Fecal microbiota transplantation (FMT)

 

 Human intestinal microbiota is extremely complex. There are more than 1000 kinds of bacteria in a healthy persons intestine and the number of bacteria reaches 100 trillion. Intestinal microbiota is involved in maintaining normal intestinal function and immune function.

 However, because of the complication of gut microbiota, human are lacking in recognizing it.

It’s reported that gut microbiota dysbiosis associated with a variety of intestinal and out of intestinal diseases, such as surgical postoperative infection, antibiotic-related diarrhea, inflammatory bowel disease (IBD), irritable bowel syndrome, metabolic syndrome, immune system diseases, allergies, epilepsy, autism and so on. The origin of fecal microbiota transplantation is from the ancient China, as Dr. Faming Zhang first time reported in American Journal of Gastroenterology in 2012. Fecal transplant was recorded in “the handbook of prescriptions for emergencies”and"Compendium of Materia Medica". In 1958, Dr. Eiseman et al. who used healthy persons’ fecal to successfully treated four cases of severe pseudomembranous colitis. In 1978, Clostridium difficile infection was found to be the main cause of pseudomembranous colitis and the value of fecal transplantation in the treatment of refractory Clostridium difficile infection was observed its importance. Therefore, the fecal transplantation was recorded in the "TIME" magazine as one of "the worlds ten medical breakthroughs". In 2013, the fecal microbiota transplantation was corned into the American medical guideline for the treatment of Clostridium difficile infection.

FMT is the core strategy of reconstructing intestinal microbiota. Although it has prominent efficacy and high security, it does need requirement of standardization. Since 2012, Dr Faming Zhang moved from advanced endoscopy into microbiota research. Faming Zhangs team focus on standardization of fecal microbiota transplantation and moving it forward for rescuing more patients.

Zhangs team is working on:

(1) To improve the lab process of fecal microbiota preparation, such as automatic purification of fecal microbiota, One-hour FMT protocol, GMP lab;

(2) To make clinical flow of transplantation better, such as protocol during safe endoscopic procedure;

(3) To make patients have better experience of treatment using microbiota, such as how to improve patients feeling;

(4) To study new delivering way of microbitoa and medication into gut, such as colonic tranendoscopic tubing (TET), the quick technique of endoscopic nasojejunal tubing (mid-gut tubing) (the shortest time of tubing is 1 min and 23 seconds);

(5) To provide national nonprofit service for all patients with refractory bacteria infections in whole China based on www.fmtBank.org;

(6) To organize cooperation researches, as leading and largest microbiota transplantation center, to explore mechanism, proper indications, better methodology and train physicians and the public in China.

 

How can wemake sure the compliance, safety, human nature and effectiveness of the FMT emergency rescue plan?

1. Ethical reviews of FMT must be completed;

2. Must ensure that it is a non-profit treatment;

3. Must have a comprehensive  capability of diagnosis and  reasonable treatment of complex bowel disease;

4. Must have specialized in the preparation of fecal’s in-service professional and technical personnel;

5. Must have a laboratory devoted to the preparation of fecal microbiota;

6. Must have a biological safety cabinet specially designed for the fecal microbiota preparations;

7. Automatic purification for enriching microbiota must be based on the system(GenFMTer, Nanjing FMT medical) in GMP level lab;

8. Must master the preservation and recovery technology of fecal microbiota;

9. Must separate the patient specimens from donated stool specimens in the processing space;

10. Must  retain donors’ stool specimens for 2 years for biological samples traceability;

11. Rational screening and pre-transplant preparation for patients and donors must be guaranteed;

12. Must be familiar withtreatment program on possible complications after transplantation;

13. A reliable psychological and privacy protectionprocess must be implemented;

14. Must be transplanted in the endoscope room or in the independent treatment room;

15. Informed consent must be signed on the basis of adequate communication between doctors and patients.


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