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Symposium Article SSCI Presidential Symposium: The MicrobiomeSymposium Editor: C. Mel Wilcox, MD| Volume 356, ISSUE 5, P424-432, November 2018

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Current Evidence in Delivery and Therapeutic Uses of Fecal Microbiota Transplantation in Human Diseases—Clostridium difficile Disease and Beyond

Published:September 04, 2018DOI:https://doi.org/10.1016/j.amjms.2018.08.010

      Abstract

      The use of fecal microbiota transplantation (FMT) was first described in China in the 4th century by Ge Hong when “yellow soup,” a fecal slurry, was administered for the treatment of severe food poisoning and diarrhea, a practice that continued for centuries. Bedouin groups also consumed stools of their camels as a remedy for dysentery. FMT was also applied in veterinary medicine in Europe in the 16th century. Additional therapeutic use of human excretions was described in Europe in the 18th and 19th century and in World War II, when gut bacteria were administered to German soldiers suffering from dysentery in the North African campaign. More scientifically, Eismann, in 1958, utilized fecal transplantation via enema in 4 patients for the treatment of severe pseudomembranous colitis with success. Following this report a number of isolated cases were published describing the use of FMT by different delivery routes for the treatment of a variety of illnesses.

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      References

        • Austin M
        • Mellow M
        • Tierney WM
        Fecal microbiota transplantation in the treatment of Clostridium difficile infections.
        Am J Med. 2014; 127: 479-483
        • Lessa FC
        • Mu Y
        • Bamberg WM
        • et al.
        Burden of Clostridium difficile infection in the United States.
        N Engl J Med. 2015; 372: 825-834
        • Desai K
        • Gupta SB
        • Dubberke ER
        • et al.
        Epidemiological and economic burden of Clostridium difficile in the United States: estimates from a modeling approach.
        BMC Infect Dis. 2016; 16: 303
        • Bagdasarian N
        • Rao K
        • Malani PN
        Diagnosis and treatment of Clostridium difficile in adults: a systematic review.
        JAMA. 2015; 313: 398-408
        • Leffler DA
        • Lamont JT
        Clostridium difficile infection.
        N Engl J Med. 2015; 372: 1539-1548
        • Cohen SH
        • Gerding DN
        • Johnson S
        • et al.
        Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA).
        Infect Control Hosp Epidemiol. 2010; 31: 431-455
        • Harris VC
        • Haak BW
        • Boele van Hensbroek M
        • et al.
        The intestinal microbiome in infectious diseases: the clinical relevance of a rapidly emerging field.
        Open Forum Infect Dis. 2017; 4: ofx144
        • Cammarota G
        • Ianiro G
        • Bibbo S
        • et al.
        Gut microbiota modulation: probiotics, antibiotics or fecal microbiota transplantation?.
        Intern Emerg Med. 2014; 9: 365-373
        • Khoruts A
        • Sadowsky MJ
        Therapeutic transplantation of the distal gut microbiota.
        Mucosal Immunol. 2011; 4: 4-7
        • Bafeta A
        • Yavchitz A
        • Riveros C
        • et al.
        Methods and reporting studies assessing fecal microbiota transplantation: a systematic review.
        Ann Intern Med. 2017; 167: 34-39
        • Kelly CR
        • Kahn S
        • Kashyap P
        • et al.
        Update on fecal microbiota transplantation 2015: Indications, methodologies, mechanisms, and outlook.
        Gastroenterology. 2015; 149: 223-237
        • Drekonja D
        • Reich J
        • Gezahegn S
        • et al.
        Fecal microbiota transplantation for Clostridium difficile infection: a systematic review.
        Ann Intern Med. 2015; 162: 630-638
        • van Nood E
        • Vrieze A
        • Nieuwdorp M
        • et al.
        Duodenal infusion of donor feces for recurrent Clostridium difficile.
        N Engl J Med. 2013; 368: 407-415
        • Youngster I
        • Sauk J
        • Pindar C
        • et al.
        Fecal microbiota transplant for relapsing Clostridium difficile infection using a frozen inoculum from unrelated donors: a randomized, open-label, controlled pilot study.
        Clin Infect Dis. 2014; 58: 1515-1522
        • Cammarota G
        • Masucci L
        • Ianiro G
        • et al.
        Randomised clinical trial: faecal microbiota transplantation by colonoscopy vs. vancomycin for the treatment of recurrent Clostridium difficile infection.
        Aliment Pharmacol Ther. 2015; 41: 835-843
        • Kelly CR
        • Khoruts A
        • Staley C
        • et al.
        Effect of fecal microbiota transplantation on recurrence in multiply recurrent Clostridium difficile infection: a randomized trial.
        Ann Intern Med. 2016; 165: 609-616
        • Hota SS
        • Sales V
        • Tomlinson G
        • et al.
        Oral vancomycin followed by fecal transplantation versus tapering oral vancomycin treatment for recurrent clostridium difficile infection: an open-label, randomized controlled trial.
        Clin Infect Dis. 2017; 64: 265-271
        • Lee CH
        • Steiner T
        • Petrof EO
        • et al.
        Frozen vs fresh fecal microbiota transplantation and clinical resolution of diarrhea in patients with recurrent clostridium difficile infection: a randomized clinical trial.
        JAMA. 2016; 315: 142-149
        • Kao D
        • Roach B
        • Silva M
        • et al.
        Effect of oral capsule- vs colonoscopy-delivered fecal microbiota transplantation on recurrent clostridium difficile infection: a randomized clinical trial.
        JAMA. 2017; 318: 1985-1993
        • Kelly CR
        • de Leon L
        • Jasutkar N
        Fecal microbiota transplantation for relapsing Clostridium difficile infection in 26 patients: methodology and results.
        J Clin Gastroenterol. 2012; 46: 145-149
        • Aroniadis OC
        • Brandt LJ
        • Greenberg A
        • et al.
        Long-term follow-up study of fecal microbiota transplantation for severe and/or complicated Clostridium difficile infection: a multicenter experience.
        J Clin Gastroenterol. 2016; 50: 398-402
        • Kassam Z
        • Hundal R
        • Marshall JK
        • et al.
        Fecal transplant via retention enema for refractory or recurrent Clostridium difficile infection.
        Arch Intern Med. 2012; 172: 191-193
        • Lee CH
        • Belanger JE
        • Kassam Z
        • et al.
        The outcome and long-term follow-up of 94 patients with recurrent and refractory Clostridium difficile infection using single to multiple fecal microbiota transplantation via retention enema.
        Eur J Clin Microbiol Infect Dis. 2014; 33: 1425-1428
        • Postigo R
        • Kim JH
        Colonoscopic versus nasogastric fecal transplantation for the treatment of Clostridium difficile infection: a review and pooled analysis.
        Infection. 2012; 40: 643-648
        • Gundacker ND
        • Tamhane A
        • Walker JB
        • et al.
        Comparative effectiveness of faecal microbiota transplant by route of administration.
        J Hosp Infect. 2017; 96: 349-352
      1. Osman M, Kelsey O'brien, Zachery Stoltzner, et al. Safety and efficacy of fecal microbiota transplantation for recurrent Clostridium difficile infection from an international public stool bank: results from a 2,050 patient multi-center cohort Paper presented at: IDWeek2016; New Orleans, LA.

        • Youngster I
        • Russell GH
        • Pindar C
        • et al.
        Oral, capsulized, frozen fecal microbiota transplantation for relapsing Clostridium difficile infection.
        JAMA. 2014; 312: 1772-1778
        • Hirsch BE
        • Saraiya N
        • Poeth K
        • et al.
        Effectiveness of fecal-derived microbiota transfer using orally administered capsules for recurrent Clostridium difficile infection.
        BMC Infect Dis. 2015; 15: 191
        • Hamilton MJ
        • Weingarden AR
        • Sadowsky MJ
        • et al.
        Standardized frozen preparation for transplantation of fecal microbiota for recurrent Clostridium difficile infection.
        Am J Gastroenterol. 2012; 107: 761-767
        • Staley C
        • Hamilton MJ
        • Vaughn BP
        • et al.
        Successful resolution of recurrent Clostridium difficile infection using freeze-dried, encapsulated fecal microbiota; pragmatic cohort study.
        Am J Gastroenterol. 2017; 112: 940-947
        • Bojanova DP
        • Bordenstein SR
        Fecal transplants: what is being transferred.
        PLoS Biol. 2016; 14e1002503
        • Bakken JS
        • Borody T
        • Brandt LJ
        • et al.
        Treating Clostridium difficile infection with fecal microbiota transplantation.
        Clin Gastroenterol Hepatol. 2011; 9: 1044-1049
        • Woodworth MH
        • Neish EM
        • Miller NS
        • et al.
        Laboratory testing of donors and stool samples for fecal microbiota transplantation for recurrent Clostridium difficile infection.
        J Clin Microbiol. 2017; 55: 1002-1010
        • Cammarota G
        • Ianiro G
        • Tilg H
        • et al.
        European consensus conference on faecal microbiota transplantation in clinical practice.
        Gut. 2017; 66: 569-580
        • Chehoud C
        • Dryga A
        • Hwang Y
        • et al.
        Transfer of viral communities between human individuals during fecal microbiota transplantation.
        MBio. 2016; 7: e00322
        • Paramsothy S
        • Borody TJ
        • Lin E
        • et al.
        Donor recruitment for fecal microbiota transplantation.
        Inflamm Bowel Dis. 2015; 21: 1600-1606
        • Wang S
        • Xu M
        • Wang W
        • et al.
        Systematic review: adverse events of fecal microbiota transplantation.
        PLoS One. 2016; 11e0161174
        • Baxter M
        • Colville A
        Adverse events in faecal microbiota transplant: a review of the literature.
        J Hosp Infect. 2016; 92: 117-127
        • Kelly CR
        • Kim AM
        • Laine L
        • et al.
        The AGA's fecal microbiota transplantation national registry: an important step toward understanding risks and benefits of microbiota therapeutics.
        Gastroenterology. 2017; 152: 681-684
        • Konijeti GG
        • Sauk J
        • Shrime MG
        • et al.
        Cost-effectiveness of competing strategies for management of recurrent Clostridium difficile infection: a decision analysis.
        Clin Infect Dis. 2014; 58: 1507-1514
        • Lapointe-Shaw L
        • Tran KL
        • Coyte PC
        • et al.
        Cost-effectiveness analysis of six strategies to treat recurrent Clostridium difficile infection.
        PLoS One. 2016; 11e0149521
        • Baro E
        • Galperine T
        • Denies F
        • et al.
        Cost-effectiveness analysis of five competing strategies for the management of multiple recurrent community-onset Clostridium difficile infection in France.
        PLoS One. 2017; 12e0170258
      2. Walker JMD, Gundacker, N, Rodriguez, M, et al. Cost effectiveness analysis of fecal transplant delivery methods for recurrent Clostridium difficile Infections in Outpatients Paper presented at: IDWeek2017; San Diego, CA.

        • Varier RU
        • Biltaji E
        • Smith KJ
        • et al.
        Cost-effectiveness analysis of fecal microbiota transplantation for recurrent Clostridium difficile infection.
        Infect Control Hosp Epidemiol. 2015; 36: 438-444
        • Paramsothy S
        • Paramsothy R
        • Rubin DT
        • et al.
        Faecal microbiota transplantation for inflammatory bowel disease: a systematic review and meta-analysis.
        J Crohns Colitis. 2017; 11: 1180-1199
        • Narula N
        • Kassam Z
        • Yuan Y
        • et al.
        Systematic review and meta-analysis: fecal microbiota transplantation for treatment of active ulcerative colitis.
        Inflamm Bowel Dis. 2017; 23: 1702-1709
        • Tian H
        • Ge X
        • Nie Y
        • et al.
        Fecal microbiota transplantation in patients with slow-transit constipation: a randomized, clinical trial.
        PLoS One. 2017; 12e0171308
        • Pinn DM
        • Aroniadis OC
        • Brandt LJ
        Is fecal microbiota transplantation (FMT) an effective treatment for patients with functional gastrointestinal disorders (FGID)?.
        Neurogastroenterol Motil. 2015; 27: 19-29
        • Bajaj JS
        • Kassam Z
        • Fagan A
        • et al.
        Fecal microbiota transplant from a rational stool donor improves hepatic encephalopathy: a randomized clinical trial.
        Hepatology. 2017; 66: 1727-1738
        • Philips CA
        • Pande A
        • Shasthry SM
        • et al.
        Healthy donor fecal microbiota transplantation in steroid-ineligible severe alcoholic hepatitis: a pilot study.
        Clin Gastroenterol Hepatol. 2017; 15: 600-602
        • Gu L
        • Ding C
        • Tian H
        • et al.
        Serial frozen fecal microbiota transplantation in the treatment of chronic intestinal pseudo-obstruction: a preliminary study.
        J Neurogastroenterol Motil. 2017; 23: 289-297
        • Satokari R
        • Fuentes S
        • Mattila E
        • et al.
        Fecal transplantation treatment of antibiotic-induced, noninfectious colitis and long-term microbiota follow-up.
        Case Rep Med. 2014; 2014913867
        • Gunaltay S
        • Rademacher L
        • Hultgren Hornquist E
        • et al.
        Clinical and immunologic effects of faecal microbiota transplantation in a patient with collagenous colitis.
        World J Gastroenterol. 2017; 23: 1319-1324
        • de Groot PF
        • Frissen MN
        • de Clercq NC
        • et al.
        Fecal microbiota transplantation in metabolic syndrome: history, present and future.
        Gut Microbes. 2017; 8: 253-267
        • Vrieze A
        • Van Nood E
        • Holleman F
        • et al.
        Transfer of intestinal microbiota from lean donors increases insulin sensitivity in individuals with metabolic syndrome.
        Gastroenterology. 2012; 143 (913-916 e917)
        • Marotz CA
        • Zarrinpar A
        Treating obesity and metabolic syndrome with fecal microbiota transplantation.
        Yale J Biol Med. 2016; 89: 383-388
        • Alang N
        • Kelly CR
        Weight gain after fecal microbiota transplantation.
        Open Forum Infect Dis. 2015; 2: ofv004
        • Smits LP
        • Bouter KEC
        • de Vos WM
        • et al.
        Therapeutic potential of fecal microbiota transplantation.
        Gastroenterology. 2013; 145: 946-953
        • Choi HH
        • Cho YS
        Fecal microbiota transplantation: current applications, effectiveness, and future perspectives.
        Clin Endosc. 2016; 49: 257-265
        • Xu MQ
        • Cao HL
        • Wang WQ
        • et al.
        Fecal microbiota transplantation broadening its application beyond intestinal disorders.
        World J Gastroenterol. 2015; 21: 102-111
        • Forsythe P
        • Kunze W
        • Bienenstock J
        Moody microbes or fecal phrenology: what do we know about the microbiota-gut-brain axis?.
        BMC Med. 2016; 14: 58
        • Rosenfeld CS
        Microbiome disturbances and autism spectrum disorders.
        Drug Metab Dispos. 2015; 43: 1557-1571
        • Kang DW
        • Adams JB
        • Gregory AC
        • et al.
        Microbiota transfer therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study.
        Microbiome. 2017; 5: 10
        • Ruggiero M
        Fecal microbiota transplantation and the brain microbiota in neurological diseases.
        Clin Endosc. 2016; 49: 579
        • Jethwa H
        • Abraham S
        The evidence for microbiome manipulation in inflammatory arthritis.
        Rheumatology (Oxford). 2017; 56: 1452-1460
        • Kim D
        • Yoo S-A
        • Kim W-U
        Gut microbiota in autoimmunity: potential for clinical applications.
        Arch Pharmacal Res. 2016; 39: 1565-1576
        • Kyburz A
        • Muller A
        The gastrointestinal tract microbiota and allergic diseases.
        Dig Dis. 2016; 34: 230-243
        • Abdollahi-Roodsaz S
        • Abramson SB
        • Scher JU
        The metabolic role of the gut microbiota in health and rheumatic disease: mechanisms and interventions.
        Nat Rev Rheumatol. 2016; 12: 446
        • Wei Y
        • Yang J
        • Wang J
        • et al.
        Successful treatment with fecal microbiota transplantation in patients with multiple organ dysfunction syndrome and diarrhea following severe sepsis.
        Crit Care. 2016; 20: 332
        • Orenstein R
        • Dubberke E
        • Hardi R
        • et al.
        Safety and durability of RBX2660 (Microbiota Suspension) for recurrent clostridium difficile infection: results of the PUNCH CD study.
        Clin Infect Dis. 2016; 62: 596-602
        • Petrof EO
        • Khoruts A
        From stool transplants to next-generation microbiota therapeutics.
        Gastroenterology. 2014; 146: 1573-1582
        • Khanna S
        • Pardi DS
        • Kelly CR
        • et al.
        A novel microbiome therapeutic increases gut microbial diversity and prevents recurrent Clostridium difficile infection.
        J Infect Dis. 2016; 214: 173-181
        • Gerding DN
        • Meyer T
        • Lee C
        • et al.
        Administration of spores of nontoxigenic Clostridium difficile strain M3 for prevention of recurrent C. difficile infection: a randomized clinical trial.
        JAMA. 2015; 313: 1719-1727
        • Ott SJ
        • Waetzig GH
        • Rehman A
        • et al.
        Efficacy of sterile fecal filtrate transfer for treating patients with Clostridium difficile infection.
        Gastroenterology. 2017; 152 (799-811 e797)