Faecal Microbiota Transplant (FMT)
Transfer of a complete microbiome from a healthy donor to reset the intestinal ecosystem
Definition
Faecal microbiota transplant (FMT) is the administration of a carefully selected healthy donor's intestinal microbiota preparation into the patient's gastrointestinal tract, with the goal of restoring a healthy microbial ecosystem. Administration routes include colonoscopy, enema, nasogastric/jejunal tube, or lyophilised oral capsules. Its established clinical indication is recurrent Clostridioides difficile infection (efficacy >90% in a single infusion), but research is rapidly extending to other conditions.
Detailed explanation
Active areas of FMT research: inflammatory bowel disease (variable efficacy, better in ulcerative colitis than in Crohn's), irritable bowel syndrome, metabolic syndrome (Nieuwdorp's studies in Amsterdam show transient improvements in insulin sensitivity), hepatic encephalopathy, autism (Sarkis Mazmanian's studies), refractory depression, multiple sclerosis, and, more recently, longevity.
The Smith et al. study (Nature, 2017) in progeroid mice showed that FMT from young donors extended lifespan and reversed intestinal aging markers. In humans, FMT from 'super-elderly' donors to frail patients is in exploratory phase.
Donor selection: strict protocols include exclusion of infectious diseases (HIV, hepatitis, syphilis, cytomegalovirus, parasites), autoimmune disease, obesity, diabetes, recent antibiotics, travel to endemic areas, and risky practices. The FDA and AEMPS classify FMT as an experimental medicine — requiring specific authorisation.
Naively anyone can receive an FMT, but risks include transmission of undetected pathogens, immune reactions, and theoretically transfer of unwanted donor phenotypes (obesity, depression). In Spain, clinical FMTs are performed in accredited hospitals; 'homemade' protocols are strongly discouraged.
Scientific sources
- PubMed — Duodenal infusion of donor feces for recurrent Clostridium difficile (NEJM)
- PubMed — Transfer of intestinal microbiota improves insulin sensitivity in metabolic syndrome (Vrieze)
- PubMed — Microbiota transfer therapy in autism (Kang)
- PubMed — FMT in aging: from preclinical evidence to clinical perspective
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