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10 FMT Advances from 2014
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Fecal microbiota transplant, or FMT, was a hot topic in 2014, with much emerging data on its safety and efficacy for the treatment of Clostridium difficile infection and inflammatory bowel disease presented at society meetings and in the journals. Below we present a round-up of 10 developments in FMT presented this year by Healio Gastroenterology.
1. FMT most cost-effective first-line treatment for recurrent Clostridium difficile infection
Researchers from Massachusetts General Hospital found that FMT via colonoscopy was the most cost-effective strategy for first-line treatment of recurrent CDI.
“In settings where FMT is not available, initial treatment with oral vancomycin was the most cost-effective strategy,” the researchers wrote in Clinical Infectious Diseases. “As more data become available, guidelines should consider incorporating use of FMT earlier in the treatment of C. difficile infection, considering its high efficacy and low CDI recurrence rate.” Read more
2. UC patients failed to show significant improvement after FMT
Patients with ulcerative colitis treated with FMT did not show significant improvements after 6 weeks of treatment, but may improve with longer therapy, a researcher said during a late-breaking presentation at Digestive Disease Week.
“FMT is an interesting approach to treating UC,” Paul Moayyedi, BSc, MB ChB, PhD, director of the division of gastroenterology at McMaster University, Hamilton, Canada, said during his presentation. “However, our random, controlled trial is negative and does not support the use of FMT at this time. We need to get more data, and we need to understand how better to use this approach. I think it is an interesting avenue, but we need to evaluate it.” Read more
3. FMT cleared C. difficile infection in immunocompromised patients
Elizabeth L. Hohmann
FMT effectively treated C. difficile infection in immunocompromised patients without a significant increase in incidence of adverse events, according to recent study data.
Although the multicenter study was retrospective, it “shows that people with significant immunocompromising conditions who have a strong indication for FMT will likely benefit from it without too much in the way of side effects,” Elizabeth L. Hohmann, MD, associate professor of medicine/infectious diseases at Massachusetts General Hospital/Harvard Medical School, told Healio Gastroenterology. Read more
4. Functional changes accompanied microbial structural changes after FMT
Specific changes in gut microbiota structure after FMT in patients with recurrent C. difficile infection were associated with functional changes in a recent study.
“By comparing community composition and structure per FMT pair, we observed differences in functional potential of the microbiome based on the type of community present within individual recipient-donor pairs,” the investigators wrote. “While current success rates are high for treatment of C. difficile infection, a clear understanding of how FMT works has the potential to aid the development of alternative biotherapeutics.” Read more
5. FMT improved symptoms in patients with Crohn's disease
Byron P. Vaughn
FMT induced early improvement of symptoms in patients with active Crohn’s disease, according to findings from a pilot study presented at the American Gastroenterological Association’s James W. Freston Conference.
“FMT is currently not ready to be offered as a treatment for patients with IBD,” Byron P. Vaughn, MD, of the Beth-Israel Deaconess Medical Center told Healio Gastroenterology. “It is still unknown if the dysbiosis causes inflammation or is an effect of inflammation, or has components of both. Yet we are starting to see a signal that improving the dysbiosis through manipulating the intestinal flora may improve symptoms related to Crohn’s disease for some patients.” Read more
6. Methodology implemented for first public stool bank for FMT
Mark B. Smith
Zain Kassam
Mark B. Smith, PhD, and Zain Kassam, MD, MPH, of Massachusetts Institute of Technology, and colleagues reviewed the literature to develop scalable protocols for screening and processing donor stool for FMT. This methodology was validated by leaders in gastroenterology, infectious diseases and related fields during its implementation in OpenBiome.
“OpenBiome was founded by a team of microbiologists, clinicians and public health advocates at MIT and Harvard and is based in Medford, Mass.,” Smith told Healio Gastroenterology. “As the first public stool bank, OpenBiome is like the Red Cross, but for stool.” Read more
7. FMT effectively treated severe, complicated Clostridium difficile infection
FMT was successful in treating patients with severe or complicated C. difficile infection, according to data presented recently at the American Gastroenterological Association’s James W. Freston Conference in Chicago.
“In our cohort of 17 patients from nine medical centers, FMT was a successful treatment option for severe or complicated C. difficile infection in whom antibiotic regimens had failed,” Olga C. Aroniadis, MD, gastroenterology fellow, Montefiore Medical Center, New York, told Healio Gastroenterology. Read more
8. Oral, frozen FMT capsules treated diarrhea linked to recurrent C. difficile infection
Ilan Youngster
Patients with recurrent C. difficile infection achieved resolution of diarrhea with no serious treatment-related adverse events with orally administered frozen FMT capsules, according to data presented at IDWeek 2014.
“The main importance of our study is that we have eliminated the need for invasive procedures and made it easier, safer and more accessible to patient,” study researcher Ilan Youngster, MD, MMSc, fellow in pediatric infectious diseases at Massachusetts General Hospital and Boston Children’s Hospital, told Healio Gastroenterology. Read more
9. Video: Fresh, frozen or lyophilized FMT via colonoscopy effectively treated recurrent C. difficile infection
Zhi-Dong Jiang, MD, DrPh, of the University of Texas School of Public Health, discusses the findings from her study of the efficacy of fresh, frozen, or lyophilized FMT administered via colonoscopy for treatment of recurrent C. difficile infection. This research was presented at the ACG Annual Scientific Meeting.
For “patients with C. difficile toxin-negative [stools] at the time of FMT, the response rate was over 90%. That’s one of our most important findings, and also we found that frozen or lyophilized products are as effective as fresh.” Watch here
10. FMT appears ineffective for treatment of IBD
Edward V. Loftus
Mounting evidence shows that while FMT appears to be a highly effective therapy for C. difficile infection, it does not appear to be efficacious for treating IBD, according to Edward V. Loftus, MD, FACG, AGAF, from Mayo Clinic in Rochester, Minn., a presenter at the Advances in IBD meeting in Orlando, Fla.
“As more objectivity and reality is being infused into this area, the results are not nearly as glowing as they were initially described,” Loftus said. Read more