications
for treating metabolic syndrome and obesity, though more studies are needed.
6- Neurological Conditions: There's emerging interest in the gut-brain axis and its
potential impact on neurological conditions like Parkinson's disease, multiple
sclerosis, and even certain psychiatric disorders. FMT is being investigated as a
potential supportive therapy.
7- Autoimmune Diseases: Research is exploring the role of the gut microbiome in
conditions like rheumatoid arthritis and systemic lupus erythematosus. FMT might
have implications in modulating the immune response in these conditions.

8. It's important to note that while FMT shows promise in these areas, further
research is necessary to establish its efficacy, safety, and optimal protocols for
different conditions. The use of FMT beyond CDI is often considered experimental,
and its application should be discussed with healthcare professionals in specialized
centers.
CONTRAINDICATIONS OF FMT
While fecal microbiota transplantation (FMT) has shown promise in treating
various conditions, there are certain situations where it might not be
recommended or where caution should be exercised due to potential risks. Some
contraindications include:
1- Risk of Infection: Recipients with a high risk of systemic infections, especially
those who are immunocompromised or have conditions that predispose them to
infections, might not be suitable candidates for FMT due to the risk of introducing
new pathogens through the transplant.

9. 2- Uncontrolled Gastrointestinal Bleeding: Patients with active gastrointestinal
bleeding may have an increased risk of complications if FMT is performed due to
the potential exacerbation of bleeding or difficulty in assessing the efficacy of the
procedure.
3- Severe Gastrointestinal Disorders: In some severe cases of gastrointestinal
disorders, such as toxic megacolon or fulminant colitis, FMT might not be
recommended due to the risk of complications or the potential inability to retain
the transplanted material.
4- Allergy or Sensitivity: Individuals with severe allergies or sensitivities to certain
components in the donor stool (such as specific proteins or microbes) might not be
suitable candidates for FMT due to the risk of allergic reactions.
5 - Psychiatric or Cognitive Conditions: Patients with certain psychiatric or
cognitive conditions that might impair their ability to understand or comply with
the procedure's requirements might not be considered suitable candidates for
FMT.

10. 6- Pregnancy: FMT is generally not recommended during pregnancy due to
potential risks to the fetus and the lack of sufficient safety data in this population.
7 - Lack of Consent or Compliance: Patients who do not provide informed consent
or are unable to comply with the pre- and post-procedure instructions might not
be suitable candidates for FMT.
These contraindications highlight situations where caution or avoidance of FMT
may be warranted. Ultimately, the decision regarding FMT should involve thorough
evaluation by healthcare professionals, considering the individual's specific medical
history, condition, and potential risks versus benefits.
THANK YOU