Jeffrey Bland discusses fecal microbial transplant with a focus on a 2019 JAMA study: 30 adults with moderate ulcerative colitis who received donor FMT over one week showed higher remission rates at eight weeks than those who received their own bacteria back. The field has moved from skepticism to acceptance, though questions remain about what causes microbiome disruption and whether similar results need live bacteria.
Questions this video answers
January 15, 2019
30 adults
One week of anaerobically prepared donor FMT
Higher likelihood of remission at eight weeks
Dr. Samuel Costello
Chapters
So 2 years ago I had the privilege of sharing the podium with Dr. Samuel Costello, a gastroenterologist at the University Medical School in Australia who had done pioneering work on fecal microbial transplant, fmt. And so FMT is really a way of instilling into the rectum through enema a, a family of favorable bacteria that come from a healthy individual's stool, basically and reinoculating their colon with the bacteria from someone who has a healthy microbiome. And he was talking at the meeting that we both shared about the preliminary work that they had published in using FMT for the ability to treat Clostridium and other kinds of intestinal infection successfully with this particular technology. There was a lot of pushback, as you probably imagine. There was all sorts of questions about using the feces of other people and giving it and administering it to someone else. And so safety questions were on the mind, therapeutic efficacy questions, even just getting over people's cultural bias. Well, I was very pleased to see then, just this last week in the JAMA, a wonderful follow up, more detailed study again by Dr. Costello and his group on fecal microbial transplantation on eight week remission in patients with ulcerative colitis. So now we've moved beyond kind of antibiotic induced gastrointestinal infection into ulcerative colitis, a chronic inflammatory disease of the bowel. And they showed in this use of.
The fecal microbial transplant a very significant improvement in outcome. In fact, they said in this study of 30 adults who had moderate ulcerative colitis, actually a one week treatment with anaerobically prepared donor fecal microbial transplant compared with autologous fecal microbial transplant resulted in a higher likelihood of remission at eight weeks. So a one week intervention with FMT led to an eight week improvement in outcome. And in fact they selected, the editors of JAMA selected this as being an article of importance and there's a follow up editorial on the same issue. This, by the way, is the January 15, 2019 issue of the JAMA entitled Manipulating the Microbiome with Fecal Transplantation to Treat Ulcerative Colitis. So this concept is moving very rapidly to be seen as not just an outlier, but a potential real therapeutic tool. The question that we might ask is how did an individual get a disturbed microbiome to begin with? What relationship does that disturbed microbiome have to inflammation of the gut? Why do certain bacteria that are transplanted.
Seem to have a remediating effect?
And can we produce this effect without.
Giving other exogenous bacteria. Can we reintroduce a healthy microbiome through other intervention technologies? So all of this is an advancing frontier of what?
Probably just as recently as five years.
Ago, if we would have been talking about this, we would have been expunged from any good conversation and expelled from the Guild because we would have been saying something that just sounded totally unreasonable and maybe even dangerous. Now we're starting to see the microbiome is really a key to so many inflammatory conditions.
