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Fecal Transplantation

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Abstract

Fecal transplantation or fecal microbiota transplantation (FMT) represents a therapeutic approach that has been applied in early Chinese medicine for diarrhea and has only recently found the way into medicine. However, while it is an intriguing concept that a disease such as Clostridium difficile-associated colitis can be “cured” by the FMT with a transferred intestinal microbiota, it became at the same time apparent that several factors have to be considered. While the data for C. difficile-associated colitis are based on a placebo-controlled trial, the data for many other indications including inflammatory bowel diseases are less clear. Thus, there is the risk of transferring potential infectious disease as well as phenotypic properties such as obesity. Consequently, the donor screening has to be clearly defined. The present book chapter will summarize the development of the field over the last decade and will provide an outlook about possible innovations in the foreseeable future.

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References

  • Aas, J., Gessert, C. E., & Bakken, J. S. (2003). Recurrent Clostridium difficile colitis: Case series involving 18 patients treated with donor stool administered via a nasogastric tube. Clinical Infectious Diseases, 36, 580–585.

    Article  PubMed  Google Scholar 

  • Alang, N., & Kelly, C. R. (2015). Weight gain after fecal microbiota transplantation. Open Forum Infectious Diseases, 2, ofv004.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bercik, P., Denou, E., Collins, J., Jackson, W., Lu, J., Jury, J., et al. (2011). The intestinal microbiota affect central levels of brain-derived neurotropic factor and behavior in mice. Gastroenterology, 141, 599–609 609 e591–593.

    Article  CAS  PubMed  Google Scholar 

  • Blossom, D. B., & McDonald, L. C. (2007). The challenges posed by reemerging Clostridium difficile infection. Clinical Infectious Diseases, 45, 222–227.

    Article  PubMed  Google Scholar 

  • Borody, T. J., & Campbell, J. (2012). Fecal microbiota transplantation: Techniques, applications, and issues. Gastroenterology Clinics of North America, 41, 781–803.

    Article  PubMed  Google Scholar 

  • Borody, T. J., Warren, E. F., Leis, S. M., Surace, R., Ashman, O., & Siarakas, S. (2004). Bacteriotherapy using fecal flora: Toying with human motions. Journal of Clinical Gastroenterology, 38, 475–483.

    Article  PubMed  Google Scholar 

  • Brandt, L. J., Aroniadis, O. C., Mellow, M., Kanatzar, A., Kelly, C., Park, T., et al. (2012). Long-term follow-up of colonoscopic fecal microbiota transplant for recurrent Clostridium difficile infection. The American Journal of Gastroenterology, 107, 1079–1087.

    Article  PubMed  Google Scholar 

  • Cammarota, G., Ianiro, G., Tilg, H., Rajilic-Stojanovic, M., Kump, P., Satokari, R., et al. (2017). European consensus conference on faecal microbiota transplantation in clinical practice. Gut, 66, 569–580.

    Article  PubMed  Google Scholar 

  • Collins, S. M., Kassam, Z., & Bercik, P. (2013). The adoptive transfer of behavioral phenotype via the intestinal microbiota: Experimental evidence and clinical implications. Current Opinion in Microbiology, 16, 240–245.

    Article  PubMed  Google Scholar 

  • Costello, S., Waters, O., Bryant, R., Katsikeros, R., Makanyanga, J., Schoeman, M., et al. (2017). OP36: Short duration, low intensity pooled faecal microbiota transplantation induces remission in patients with mild-moderately active ulcerative colitis: a randomized controlled trial. JCC, 11S1, S23.

    Google Scholar 

  • Couturier-Maillard, A., Secher, T., Rehman, A., Normand, S., De Arcangelis, A., Haesler, R., et al. (2013). NOD2-mediated dysbiosis predisposes mice to transmissible colitis and colorectal cancer. The Journal of Clinical Investigation, 123, 700–711.

    PubMed  PubMed Central  CAS  Google Scholar 

  • Deltheil, T., Guiard, B. P., Cerdan, J., David, D. J., Tanaka, K. F., Reperant, C., et al. (2008). Behavioral and serotonergic consequences of decreasing or increasing hippocampus brain-derived neurotrophic factor protein levels in mice. Neuropharmacology, 55, 1006–1014.

    Article  CAS  PubMed  Google Scholar 

  • Eiseman, B., Silen, W., Bascom, G. S., & Kauvar, A. J. (1958). Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis. Surgery, 44, 854–859.

    PubMed  CAS  Google Scholar 

  • Ge, H. D. D. (2000). Zhou Hou Bei Ji Fang. Tianjin: Tianjin Science & Technology Press.

    Google Scholar 

  • George, R. H., Symonds, J. M., Dimock, F., Brown, J. D., Arabi, Y., Shinagawa, N., et al. (1978a). Identification of Clostridium difficile as a cause of pseudomembranous colitis. British Medical Journal, 1, 695.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • George, W. L., Sutter, V. L., Goldstein, E. J., Ludwig, S. L., & Finegold, S. M. (1978b). Aetiology of antimicrobial-agent-associated colitis. Lancet, 1, 802–803.

    Article  CAS  PubMed  Google Scholar 

  • Gilbert, D. N., Moellering, R. C., Eliopoulos, G. M., & Sande, M. A. (2004). The Sanford guide to antimicrobial therapy (34th ed.). Sperryville, VA: Antimicromial Therapy, Inc..

    Google Scholar 

  • Hamilton, M. J., Weingarden, A. R., Sadowsky, M. J., & Khoruts, A. (2012). Standardized frozen preparation for transplantation of fecal microbiota for recurrent Clostridium difficile infection. The American Journal of Gastroenterology, 107, 761–767.

    Article  PubMed  Google Scholar 

  • Johnsen, P. H., Hilpusch, F., Cavanagh, J. P., Leikanger, I. S., Kolstad, C., Valle, P. C., et al. (2018). Faecal microbiota transplantation versus placebo for moderate-to-severe irritable bowel syndrome: a double-blind, randomised, placebo-controlled, parallel-group, single-centre trial. The Lancet Gastroenterology and Hepatology, 3, 17–24.

    Article  PubMed  Google Scholar 

  • Kelly, C. P. (1996). Immune response to Clostridium difficile infection. European Journal of Gastroenterology and Hepatology, 8, 1048–1053.

    Article  CAS  PubMed  Google Scholar 

  • Khoruts, A., & Sadowsky, M. J. (2011). Therapeutic transplantation of the distal gut microbiota. Mucosal Immunology, 4, 4–7.

    Article  CAS  PubMed  Google Scholar 

  • Koo, H. L., Van, J. N., Zhao, M., Ye, X., Revell, P. A., Jiang, Z. D., et al. (2014). Real-time polymerase chain reaction detection of asymptomatic Clostridium difficile colonization and rising C. difficile-associated disease rates. Infection Control and Hospital Epidemiology, 35, 667–673.

    Article  PubMed  Google Scholar 

  • Kootte, R. S., Levin, E., Salojarvi, J., Smits, L. P., Hartstra, A. V., Udayappan, S. D., et al. (2017). Improvement of insulin sensitivity after lean donor feces in metabolic syndrome is driven by baseline intestinal microbiota composition. Cell Metabolism, 26, 611–619 e616.

    Article  CAS  PubMed  Google Scholar 

  • Kump, P., Wurm, P., Grochenig, H. P., Wenzl, H., Petritsch, W., Halwachs, B., et al. (2018). The taxonomic composition of the donor intestinal microbiota is a major factor influencing the efficacy of faecal microbiota transplantation in therapy refractory ulcerative colitis. Alimentary Pharmacology and Therapeutics, 47, 67–77.

    Article  CAS  PubMed  Google Scholar 

  • Kyne, L., Warny, M., Qamar, A., & Kelly, C. P. (2000). Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. The New England Journal of Medicine, 342, 390–397.

    Article  CAS  PubMed  Google Scholar 

  • Kyne, L., Warny, M., Qamar, A., & Kelly, C. P. (2001). Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea. Lancet, 357, 189–193.

    Article  CAS  PubMed  Google Scholar 

  • Larson, H. E., Price, A. B., Honour, P., & Borriello, S. P. (1978). Clostridium difficile and the aetiology of pseudomembranous colitis. Lancet, 1, 1063–1066.

    Article  CAS  PubMed  Google Scholar 

  • Lee, C. H., Steiner, T., Petrof, E. O., Smieja, M., Roscoe, D., Nematallah, A., et al. (2016). Frozen vs fresh fecal microbiota transplantation and clinical resolution of diarrhea in patients with recurrent clostridium difficile infection: A randomized clinical trial. JAMA, 315, 142–149.

    Article  CAS  PubMed  Google Scholar 

  • Leffler, D. A., & Lamont, J. T. (2015). Clostridium difficile infection. The New England Journal of Medicine, 372, 1539–1548.

    Article  CAS  PubMed  Google Scholar 

  • Lewin, R. A. (2001). More on Merde. Perspectives in Biology and Medicine, 44, 594–607.

    Article  CAS  PubMed  Google Scholar 

  • Li, S. M. D. (2011). Ben Cao Gang Mu. Bejing: Huaxia Press.

    Google Scholar 

  • Miller, B. A., Chen, L. F., Sexton, D. J., & Anderson, D. J. (2011). Comparison of the burdens of hospital-onset, healthcare facility-associated Clostridium difficile Infection and of healthcare-associated infection due to methicillin-resistant Staphylococcus aureus in community hospitals. Infection Control and Hospital Epidemiology, 32, 387–390.

    Article  PubMed  Google Scholar 

  • Moayyedi, P., Surette, M. G., Kim, P. T., Libertucci, J., Wolfe, M., Onischi, C., et al. (2015). Fecal microbiota transplantation induces remission in patients with active ulcerative colitis in a randomized controlled trial. Gastroenterology, 149, 102–109 e106.

    Article  PubMed  Google Scholar 

  • Ott, S. J., Waetzig, G. H., Rehman, A., Moltzau-Anderson, J., Bharti, R., Grasis, J. A., et al. (2017). Efficacy of sterile fecal filtrate transfer for treating patients with Clostridium difficile Infection. Gastroenterology, 152, 799–811 e797.

    Article  PubMed  Google Scholar 

  • Paramsothy, S., Kamm, M. A., Kaakoush, N. O., Walsh, A. J., van den Bogaerde, J., Samuel, D., et al. (2017). Multidonor intensive faecal microbiota transplantation for active ulcerative colitis: A randomised placebo-controlled trial. Lancet, 389, 1218–1228.

    Article  PubMed  Google Scholar 

  • Postigo, R., & Kim, J. H. (2012). Colonoscopic versus nasogastric fecal transplantation for the treatment of Clostridium difficile infection: A review and pooled analysis. Infection, 40, 643–648.

    Article  CAS  PubMed  Google Scholar 

  • Ratner, M. (2014). Fecal transplantation poses dilemma for FDA. Nature Biotechnology, 32, 401–402.

    Article  CAS  PubMed  Google Scholar 

  • Ridaura, V. K., Faith, J. J., Rey, F. E., Cheng, J., Duncan, A. E., Kau, A. L., et al. (2013). Gut microbiota from twins discordant for obesity modulate metabolism in mice. Science, 341, 1241214.

    Article  CAS  PubMed  Google Scholar 

  • Rossen, N. G., Fuentes, S., van der Spek, M. J., Tijssen, J. G., Hartman, J. H., Duflou, A., et al. (2015). Findings from a randomized controlled trial of fecal transplantation for patients with ulcerative colitis. Gastroenterology, 149, 110–118 e114.

    Article  PubMed  Google Scholar 

  • Sambol, S. P., Merrigan, M. M., Tang, J. K., Johnson, S., & Gerding, D. N. (2002). Colonization for the prevention of Clostridium difficile disease in hamsters. The Journal of Infectious Diseases, 186, 1781–1789.

    Article  PubMed  Google Scholar 

  • Sandler, R. H., Finegold, S. M., Bolte, E. R., Buchanan, C. P., Maxwell, A. P., Vaisanen, M. L., et al. (2000). Short-term benefit from oral vancomycin treatment of regressive-onset autism. Journal of Child Neurology, 15, 429–435.

    Article  CAS  PubMed  Google Scholar 

  • Satokari, R., Mattila, E., Kainulainen, V., & Arkkila, P. E. (2015). Simple faecal preparation and efficacy of frozen inoculum in faecal microbiota transplantation for recurrent Clostridium difficile infection – An observational cohort study. Alimentary Pharmacology and Therapeutics, 41, 46–53.

    Article  CAS  PubMed  Google Scholar 

  • Sepehri, S., Kotlowski, R., Bernstein, C. N., & Krause, D. O. (2007). Microbial diversity of inflamed and noninflamed gut biopsy tissues in inflammatory bowel disease. Inflammatory Bowel Diseases, 13, 675–683.

    Article  PubMed  Google Scholar 

  • Siegmund, B. (2017). Is intensity the solution for FMT in ulcerative colitis? Lancet, 389, 1170–1172.

    Article  PubMed  Google Scholar 

  • Smith, M., Kassam, Z., Edelstein, C., Burgess, J., & Alm, E. (2014). OpenBiome remains open to serve the medical community. Nature Biotechnology, 32, 867.

    Article  CAS  PubMed  Google Scholar 

  • Sokol, H., Seksik, P., Furet, J. P., Firmesse, O., Nion-Larmurier, I., Beaugerie, L., et al. (2009). Low counts of Faecalibacterium prausnitzii in colitis microbiota. Inflammatory Bowel Diseases, 15, 1183–1189.

    Article  CAS  PubMed  Google Scholar 

  • Surawicz, C. M., & Alexander, J. (2011). Treatment of refractory and recurrent Clostridium difficile infection. Nature reviews. Gastroenterology and Hepatology, 8, 330–339.

    PubMed  CAS  Google Scholar 

  • Turnbaugh, P. J., Ley, R. E., Mahowald, M. A., Magrini, V., Mardis, E. R., & Gordon, J. I. (2006). An obesity-associated gut microbiome with increased capacity for energy harvest. Nature, 444, 1027–1031.

    Article  PubMed  Google Scholar 

  • van Nood, E., Vrieze, A., Nieuwdorp, M., Fuentes, S., Zoetendal, E. G., de Vos, W. M., et al. (2013). Duodenal infusion of donor feces for recurrent Clostridium difficile. The New England Journal of Medicine, 368, 407–415.

    Article  CAS  PubMed  Google Scholar 

  • Walker, A. W., Sanderson, J. D., Churcher, C., Parkes, G. C., Hudspith, B. N., Rayment, N., et al. (2011). High-throughput clone library analysis of the mucosa-associated microbiota reveals dysbiosis and differences between inflamed and non-inflamed regions of the intestine in inflammatory bowel disease. BMC Microbiology, 11, 7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zhang, F., Luo, W., Shi, Y., Fan, Z., & Ji, G. (2012). Should we standardize the 1,700-year-old fecal microbiota transplantation? The American Journal of Gastroenterology, 107, 1755 author reply pp. 1755–1756.

    Article  PubMed  Google Scholar 

  • Zuo, T., Wong, S. H., Lam, K., Lui, R., Cheung, K., Tang, W., et al. (2018, April). Bacteriophage transfer during faecal microbiota transplantation in Clostridium difficile infection is associated with treatment outcome. Gut, 67(4), 634–643.

    PubMed  Google Scholar 

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Correspondence to Britta Siegmund .

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Schmidt, F., Siegmund, B. (2018). Fecal Transplantation. In: Haller, D. (eds) The Gut Microbiome in Health and Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-90545-7_20

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