An article in the New England Journal of Medicine, January 2013 explores the validity of faecal transplant therapy for the resolution of C. difficile therapy and reminds us that back in 1958 clinicians in Denver trialled this therapy to “re-establish the balance of nature” within the intestinal flora to correct the disruption caused by antibiotic treatment.
Since then systematic reviews reveals that the reported efficacy of FMT in treating recurrent C. difficile infection is greater than 90%.
So why has this treatment option taken nearly half a century to be taken more and more seriously?
Well the burgeoning field of microbiome research, initially made possible by technologies to identify bacterial 16S ribosomal RNA in complex biologic samples, has developed a far clearer analysis of the abundant, diverse, and influential nature of the gut microbiota. Microbiome research has been expanded and complemented by methods to characterise the protein composition (proteomics) and metabolic processes (metabolomics) of the intestinal contents and those from other body sites.
The results of this study represent a clear precedent in which planned therapeutic manipulation of the human intestinal microbiota can lead to demonstrable, clinically important benefits, thereby bringing faecal transplant therapy to the mainstream of modern, evidence-based medical practice.,2,
The mechanism underlying the efficacy of donor-faeces infusion is probably the reestablishment of the normal microbiota as a host defence against C. difficile. Changes in the gut bacterial phyla Firmicutes and Bacteroidetes were associated with C. difficile infection.The researchers found that the faecal microbiota in patients with C. difficile infection had a reduced bacterial diversity, as compared with healthy persons, extending previous observations. Infusion of donor faeces resulted in improvement in the microbial diversity, which persisted over time. Also, there was an increase in Bacteroidetes species and clostridium clusters IV and XIVa (Firmicutes), whereas Proteobacteria species decreased.
In conclusion, in patients with recurrent C. difficile infection, the infusion of donor faeces, as compared with vancomycin therapy, resulted in better treatment outcomes. In particular, patients with multiple relapses of C. difficile infection benefited from this unconventional approach.
What can we learn from these studies, and how may these translate across other conditions?
- The first is that dysbiosis is an increased risk for persistent infection and that antibiotics are a risk for the development of persistent dysbiosis.
- The second is that restoring a permanent change to bacterial ratios seems possible with faecal transplant – whereas with probiotics this has been elusive
- The implications are that other conditions in which dysbiosis is a causative of amplifying event may respond to faecal transplant therapy
- Lastly, food choice and prebiotics, whilst not discussed also make credible options for manipulation of the ecological mix.
 Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infect Dis 2011;53:994-1002 View Full Paper
 Khoruts A, Dicksved J, Jansson JK, Sadowsky MJ. Changes in the composition of the human fecal microbiome after bacteriotherapy for recurrent Clostridium difficile-associated diarrhea. J Clin Gastroenterol 2010;44:354-360 View Abstract
 Manges AR, Labbe A, Loo VG, et al. Comparative metagenomic study of alterations to the intestinal microbiota and risk of nosocomial Clostridium difficile-associated disease. J Infect Dis 2010;202:1877-1884 View Abstract
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