Fecal transplant involves introducing a healthy person’s stool into a patient’s digestive tract in order to reconstruct their intestinal flora and help them fight pathogenic bacteria.
The equilibrium between “good” and “bad” microbiota bacteria can be disrupted by many different phenomena. This imbalance, known as dysbiosis, can cause many diseases of varying severity. Fecal transplant (also called fecal bacteriotherapy) is a possible therapeutic solution.
Fecal transplant: a centuries-old solution
Fecal transplant is a very old treatment, since it was already being carried out in China in the 4th century! Its effectiveness was only recognized by European learned societies in 2013. To date, it has only been indicated in recurring C. difficile pathogenic bacteria infections, which it cures in 90% of cases.
However, the involvement of microbiota in numerous other diseases (Inflammatory Bowel Diseases, diabetes, obesity, neuropsychiatric disorders, etc.) suggests that indications for fecal transplant could soon be expanded.
Once selected, the donor prepares by taking laxatives. Their stool is then diluted in a sterile solution and filtered to be administered to the recipient. The recipient ingests a preparation similar to that used for colonoscopies in order to eliminate the disrupted microbiota.
There are several administration routes for the stool: the introduction of a probe through the nose to the stomach or duodenum, colonoscopy, enema, or, more rarely, ingestion of gastro-resistant capsules. It is up to the patient to decide with their doctor which route best suits their situation.
Zhang F, Luo W, Shi Y, Fan Z, Ji G. Should we standardize the 1,700-year-old fecal microbiota transplantation? Am J Gastroenterol 2012 ; 107 : 1755 ; author reply p. 1755-6.
Debast SB, Bauer MP, Kuijper EJ. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect 2014 ; 20 : 1-26.
Surawicz CM, Brandt LJ, Binion DG, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol 2013 ; 108 : 478-98 ; quiz 499.
La transplantation de microbiote fécal et son encadrement dans les essais cliniques. ANSM. Juin 2015 http://ansm.sante.fr/S-informer/Points-d-information-Points-d-information/La-transplantation-de-microbiote-fecal-et-son-encadrement-dans-les-essais-cliniques-Point-d-Information2
Hudson L, Anderson A, Corbett A et al. Gleaning Insights from Fecal Microbiota Transplantation and Probiotic Studies for the Rational Design of Combination Microbial Therapies. Clin Microbiol Rev 2017 ; 30(1):191-231
Modalités pratiques pour la réalisation d'une transplantation de microbiote fécal (TMF). Groupe Français de Transplantation Fécale. http://www.gftf.fr/45+modalites-pratiques-pour-la-realisation-d-une-transplantation-de-microbiote-fecal-tmf.html Groupe