Bacteriotherapy

Bacteriotherapy is the purposeful use of bacteria or their products in treating an illness. Forms of bacteriotherapy include the use of probiotics, microorganisms that provide health benefits when consumed; fecal matter transplants (FMT) /intestinal microbiota transplant (IMT), the transfer of gut microorganisms from the fecal matter of healthy donors to recipient patients to restore microbiota; or synbiotics which combine prebiotics, indigestible ingredients that promote growth of beneficial microorganisms, and probiotics. Through these methods, the gut microbiota, the community of 300-500 microorganism species that live in the digestive tract of animals aiding in digestion, energy storage, immune function and protection against pathogens, can be recolonized with favorable bacteria, which in turn has therapeutic effects. Bacteriotherapy is the purposeful use of bacteria or their products in treating an illness. Forms of bacteriotherapy include the use of probiotics, microorganisms that provide health benefits when consumed; fecal matter transplants (FMT) /intestinal microbiota transplant (IMT), the transfer of gut microorganisms from the fecal matter of healthy donors to recipient patients to restore microbiota; or synbiotics which combine prebiotics, indigestible ingredients that promote growth of beneficial microorganisms, and probiotics. Through these methods, the gut microbiota, the community of 300-500 microorganism species that live in the digestive tract of animals aiding in digestion, energy storage, immune function and protection against pathogens, can be recolonized with favorable bacteria, which in turn has therapeutic effects. FMT is being used as a new and effective treatment for C. diff infections, a gastrointestinal disease in which Clostridium difficile colonizes the gut of an organism disrupting microbial balance and causing diarrhea that can potentially be deadly. Bacteriotherapy has also begun to be used in the treatment of mental disorders such as depression, anxiety, and Autism Spectrum Disorder. Recolonization of gut flora can be used effectively in the treatment of mental disorders because of the existence of the gut-brain axis, the bidirectional route of communication between the brain and the gut, specifically the gut microbiota. Fecal Matter Transplant (FMT) was first documented in humans in 1958. The FDA considers FMT a suitable treatment for select patients with C. diff, specifically when standard treatment has failed. It shows a 90% success rate in clinical trials for recurrent C. diff infections. For other illness, it is considered an experimental treatment and should only be done within a research program. The process of FMT involves injecting a liquid suspension of healthy stool into the gastrointestinal tract of a patient. FMT does not require immunological matching or suppression (unlike typical organ transplants). FMT can be performed through nasogastric intubation, nasojejunal intubation, nasoduodenal intubation, upper tract endoscopy, retention enema, gentle rectal enema, or colonoscopy. Research is currently being done to see if FMT can be encapsulated and taken orally as a pill. FMT is a novel treatment, with few complications known thus far. Minor side effects have been reported as mild diarrhea, cramping, abdominal pain, changes in bowel movements, upper gastrointestinal hemorrhage, IBS symptoms (infectious or not), constipation, and irritable colon. There is little known about the possible long-term risk of transmitting an autoimmune disease. Protocols vary with regard to quantity of stool being transplanted and method of infusion. Fresh unfrozen stool samples are more commonly used than frozen samples. The transplant of unfrozen sample is preferably completed within 6 hours. Resolution and relapse rates also differ based on the diluents used to make FMT solutions (water, saline, yogurt, milk or saline with psyllium). Resolution rates increased with increased volume and relapse rates increased with decreased mass of FMT. Further research on FMT is required to directly compare routes of administration, optimal protocol for infusions, and ideal amounts of fecal matter required. Researchers suggest using a large sample size in order to yield statistically significant results. Donors must have refrained from antibiotic usage for as little as 2 months or up to 6 months prior to donating stool. Additionally, donors must not have any history of gastrointestinal disease. Blood tests commonly screen donors for hepatitis A, B and C, HIV and syphilis. Stool tests may include CD toxin, ova, and parasites. 1 donor provides feces for more than 1 patient. Fresh donations should be provided on the day of treatment. Donors related to recipients typically show higher resolution rates (93%) compared to unrelated donors (84%). C. diff infections typically result from the use of broad spectrum antibiotics that alter the microbiota balance, allowing C. diff to colonize. Typical treatment of C. diff with antibiotics, can further disrupt the microbiome of the gut often leading to a cyclical recurrence of C. diff with 35% of patients experiencing recurrence, additionally antibiotic resistance is a growing problem.