Does Fecal Transport Always Work?

Aziz Koleilat*

Makassed General Hospital, Lebanon

*Corresponding Author:
Aziz Koleilat
Pediatric Specialist
Makassed General Hospital
Beirut, Lebanon
Tel: 009613231717
E-mail: drkoleilat@hotmail.com

Received Date: December 04, 2017; Accepted Date: December 08, 2017; Published Date: December 12, 2017

Citation: Koleilat A (2017) Does Fecal Transport Always Work? J Genet Disord. 1:10.

Visit for more related articles at Journal of Genetic Disorders

What humans can do with the feces and what feces can do with the humans? The idea that the intestine especially large intestine contain material which is of no use is already past history, now we admit that the material found there is an organ by itself (microbial flora) contain microbes, bacteria of various types, fungi, parasites, which affect and play a part with our immune development in preventing or causing diseases [1]. When the idea of fecal microbial transplant (FMT) started or let us say rediscovered. It captured the attention of gastroenterologists and nearly all members of medical fields and workers in health.

Historically, it was used in old times by the Chinese and in the sixties by some European gastroenterologist [2]. Fecal transplant is introducing healthy feces (microbial flora) from healthy donor to a diseased person with certain difficult disease, “it started to treat C. difficile resistant pathogens” and now tried with communicable and non-communicable disease, with inflammatory, autoimmune or even mental diseases and obesity. It spread like almost no other treatment as an intervention in recent medical history, probably due in part to its rapid and high success rate with high margin of safety. The start was for antibiotic-resistant Clostridium difficile (C. difficile) infections and to its novel nature and somehow practical and easy procedures. The hypothesis behind fecal microbiota transplant rests on the concept of bacterial interference, i.e. using harmless bacteria to displace and prevent pathogenic organisms [3], by restoring of missing components of the flora including Bacteriods and Firmicutes, decreasing bacteria with genes resistant antibiotics. Triggering mucosal immune responses [4], depending on the microbiota composition and the recipient’s genotype [5] and rapid production of anti-inflammatory mediators that might counteract pro-inflammatory cytokines [6]. The fecal transplant is done by taking stool from healthy donor after screening the donor for stool serum safety and other infections and used to replace a patient gut microbial flora. The exact preparation varies, but usually the stool is blended with saline and put through a strainer, it can be frozen before use, the stool can be applied into the small intestine via a tube through the nose or the mouth, or deep into the colon, using colonoscopy or enemas which were popular for home treatment.

In the future, scientist hope to replace fecal transplant with an odorless mix of bacterial strains of human stool grown in the lab and could be applied using existing methods or as capsules.

The ideal Dose is of at least 50 grams of stool which showed to have better results than lesser doses [7]. The new gut micro biome appears to be stable in the recipients for at least 151 days (22 weeks) [8]. Studies have utilized different delivery methods that include: Nasogastric tube, nasojejunal tube, Enemas, Colonoscopy (Ileocecal, rectal) or capsule form of the product, delivering to the ileocecal area guarantees delivery of the transplanted microbiome to the entire colon [9]. Rectal enemas limit the delivery of FMT to the rectum and left colon which limit their efficacy beyond those areas. There are some associated risks with FMT, as food allergies.

Children “theoretically” that are highly sensitized to foods may develop anaphylactic reaction when they have contact with antigens from the transplant, and this must be taken into consideration during selecting and exanimating the donor.

The question then arises when such a child needs to undergo fecal transplant? Can there be enough food antigen ingested by the donor that can trigger an anaphylactic reaction upon FMT [9]?

The acceptability of the concept of FMT transplant remains an issue, even though an intriguing report by Kahn et al. [10]. “The opinion and view of patients and families towards fecal transplant, with patients and parents of children with inflammatory bowel disease, readily consider fecal transplant were eager for it to become available”.

The subject and family willingness to accept and undergo fecal microbial transplant for another indication as for resistant C. difficile, remains to be explored.

Potential side effects and risks are rare and infrequent like, bloating, abdominal pain, changes in bowel habits, upper gastrointestinal hemorrhage, irritable bowel syndrome (IBS) symptoms, infectious IBS symptoms, constipation and signs of irritable colon. Transient fever immediately following FMT has also been reported [11].

In General, and up till now, FMT appears to be safe and well tolerated, with no serious adverse events (SAEs) during shortterm follow-up [12,13]. Most reported adverse events include IBS symptoms of mild diarrhea (up to 94%) abdominal cramping and tenderness on the day of infusion (31%) resolved quickly [12] with abdominal tenderness, and rectal discomfort, fatigue, bloating and flatulence, nausea [14,15]. At least theoretically, FMT from a donor with certain disease phenotype could potentially transmit the disease to the recipient. Data on long-term safety of FMT is lacking [16].

The therapeutic potentials & utilization of FMT with promising results [17-20] and conditions include: Auto immune disorders, obesity, increased insulin sensitivity, food allergy, metabolic syndrome and diabetes, neurological conditions, multiple sclerosis, parkinson’s disease, tumors. The future goal in pediatrics as therapy for Autism is promising, FT found to improve autism 80% improvement in gastrointestinal symptoms, 20-25% improvement in behavioral symptoms [21].

The future considerations and Potential applications for FMT in pediatrics could be in treating obesity, IBD, food allergy and other conditions that may prove to be associated with altered microbiomes. Future advancement in delivery of FMT would be in the commercial use of a capsule form with desiccated microorganisms. Microorganisms could be tailored to a specific disease and future advancement in delivery of FMT will soon allow commercial use of a capsule form of FMT with desiccated microorganisms. Similar to a blood bank, a stool bank would collect, test and store donations from numerous donors. Open Biome is a nonprofit stool bank, provide stool preparations to clinicians for fecal microbiota transplantation, and work with clinical researchers investigating the role that the microbiome plays in human health. The future holds a lot of promise for the potential applications for FMT. A key question now arises: Could we manipulate the microbiota environment to treat or prevent diseases in humans especially children?

Can FMT play a role in pediatric IBS, inflammatory bowel disease, atopy, obesity and inflammation which has been shown also to have a disturbed micro biome which are fairly common and difficult to treat? [22]. Do we need all the microorganisms or can we tailor them to a specific disease [23]? Would Bacteroides (probiotics with prebiotics) alone be sufficient to cure patients since they seem to be key organisms these diseases [24]?

Can we optimize microbiota to prevent infections or to reconstitute the microbiota following antibiotic treatment? Should the administration of microbiota components be matched to the host’s genotype, diet, or environment!! Since some specific commensal bacterial species might cause disparate immune responses in different individuals. To what extent can dietary changes optimize the intestinal microbiota, and how will this influence the immune system [5]?

To all above questions, all may be possible need research …. but what is the time frame for this….... till now not it is unclear, although our understanding of the microbiome and mucosal immune system is moving forward rapidly.

The diversity of the fecal microbiota and the marked genomic variation even within well-defined bacterial species is making the design of optimal probiotic combinations challenging!!!

Final point, eventually, with the development of probiotic combinations, fecal transplantation will be replaced by administration of probiotic consortia. Diet has been demonstrated to alter the microbiota and enhance the ability of the microbiota to absorb calories, and this is likely to also extend to relative immune activation. Knowing the impact of the microbiota on gut-associated immune tissues and systemic immune development, this will remain the focus research for many years to come.

Conclusion

Fecal microbiota transplant (FMT) has been introduced several decades ago in an attempt to restore the gut microbial balance. FMT appears to be the most efficient method to effectively change and sustain the gut microbial composition. Success in eliminating recurrent Clostridium difficile infections and restoring the gut microbial profile to resemble that of the healthy donor in this difficult to treat population is 90%. FMT has increasingly become a focus in both the public media and peer-reviewed literature. FMT is still difficult for the pediatric scientific community to embrace and accept this therapy as there are only sporadic reports in children. FMT has also been used to treat inflammatory bowel disease, especially ulcerative colitis and was successful FMT may be a treatment of many difficult diseases. FMT could be adjuvant for the treatment of non-communicable diseases. FMT will be the future of treatment, who knows, it may replace antibiotics!!!!! There is a strong need to determine the safety and efficacy of FMT in future pediatric randomized controlled studies, especially in inflammatory bowel disease [7]. There will come a day that we will write in our will to which our feces will be donated and we will donate it as we donate our organs. As an old grandmother told her granddaughter giving her a box of feces, these were my mother microbes and now they are yours take care of them they may help you in the future.

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