Faecal Microbiota Transplantation (FMT)

Faecal Microbiota Transplantation (FMT)

Faecal microbiota transplantation (FMT) is exactly what it sounds like: transferring the stool of one person into another. There is a long history of using FMT in human beings, dating all the way back to the 4th century where Chinese physicians administered faeces to treat gastrointestinal maladies. These days FMT is only approved for use in Australia to treat recurrent or refractory Clostridium Difficile Infection (CDI).

Clostridium Difficile Infection (CDI)

CDI is the most common cause of health care associated diarrhoea, and its incidence has been increasing in the last decade. While CDI is caused by a bacteria, and therefore treated by antibiotics, there has been an emergence of hyper virulent strains that are unresponsive to antibiotics. This has lead to increased morbidity and mortality. FMT has been shown to be effective as a treatment for CDI and is recommended as one of the treatments by the Gastroenterological Society of Australia (GESA).

How is FMT made?

FMT is made by collecting stool from one or multiple healthy donors. It is mixed it with saline and glycerol, aliquoted and then frozen at -80°C. Over 200 treatments of FMT have been given to CDI patients at the Queen Elizabeth Hospital since the service began in 2013, with no serious complications.

Current research into FMT and Ulcerative Colitis

So, we know that gut microbes are involved in the pathogenesis of UC.  The majority of therapies for IBD target the mucosal immune system but these come with significant side effects and incomplete efficacy.

Many studies have shown that remission in Ulcerative Colitis can be induced with FMT.

  Rossen et al. 2015 Moayyedi et al. 2015 Paramsothy et al. 2017 Costello et al. 2017
Patients enrolled 50 (23/25) 75 (38/37) 81 (41/40) 73 (38/35)
Method of delivery Nasoduodenal Enema Colonoscopy + Enema Colonoscopy + Enema
Stool Processing Fresh single donor Fresh or Frozen single donor 3-7 Pooled Frozen donor 3-4 Pooled Frozen donor: anaerobically prepared
End point 12 weeks 6 weeks 8 weeks 8 weeks
Clinical remission 7/23 versus 8/25 p=1.0 18/41 vs 8/40 p=0.02 19/38 vs 6/35 p<0.01
Clinical response 11/23 vs 13/25 p=0.58 15/38 vs 9/37 p=0.16 22/41 vs 9/40 p<0.01 21/38 vs 7/34 p<0.01

BiomeBank has been established to provide FMT for CDI and further research purposes. The team at IBD SA has links with the research teams the Queen Elizabeth Hospital, Flinders Medical Centre, the Royal Adelaide Hospital and Lyell McEwen Hospital and can refer you out if there are clinical trials that may be of use.

 

Contributed by Dr Karmen Telfer, The Queen Elizabeth Hospital