Fecal transplant consists of implanting a healthy microbiota through natural passages into a patient to restore their microbial ecosystem.
Fecal transplant is an intervention that has been known and practiced for a long time, since the first signs of its use appear in China in the 4th century. However, it was only recently that a study completely validated its practice to treat Clostridium difficile infections, an illness for which it is now recommended by health authorities (in Europe1 and the United States2).
The procedure is based on a suspension of fresh or frozen liquid stool taken from a healthy donor, which is introduced into the patient’s digestive tract, primarily via the lower GI tract through an enema, or via the upper GI tract by a nasoduodenal probe (administration in the form of a more practical capsule has been studied3).
Effectiveness and indications
Fecal transplant is effective in 80% to 90% of cases for the treatment of Clostridium difficile infection (in this case, effectiveness is defined as the treatment of diarrhea without relapse at 10 weeks). These results are better than with antibiotics4. Although the exact mechanisms of this therapy are not completely understood, it seems that the implantation of a healthy microbiota via transplant works by ecological competition for nutrients with Clostridium difficile. Its use in other illnesses is being studied: cases of patients with chronic inflammatory bowel diseases (IBDs) treated with this kind of therapy5 have been reported, as well as patients with irritable bowel syndrome6 and obesity7. However, the technique was developed too recently to properly evaluate potential secondary effects and long-term effectiveness.
1. Debast SB et al. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect. 2014 ; 20 (Suppl 2) : 1-26. https://www.ncbi.nlm.nih.gov/pubmed/24118601
2. Surawicz et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol 2013 ; 108 : 478-98 ; quiz 499. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol 2013 ; 108 : 478-98 ; quiz 499 https://www.ncbi.nlm.nih.gov/pubmed/23439232
3. Youngster I. et al. Oral, Capsulized, Frozen Fecal Microbiota Transplantation for Relapsing Clostridium difficile Infection. JAMA 2014 ; 312(17) : 1772-1778. http://jamanetwork.com/journals/jama/fullarticle/1916296
4. Van Nood E. et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med 2013 ; 368 : 407-15. http://www.nejm.org/doi/full/10.1056/NEJMoa1205037
5. Colamn RJ et al. Fecal microbiota transplantation as therapy for inflammatory bowel disease: a systematic review and meta-analysis. J Crohns Colitis 2014 ; 8 : 1569-81. https://www.ncbi.nlm.nih.gov/pubmed/25223604
6. Noortje G Rossen et al. Fecal microbiota transplantation as novel therapy in gastroenterology: A systematic review. World J Gastroenterol. 2015 ; 21(17) : 5359–5371. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419078/
7. Vrieze A. et al. Transfer of intestinal microbiota from lean donors increases insulin sensitivity in individuals with metabolic syndrome. Gastroenterology 2012 ; 143 : 913-6. https://www.ncbi.nlm.nih.gov/pubmed/22728514
La transplantation de microbiote fécale et son encadrement dans les essais cliniques – Mars 2014 – ANSM. http://ansm.sante.fr/var/ansm_site/storage/original/application/5e5e01018303790194275ded0e02353c.pdf