Does Faecal Microbiota Transplantation Work?

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Faecal microbiota transplantation has shown promising results in treating various gastrointestinal disorders, including ulcerative colitis, irritable bowel syndrome, and Clostridium difficile infection. The efficacy of FMT in decolonizing antibiotic-resistant bacteria also appears promising. While the safety profile is generally favorable, further research is needed to optimize treatment protocols and donor-recipient matching. Overall, FMT represents a valuable therapeutic option with the potential to significantly improve patient outcomes.

Faecal microbiota transplantation (FMT) has emerged as a novel therapeutic approach aimed at restoring healthy gut microbiota by transferring stool from a healthy donor to a recipient. This method has been explored for various gastrointestinal disorders, including ulcerative colitis (UC), irritable bowel syndrome (IBS), and Clostridium difficile infection (CDI). This article reviews the efficacy and safety of FMT based on recent research findings.

Efficacy in Ulcerative Colitis

Several studies have investigated the role of FMT in treating ulcerative colitis. A randomized placebo-controlled trial demonstrated that intensive-dosing, multidonor FMT induced clinical remission and endoscopic improvement in patients with active UC. The study reported a significant increase in microbial diversity and identified specific bacterial taxa associated with clinical outcomes. Another systematic review and meta-analysis confirmed the effectiveness of FMT in inducing remission in UC, highlighting the importance of treatment intensity and administration route .

Efficacy in Irritable Bowel Syndrome

FMT has also been evaluated for its potential benefits in irritable bowel syndrome. A randomized, double-blind, placebo-controlled study found that FMT significantly improved IBS symptoms, fatigue, and quality of life. The study emphasized the importance of using a well-defined donor and noted that the response to FMT increased with the dose. Long-term follow-up of patients revealed sustained benefits up to three years post-transplantation, with no significant long-term adverse events.

Efficacy in Clostridium difficile Infection

FMT is well-established as an effective treatment for recurrent Clostridium difficile infection. A systematic review and meta-analysis of cohort studies reported high initial and overall cure rates, with minimal recurrence. The study concluded that FMT is a safe and effective therapy for CDI, even in patients with underlying inflammatory bowel disease.

Efficacy in Antibiotic-Resistant Bacteria

The potential of FMT to decolonize antibiotic-resistant bacteria from the gut has also been explored. A systematic review found that FMT achieved decolonization in a significant proportion of cases, particularly for Pseudomonas aeruginosa. The review suggested that FMT could be a promising intervention for managing antibiotic-resistant infections, although further well-designed randomized controlled trials are needed .

Safety and Adverse Events

The safety profile of FMT has been generally favorable across studies. Most adverse events reported were mild and self-limiting gastrointestinal symptoms. Serious adverse events were rare and did not significantly differ between FMT and placebo groups . Long-term follow-up studies have not identified any significant long-term adverse events, further supporting the safety of FMT.

 


Does faecal microbiota transplantation work?

Kate Secombe has answered Likely

An expert from University of Adelaide in Microbiome, Cancer

Faecal microbiota transplantation (FMT) works in some scenarios. It is most known to be useful as a treatment for recurrent Clostridium difficile infection (see British Society of Gastroenterology guidelines at: https://gut.bmj.com/content/gutjnl/67/11/1920.full.pdf), and has a high success rate in this condition. A recent study showed that most adverse events from FMT were mild, and overall the procedure is very safe (https://pubmed.ncbi.nlm.nih.gov/33159374/).

Due to its success in C. diff treatment, scientists have researched the use of FMT in a wide range of other conditions. There are over 1000 published papers in the area in the past 5 years! There have been varying results in this research, with FMT having positive results in some conditions, and less success in other areas. More research may be required to determine ideal treatment schedules and FMT preparation methods.

 

Does faecal microbiota transplantation work?

Hannah Wardill has answered Likely

An expert from University of Adelaide in Gastroenterology, Microbiome

FMT is an ancient technique that has more recently been refined to be more effective and safer. In answer to this question, it really depends on what is meant by “work”. If referring to its ability to change the microbiome composition, then yes, certainly it works – but only transiently (i.e. usually the host’s microbiome reverts back to its original composition pretty quickly). If referring to a clinical effect, i.e. disease cured, then … the answer is a little less clear cut.

Despite the huge amount of interest in this area, FMT is only indicated for the treatment of a gut infection called Cdiff. There are a number of emerging indications including inflammatory bowel disease, autism, Parkinson’s disease, GvHD and hundreds of clinical trials hoping to identify new applications, but ultimately its approved use remains pretty narrow.

I would not be surprised if in a 5-10years, there will be a much longer list of diseases where FMT is effective. In saying that though, I think we will also begin to see a lot more refinement in the approach, so it may actually be that FMT does not exist, but instead a poo capsule or more sophisticated probiotic formulation.

 

Does faecal microbiota transplantation work?

Ulrich Desselberger  has answered Near Certain

An expert from University of Cambridge in Virology

Fecal microbiota (in particular probiotic bacteria) works, but the conditions must be well defined. There are problems if the fecal transplant contains microbes which may be pathogenic on their own, and the residual gut microbiome of the treated person may affect the ‘take’ of the transplant. For wider and universal applications the composition of the fecal transplant has to be better defined.

 

Does faecal microbiota transplantation work?

Edward Deehan has answered Likely

An expert from University of Alberta in Nutrition, Microbiome

Yes, faecal microbiota transplantation (FMT) is be an effective treatment, but it is completely dependent on the disease you are aiming to treat and the individual. While FMT is highly effective at treating Clostridioides difficile infections, with a success rate of at least 90%, its efficacy for the treatment of other diseases, such as inflammatory bowel disease and metabolic syndrome, remains less clear. Efforts are needed to determine the microbial consortia and metabolites that underlie the effects of FMT in order to develop more effective and safer live biotherapeutic alternatives.

 

Does faecal microbiota transplantation work?

Javier Santos has answered Likely

An expert from Hospital Vall d’Hebron in Gastroenterology, Microbiome

In preclinical models, there is enough evidence for the role of FMT to improve several gastrointestinal and extraintestinal conditions, from mental disorders to exercise performance. In humans, there is also strong evidence for FMT “working” for refractory Cl. Difficile infection reaching up to 90% of efficacy and this therapy has been implanted in many public hospitals around the world. In addition, there are also several ongoing initiatives to understand and develop varieties of FMT to treat gastrointestinal conditions such as as inflammatory bowel disease or irritable bowel syndrome, metabolic disorders, mental conditions, systemic auto-immune disorders, neurological diseases and an increasing range of pathological conditions. While published results suggest the efficacy of FMT (commonly modest in quantitative terms), caution is advised until replicated in large independent cohorts. There are also many uncertainties regarding donor selection, fecal and recipient preparation, delivery methods and security issues that need to be solved before steeping ahead in generalizing FMT therapy. In summary, a promising therapy but not the panacea.

 

Does faecal microbiota transplantation work?

Josbert Keller has answered Near Certain

An expert from HMC Hospital in Gastroenterology

the first randomized controlled trial confirming the efficacy of FMT against recurrent C.difficile infection was published in 2013.

afterwards, numerous reports have shown similar results, and the treatment is metnioned in the treatment guidelines in Europe and the US. Also, consensus reports made by experts carefully dsescribe how FMT should be organised and offered to patients.

Importantly, FMT is only an established treatment apporach for patients with C. difficile infection. For other indications FMT might be promising, but should still be considered experimental treatment.

 

Does faecal microbiota transplantation work?

Ian Beales has answered Near Certain

An expert from Norfolk and Norwich University Hospital in Internal Medicine

Faceal microbiota transplantation (FMT) does work. However the reason for using it (the indication) very much influences the results. For recurrent Clostroides difficile (previous name Clostridium difficile) infection (rCDI) Faceal microbiota transplantation is very effective and very safe. So much so that it is clearly the treatment of choice. Approximately 90% of patients with rCDI can be cured with FMT, results with antibiotics instead are much less satisfactory, only about 30% cure (1).

FMT has been applied to a multitude of other conditions both gastrointestnal and outside the gastrointeatinal tract. Results are much more mixed and uncertain. Promising results have been shown with positive results in ulcerative colitis (2) and irritable bowel syndrome (3) and ulcerative colitis, although unlike the situation in rCDI, not all of the trials have given positive results (4.5) . Certainly for ulcerative colitis, it seems that there are “super-donors,” where the transplantated microbiota are effective, and other donors where the treatment is ineffective. In contrast in rCDI, it appears that transplantation from any suitably screened healthly donor is effective. At present, we do not know what makes anyone a “super-donor.”

FMT has also been used and advocated for a host of other conditions, including but not limited to fatty liver disease, obesity, chronic fatigue syndrome/myalgic encephalitis and Parkinson’s disease. It has not yet been proven to be effective in any of these. In all conditions apart from rCDI, faceal microbiota transplantation can only be regarded as experimental, and best performed within carefully controlled trial situations.

There are various ways of adminstering FMT, capsules, tubes into the stomach or small bowel, colonoscopy, enemas and it is quite possible that the optimal route and method will vary with the underlying clinial problem.

  1. Fecal microbiota transplantation for treatment of recurrent C. difficile infection: An updated randomized controlled trial meta-analysis. Wenjia Hui , Ting Li , Weidong Liu, Chunyan Zhou, Feng Gao. PLoS One 2019 Jan 23;14(1):e0210016. doi: 10.1371/journal.pone.0210016. eCollection 2019.
  2. Fecal Microbiota Transplantation Induces Remission in Patients With Active Ulcerative Colitis in a Randomized Controlled Trial. Moayyedi P, Surette MG, Kim PT, Libertucci J, Wolfe M, Onischi C, Armstrong D, Marshall JK, Kassam Z, Reinisch W, Lee CH. Gastroenterology. 2015 Jul;149(1):102-109.e6. doi: 10.1053/j.gastro.2015.04.001
  3.  Efficacy of faecal microbiota transplantation for patients with irritable bowel syndrome in a randomised, double-blind, placebo-controlled study. El-Salhy M, Hatlebakk JG, Gilja OH, Bråthen Kristoffersen A, Hausken T. Gut. 2020 May;69(5):859-867. doi: 10.1136/gutjnl-2019-319630.
  4. Fecal transplantation for treatment of inflammatory bowel disease. Imdad A, Nicholson MR, Tanner-Smith EE, Zackular JP, Gomez-Duarte OG, Beaulieu DB, Acra S. Cochrane Database Syst Rev. 2018 Nov 13;11(11):CD012774. doi: 10.1002/14651858.CD012774.pub2
  5. Fecal microbiota transplantation in irritable bowel syndrome: A systematic review and meta-analysis. Kanchana Myneedu, Abhizith Deoker, Max J Schmulson , Mohammad Bashashati.. United European Gastroenterol J. 2019 Oct;7(8):1033-1041. doi: 10.1177/2050640619866990.

 

Does faecal microbiota transplantation work?

Eleonore Fröhlich has answered Near Certain

An expert from Medical University of Graz, Austria in Medicine, Toxicology

For specific indications (recurrent infections with C. difficile colitis), efficacy has been shown and is performed routinely in renowned hospitals in the United States see: https://www.hopkinsmedicine.org/gastroenterology_hepatology/clinical_services/advanced_endoscopy/fecal_transplantation.html

It works less reliably but holds some promise in the treatment of chronic inflammatory bowel diseases (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421596/).

 

Does faecal microbiota transplantation work?

Julian Marchesi has answered Likely

An expert from Imperial College London in Microbiome

It all depends on the context of the faecal microbiota transplantation (FMT). FMT for recurrent Clostridiodes difficile infection works >90% which is massively better than current standard of care i.e. antibiotics. However when you try FMT in other areas it is less likely to work e.g. obesity. So the question needs to be more nuanced and the context considered.

 

Does faecal microbiota transplantation work?

Stefano Di Bella has answered Near Certain

An expert from University of Trieste in Infectious diseases

There are many evidence regarding FMT and C. difficile infection.

There are evidence also for inflammatory bowel diseases.

 

Does faecal microbiota transplantation work?

Romy Zwittink has answered Near Certain

An expert from Leiden University Medical Center in Microbiome, Microbiology

Faecal microbiota transplantation is a very rigorous way of modulating the microbial communities in the gut (gut microbiota). The procedure consists of the introduction of diluted, filtered stool from a healthy donor into a patient’s bowel via a duodenal tube, colonoscopy, enema, or via capsules. The mechanism of action is complex and appears to be based on direct interaction of metabolites and bacteriocins in the transplanted material and, as well as on the restoration of microbiota function via acquiring the healthy donor microbiota (https://www.frontiersin.org/articles/10.3389/fmicb.2018.01242/full). At this moment, there is only one indication for which FMT works; a recurrent (or very serious case of) Clostridioides difficile infection (rCDI), formerly known as Clostridium difficile infection, (https://www.nejm.org/doi/full/10.1056/nejmoa1205037). In the Netherlands, the cure rate of FMT for rCDI is around 85%. At this point, it is yet unclear whether FMT also works for other indications, such as inflammatory bowel disease or irritable bowel syndrome and extra-intestinal conditions. In the Netherlands, FMTs for other indications than rCDI are only given for research purposes and in the context of a compassionate use program.

 

Does faecal microbiota transplantation work?

Vera Tavoukjian has answered Likely

An expert from St George’s, University of London in Nursing, Clinical Research

The efficacy of faecal microbiota transplantation in the treatment of recurrent Clostridium difficile infections has been confirmed with a resolution success rate of around 90% showing superiority over standard treatment (e.g. antibiotics).

The prospect of restoration of normal gut microbiota with FMT has raised speculation that it might prove beneficial in other conditions and diseases associated with alteration of the gut microbiota composition, such as inflammatory bowel disease, irritable bowel syndrome, metabolic syndrome, neurological disease and for decolonisation of antibiotic-resistant bacteria.

To date there is no definitive evidence to say FMT is effective for these conditions. There is an indication of potential benefit, however more studies are needed to reach this conclusion.

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