Jeffrey Bland leads a panel on fecal microbial transplants for recurrent C. difficile infection. A 2017 JAMA trial found oral FMT capsules worked as well as colonoscopy delivery over 12 weeks. Questions remain about whether live microbes or their metabolites do the work.
JAMA, 2017, volume 318, page 1985.
12 weeks.
So this is an update on fecal.
Microbial transplant FMT recall.
We had a little bit of a.
Discussion about this not too long ago, and we got some pushback and some negative feeling like, you've got to be kidding me. You're going to be giving an oral dose to somebody of a fecal bacterial culture to treat something like Clostridia difficile.
And it did seem a little bit.
Strange, I have to admit, but the.
Data is accumulating and remember I said.
That there is now even data that say that a pasteurized or sanitized version of those microbes when orally administered can have positive benefit because it may not.
Be just the living organisms, but it may be what those organisms produced as.
Their metabolites or part of their bacterial cell walls that actually impart these beneficial effects on the GI immune system.
So maybe it doesn't even require a living organism.
So it's not a concern about infection.
But with that as a precept, let.
Me talk about the most recent paper.
I've seen in this area, which I think again advances our knowledge about the potential therapeutic value of FMT fecal microbial transplant.
This is in the JAMA 2017, volume 318 on page 1985.
And this study is entitled It's Fairly Obvious the Focus Effect of an Oral Capsule versus Colonoscopy Delivered Fecal Microbial transplantation.
On recurrent Clostridium difficile infection.
So this is a randomized clinical trial.
Asking the question, do you have to.
Put the cultured fecal microbial material directly into the rectum by a colon implant, or can you orally administer this and get positive effects on something that's going.
On in the south hemisphere, which is.
Infection of the gut with Clostrinium difficile? To give you the outcome, which is.
Let'S cut to the chase among adults.
With this problem of a recurrent Clostridium difficile infection, it was found that fecal.
Microbial transplant orally.
Was not inferior to.
Delivering the microbes by direct installation colonoscopy, and it did help prevent recurrent infection over 12 weeks. And therefore they go on to state that treatment with oral capsules may be an effective approach to treating reoccurrent Clostridium difficile infection. So I think again, we're seeing this technology move forward.
It doesn't mean that there's not some risk. It doesn't mean that we have to be cautious. So, so that we're not introducing toxic.
Infective bacteria, but it does indicate that.
There'S something very powerful about the bacterial.
Community, the microbiome in healthy individuals that.
Can be therapeutically transferred to people who.
Have disturbed microbiome to enhance or even treat a condition of disturbed bacterial origin, which we call dysbiosis. And I think that we're still seeing that.
There is a lot yet to learn, but this may be opening up a.
Very, very powerful new therapeutic tool in enhancing immune function of the Guide.
