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Fecal Microbiota Transplant (FMT)

What is a Fecal Microbiota Transplant?

FMT stands for Fecal Microbiota Transplant (also known as Human Microbiota Transplant, or HMT), which is defined by the taking of gut bacteria from a healthy donor and reintroducing it into a patient, allowing the patient’s gut to repopulate with healthy bacteria that it might have lost. This re-population thereby destroys overpowering bacteria (such as clostridium difficile (C. diff)) and brings other bacteria back to a normal level. 

But FMT has nothing to do with my condition!

Actually, if you have a neurological condition, it probably does. Many diverse bacteria and organisms live in our gut and their symbiotic relationship with us significantly impacts our immune system. When this ecosystem gets out of balance or becomes infected with pathogenic microbes, our bodies become sick. The gut-brain connection has shown a correlation between this dysbiosis (unbalanced gut flora/microbiome) and gastrointestinal illness, neurological disease, and other conditions. The purpose of the HMT is to bring back that balance in a sick person by introducing a healthy ecosystem once again. This can restore the bacteria that might have been lost or in low quantity, and help to fight off bad bacteria that has taken over the sick gut.

FAQ About FMT

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Your microbiome is a combination of all the bacteria and microorganisms that make up who you are. YOU, in fact, are not you. You are made up of trillions of bacteria that live symbiotically with you, keeping you alive and healthy. Your microorganisms outnumber your human cells 10 to 1.  Weird, right? But don’t worry- because of their small size, they only make up 1-3% of your actual body weight. What might be scarier is that they are so inextricably tied to you that your health depends on their balance.

The gut-brain connection is a general term for the influence the gut and the brain have on each other. This connection is actually quite old – have you ever had “butterflies in your stomach” or decided to “go with your gut”? Have you ever felt nauseous when you were stressed? These are all examples of the gut-brain connection. Now, however, science has caught up to what we have always intuitively known. Our body has nerves and neurotransmitters that are responsible for communicating between the gut and brain. These neurotransmitter communicate emotion, sometimes from the brain to the gut (like feeling nauseous before a big test), and sometimes from the gut to the brain (this is less noticeable by us, but it has been shown to affect our anxiety levels). The gut-brain connection is much more intricate than we previously thought, backed up by studies that have been done all over the world including at Harvard Medical School and Johns Hopkins Medicine. 

We use HMT from a stool bank in Hong Kong, called Asia Microbiota Bank. It is the first and largest Asia based commercial stool bank comprised of medical doctors, PhDs, and entrepreneurs, with advisers including the leading fecal transplant doctors and researchers in the world. Started in 2016, AMB provides HMT solutions to medical practitioners to support fecal transplant procedures. The stool specimens come from highly screened donors, and go through an isolation and filtration process, which separates the waste particles and extracts the live bacteria (microbiota) from the specimen. The solution is then preserved in a deep freeze for future use.

The purpose of FMT is to reintroduce a patient’s gut with the healthy bacteria needed for proper gut function. It has famously been used to treat clostridium difficile, with over a 90% success rate. It can similarly treat other GI problems, but it can even be used for treating the symptoms of neurological conditions. Patients with neurological conditions have an overarching similarity in that almost all of them develop GI problems (such as constipation, diarrhea, IBS, etc) in addition to their other symptoms. HMT helps these patients relieve these symptoms, but it has also shown to mitigate some of their other symptoms not related to the GI tract. This has been credited to the brain-gut connection, which science is finding out holds a much stronger connection than previously thought. 

FMT typically starts working within the first few days after treatment.

HMT side effects tend to be mild and go away quickly. It is common to have diarrhea or constipation, though bowel movements should become normal within a few days. Abdominal discomfort, bloating, and cramping are also normal in the hours and days following a HMT session, but if these symptoms turn into pain or don’t go away within a few days, you should consult your doctor. 

There are three main ways to perform a human microbiota transplant:

      1. HMT 250 mL solution for colonoscope/endoscope/enema 
      2. HMT 50 mL high concentration solution for enema
        • The enema procedure uses a flexible thin tube (catheter) which delivers the liquid solution into a patient’s colon while lying down in less than 15 minutes. The tube is removed and the patient rests for 30 minutes (or as long as possible) while the bacteria is engrafted into the colon. Sometimes the patient will have the urge to have a bowel movement 5-10 minutes after the enema procedure. This is normal, but the goal is to retain the liquid as long as possible. 
      3. HMT oral enteric capsule. This capsule has a very tough outer shell so that it will not release the bacteria until it has entered the gut.
        • The capsule procedure is comprised of 10 medium size capsules, which are swallowed with water. It is important not to eat one hour before or after the capsules are taken. 

It is possible that a diet guideline, bowel cleanse, or other simple protocol might be required before the treatment, depending on each individual and their condition. Most patients will receive 5-10 doses for the best effect. 

Our provider, Asia Microbiota Bank, follows a strict protocol for donor screening: 

  1. Donor screening questionnaire
  2. Stool- routine culture E. Coli, Salmonella, Shigella, Campylobacter, Vibrio, Ova & Parasites, Cryptosporidium, Isospora, Giardia, Microsporidia, C. difficile, H. Pylori, VRE, CRE, ESBL, MRSA, Rotavirus, Norovirus, Adenovirus, and 15 other screening targets 
  3. Blood- CBC, HIV, HLTV, Hepatitis A, B, C, Strongyloides, RPR, and 11 other screening targets
  4. Urine- STD
  5. Digestive- AST, ALT, ALP, bilirubin, albumin, and additional profiling 
  6. Psychiatry questionnaire 
  7. There is also “Next Generation Sequencing” which is metagenomic sequencing of 15-20M reads to ensure donors have a mix of the most commonly found microbiota species in the GI tracts and several highly protective unique species. 
  8. Lastly, each sample after testing will be put in a 60-day holding period, and then tested again after those 60 days. 

Clinical Trials

Read full study here

Published March, 2018

Key points: 

  • Many articles emphasize the connection between intestinal autoimmune diseases and dysbiosis or imbalance in gut microbiota, but little is known about non intestinal autoimmune diseases. This article discusses those possibilities as well as how metabolites derived from bacteria could be used as potential therapies for non-intestinal autoimmune diseases. 

Read full study here

Published 2014

Key points: 

  • Article discusses role of microbiome in central nervous system disorders 
  • Immune-mediated CNS disorders discussed: Multiple Sclerosis, Neuromyelitis optica, Guillain-Barre syndrome, and other immune-mediated conditions
  • Non-immune-mediated CNS disorders discussed: autism and depression, anxiety and stress, pain, other neuro-psychiatric symptoms 
  • Factors linking microbiome and CNS: hygiene, antibiotics usage, microbiota composition, probiotics, microbiota-derived products, diet, gut permeability 

Read full study here

Published 2016, 6 ALS patients and 5 healthy

Key points:

  • Showed microbial change, which indicates that the imbalance in intestinal micro flora constitution had a strong association with pathogenesis of ALS

Read full study here

Published 2017, 18 ASD children aged 7-17

Key points: 

  • Purpose of the study is to evaluate the impact of Microbiota Transfer Therapy (MTT) on gut microbiota composition and GI and ASD symptoms of 18 ASD children
  • Patients were put on a 2-week course of antibiotics, then a bowel cleanse, and then FMT
  • There was an 80% reduction of GI symptoms in patients, as well as improved behavioral symptoms which lasted at least 8 weeks (the end point of the followup), suggesting long term impact. 

 

Read full study here

Published 2002, stool data: 13 ASD children and 8 control, gastric and small-bowel data: 7 ASD children and 4 control

Key points: 

  • Children with autism were found to have 9 species of Clostridium not found in control children. Control children had 3 species that were not found in autistic children. 25 species in total were found. 
  • “In gastric and duodenal specimens, the most striking finding was total absence of non-spore-forming anaerobes and microaerophilic bacteria from control children and significant numbers of such bacteria from  children with autism. These studies demonstrate significant alterations in the upper and lower intestinal flora of children with late-onset autism and may provide insights into the nature of this disorder.”

Read full study here

Published 2010, 33 ASD children with GI symptoms, 7 sibling and 8 non-sibling control group

Key points: 

  • Bacteroidetes were found in higher levels in severely autistic children, and Firmicutes were more predominant in control group 
  • Desulfovibrio species and Bacteroides vulgatus were present in significantly higher numbers in the stool of autistic children than in control.
  • Conclusion: “If the unique microbial flora is found to be a causative or consequent factor in this type of autism, it may have implications with regard to a specific diagnostic test, its epidemiology, and for treatment and prevention.” (“this type of autism” not specified) 

Read full study here.

Published 2004, 15 ASD patients and 8 control

Key points:

  • Study was done based on the hypothesis that intestinal clostridia play a role in late-onset autism, and therefore the study characterized clostridia from stools of autistic and control children 
  • Results showed significant differences in cell counts of C. bolteae and other Clostridium groups. 

Read full study here

Published 2000, 11 children with regressive-onset ASD, and 8 control

Key points: 

  • It’s noted that many parents of children with regressive-onset autism notice antecedent antibiotics followed by chronic diarrhea
  • Hypothesis: In some children, disruption in the gut flora might promote colonization of neurotoxin-producing bacteria, at least partially contributing to autistic symptoms. If this is true, then appropriately targeted antimicrobial therapy might reduce those autistic symptoms. 
  • Vancomycin was chosen for its efficacy, and it’s minimal absorption, staying in the intestinal tract until excreted in stool. 
  • Results: short-term improvements were noted, and though this method is not suggested as a treatment, it does suggest the gut flora-brain connection warrants further investigation. 

Read full study here.

Published 2011, 30 regressive-onset ASD children, 7 sibling controls and 12 non-sibling controls

Key points: 

  • Studies have indicated intestinal bacteria play a role in regressive-onset ASD because it responds to oral vancomycin, which stays in the intestinal tract until excreted in stool. 
  • Study presents preliminary evidence suggesting that Desulfovibrio may play a key role in regressive-onset ASD.
  • Desulfovibrio species were found in 14 of 30 regressive-onset ASD children (46.7%), as opposed to the stools of 7 healthy siblings (28.6%), and zero of 12 healthy controls. 

Read full study here

Published 2016, 60 MS patients and 43 control (healthy)

Key points: 

  • Proves that MS, while having a largely similar rate of diversity as well as similar types of microbes, still has some microbes that are different from healthy people
  • Patients that have received immunomodulatory therapy have been shown to have somewhat regulated those notable microbial differences in the gut
  • NOTE: This shows evidence of association and not causation, making FMT treatment still an experimental treatment in terms of helping disease symptoms. However, other studies do prove that GI issues can be mitigated through FMT, if not other disease symptoms. 

Read full study here

Published 2016, 31 RRMS patients and 36 control

Key points:

  • It is hypothesized that microbiota could play a large part in the pathogenesis of MS, so the study is to investigate if microbiota are altered in MS patients
  • Found that MS patients have  an increased abundance of certain microbiota in MS patients, suggesting that there is indeed a dysbiosis in MS patients, but further studies would be needed to prove any kind of causation or part played in pathogenesis. 

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