There are several different therapeutic strategies currently available to clinicians that wish to restore the balance of microbial communities in patients. These include treatments that reduce certain types of bacteria, such as antibiotics, and treatments that add bacteria back into the ecosystem, such as probiotics.
An emerging strategy amongst clinicians is a medical treatment called Faecal Microbiota Transplantation (FMT), which involves the transfer of bacteria from a healthy persons gut into the gut of someone suffering from a disease or infection associated with imbalances of bacteria. The microbial communities contained within the transferred microbiota repopulates the bowel of the recipient and restores the imbalance.
FMT can be carried out using a number of methods such as capsule, rectal enema, colonoscopy, nasogastric tube and nasoduodenal tube. Research has shown that FMT is a highly effective treatment for recurrent cases of Clostroides difficile infection, with clinical trials reporting cure rates of around 90%. There is also emerging evidence for FMT in other conditions such as Ulcerative Colitis.
FMT delivers a full microbial ecosystem into the recipient rather than a single or a few strains as is delivered when using probiotics, which means that the treatment could have therapeutic effects on numerous targets. Furthermore, when combined with robust analysis of donors and patients, transferring the full microbial ecosystem could be a powerful research tool that may facilitate patient stratification and personalised microbial therapeutics.
FMT can either be allogenic in nature, where the microbiota that is transferred is derived from a healthy donor, or autologous in nature, where the microbiota is banked by a person when they are healthy for reinstatement at a later date after medical treatment such as chemotherapy or antibiotics.
Both strategies hold promise for patients in hospitals and beyond. Indeed, there are many clinical trials ongoing around the world investigating the use of allogenic and autologous FMT in patients. There are however, several challenges associated with providing FMT in a safe and effective manner, which means that there is limited access for donors and patients.
One difficulty is that because there is no national donor registry, it can be hard to source suitable donors to donate samples for the treatment. A further difficulty is that doctors often have to process the samples themselves, which is time consuming and inconvenient. Ultimately, the costs and logistical factors associated with doctor sourced donors critically limits access to FMT for patients.