Fecal Microbiota Transplant

Question 1

FMT

Answer 1

Introduction of fecal suspension derived from a healthy donor into the GI tract of a diseased individual

Question 2

Goals of FMT

Answer 2

1. Restore phylogenetic diversity and therefore physiological functions
2. Replace/inhibit pathogenic species

Question 3

FMTs started

Answer 3

1700 years ago in China for severe diarrhea + 4th century for severe diarrhea

Question 4

Yellow soup

Answer 4

Infant feces used to treat diarrheal illness in the 16th century

Question 5

Growth of FMT in recent years due to

Answer 5

1) Global C. difficile epidemic (CDI)
2) Growing appreciation of the complexity of the GI microbiome and its role in health and disease

Question 6

Current indication for FMT

Answer 6

CDI

Question 7

Future indications for FMT

Answer 7

UC (curable in some) + CD (supporting role?)

Question 8

Antibiotics for CDI

Answer 8

Metronidazole, Vancomycin, Fidaxomicin, Rifaximin

Question 9

Downfalls of CDI antibiotic therapy (4)

Answer 9

Further microbial damage + reoccurrence rate of 20% + rising reoccurrence rate with each episode + do not correct normal microbiome

Question 10

CDI symptoms

Answer 10

fever, abdominal cramps, diarrhea

Question 11

CDI mechanism

Answer 11

Endospores survive acidity and reach intestines and grows in colon –> produces Toxin A and B to cause mucosal damage –> Pseudomembranous colitis where yellow plaques form over damaged epithelium –> antibiotics make it worse by altering normal microbiota and causing dysbiosis

Question 12

CDI is the

Answer 12

Most common infectious cause of nosocomial diarrhea

Question 13

CDI epidemic

Answer 13

2000-2002: number of cases doubled and severity, death, and surgeries increased

Question 14

CDI epidemic was associated with…

Answer 14

Quinolone use and hypervirulent strains

Question 15

Cure rate of FMTs

Answer 15

85-90% in case series

Question 16

Efficacy of FMT in CDI

Answer 16

Clinical trial: First round 81% and second 94% (30% vancomycin)

Question 17

OTUs relative abundance in FMT

Answer 17

Switch from a recipient to donor microbiome

Question 18

IBD and FMT

Answer 18

Has had a systemic review and meta analysis done with 18 studies and 1 randomised –> 122 patient (79 UC, 39 CD, and 4 unclassified)

Question 19

Remission of IBD in Systemic Review

Answer 19

45% had clinical remission: 36% in cohort studies, 22% in UC, and 61% in CD

Question 20

Conclusions of IBD analysis

Answer 20

Study bias and more randomized studies needed with clinical and microbiological data needed + no serious safety concerns

Question 21

How to FMT

Answer 21

1. Donor selection
2. Donor screening
3. Stool collection and prep
4. Patient prep and stool administration

Question 22

Donor selection

Answer 22

Unrelated member or family and friends: must be healthy and devoid of transmissible or microbiota associated disease (IBS, obesity, constipation, GI malignancy) + no recent antibiotics

Question 23

Only ___ candidates for FMT are selected when screened

Answer 23

30%

Question 24

Types of screening for donor

Answer 24

Medical interview + medical history and exam + blood + stool

Question 25

Stool preparation

Answer 25

Fresh stool blended in saline solution –> filter out larger particles –> place into barium enema kit or make capsules…

Question 26

Stool must be delivered for processing

Answer 26

Within hour

Question 27

Freezing of stool

Answer 27

Can be frozen after processing in stool bank

Question 28

No consensus for

Answer 28

FMT preparation, processing, patient prep, or rout of administration

Question 29

Patient prep

Answer 29

Stop antibiotics (24-72 hours before), colonoscopy prep night before

Question 30

Main routes of FMT

Answer 30

Retention enema, colonoscopy, naso-duodenal infusion, pills

Question 31

Safety of FMT

Answer 31

Generally well tolerated

Question 32

Risks of FMT (3)

Answer 32

Infection, microbiota associated disease, complication of procedure

Question 33

Most common symptom day of infection

Answer 33

Diarrhea

Question 34

Frozen stool banks

Answer 34

Permit post donation screening and no “same day delivery” + shown efficacious

Question 35

Next Generation FMT

Answer 35

Starting up in CDI as standardised pharmaceutical grade, prep of beneficial mix of bacteria

Question 36

Next Generation FMT composition

Answer 36

Can be whole microbiome or few beneficial strains

Question 37

Example of Next Generation FMT

Answer 37

RBX2660 (87% success in Phase II trails)