#Faecal Microbiota Transplantation

[academiavet]

"Transplante fecal" (FMT - Faecal microbial transplantation ou, na verdade, Transplante de Microbiota Fecal) em cães com Enteropatia Crônica - Atualização/Update TORESSON et al (2023) - Resumo da Importância do Transplante de Microbiota Fecal

O estudo de TORESSON et al (2023) descreve os efeitos dos transplantes de microbiota fecal em 41 cães com enteropatia crônica, com tempo de acompanhamento de 3 a 41 meses. Nenhum dos cães havia respondido anteriormente de forma satisfatória ao tratamento padrão. A maioria dos cães recebeu três tratamentos de FMT com intervalo de 10 a 20 dias entre eles. O tratamento foi administrado paralelamente ao tratamento médico de manutenção e dieta com que o cão já estava sendo tratado. Após o tratamento, 31/41 cães apresentaram diminuição dos sinais clínicos, com a maioria dos cães apresentando menos diarreia e/ou tornando-se mais ativos. De 16 cães, foram colhidas amostras fecais antes do primeiro FMT. Cães com disbiose mais grave, conforme indicado por um índice de disbiose fecal gravemente aumentado, responderam menos ao FMT em comparação com cães com forma mais leve de disbiose. Este estudo apoia relatos de casos anteriores de que o transplante de microbiota fecal pode ser útil como complemento ao tratamento padrão de cães com enteropatia crônica. O procedimento utilizado para FMT no presente estudo pode ser facilmente utilizado em ambientes de cuidados primários. Usar fezes frescas congeladas é conveniente em comparação com fezes frescas, que podem não estar prontamente disponíveis. As fezes congeladas foram consideradas tão eficazes quanto as frescas no tratamento da Infecção recorrente por Clostridioides difficile (Clostridioides difficile infection - CDI) em uma meta-análise recente [70]. O congelamento também pode ter um efeito protetor contra potenciais ovos de endoparasitas fecais ou oocistos de parasitas protozoários que o cão doador poderia ter contraído após a última triagem [71,72,73]. Os efeitos colaterais foram leves e autolimitados e foram observados tanto em respondedores quanto em não respondedores. Consequentemente, diarreia leve de curta duração ou outros sinais gastrointestinais após FMT não excluem um efeito benéfico, e os efeitos colaterais leves não parecem diferir entre os respondedores e os não respondedores neste estudo. Este estudo retrospectivo tem várias limitações. A maioria dos cães foi tratada com um transplante processado dentro de 6 horas, mas alguns cães foram tratados com um transplante processado até 72 horas antes. Isto pode ter afetado a resposta ao FMT. As informações sobre o intervalo de tempo entre o processamento do transplante e o FMT não estavam disponíveis para cães individuais. Muitas questões ainda precisam ser respondidas sobre o uso do FMT em cães com Enteropatia Crônica (Chronic Enteropathy - CE). São necessários mais dados sobre quanto tempo normalmente dura a melhoria clínica, embora a experiência clínica deste estudo sugira que a resposta ao tratamento é muito individual. Outras questões de pesquisa para estudos futuros incluem quantos tratamentos sequenciais devem ser administrados, se as ferramentas de diagnóstico podem diferenciar os respondedores fracos dos respondedores bons no início do estudo e como o microbioma e o metaboloma são afetados ao longo do tempo.

Dois de quatro cães com inflamação grave do intestino delgado ou grosso tiveram uma boa resposta, um em cada quatro teve uma resposta de curta duração e um em cada quatro teve uma resposta fraca. O índice de disbiose foi significativamente menor no início do estudo em bons respondedores em comparação com maus respondedores. O procedimento utilizado para FMT no presente estudo pode ser facilmente utilizado em ambientes de cuidados primários. Usar fezes frescas congeladas é conveniente em comparação com fezes frescas, que podem não estar prontamente disponíveis. As fezes congeladas foram consideradas tão eficazes quanto as frescas no tratamento de ICD recorrente em uma meta-análise recente [70]. O congelamento também pode ter um efeito protetor contra potenciais ovos de endoparasitas fecais ou oocistos de parasitas protozoários que o cão doador poderia ter contraído após a última triagem [71,72,73]. Os efeitos colaterais foram leves e autolimitados e foram observados tanto em respondedores quanto em não respondedores. Consequentemente, diarreia leve de curta duração ou outros sinais gastrointestinais após TMF não excluem um efeito benéfico, e os efeitos colaterais leves não parecem diferir entre os respondedores e os não respondedores neste estudo. Este estudo retrospectivo tem várias limitações. A maioria dos cães foi tratada com um transplante processado dentro de 6 horas, mas alguns cães foram tratados com um transplante processado até 72 horas antes. Isto pode ter afetado a resposta ao FMT. As informações sobre o intervalo de tempo entre o processamento do transplante e o FMT não estavam disponíveis para cães individuais. Muitas questões ainda precisam ser respondidas sobre o uso do FMT em cães com CE. São necessários mais dados sobre quanto tempo normalmente dura a melhoria clínica, embora a experiência clínica deste estudo sugira que a resposta ao tratamento é muito individual. Outras questões de pesquisa para estudos futuros incluem quantos tratamentos sequenciais devem ser administrados, se as ferramentas de diagnóstico podem diferenciar os respondedores fracos dos respondedores bons no início do estudo e como o microbioma e o metaboloma são afetados ao longo do tempo.

Referência: Veterinary Sciences | Free Full-Text | Clinical Effects of Faecal Microbiota Transplantation as Adjunctive Therapy in Dogs with Chronic Enteropathies—A Retrospective Case Series of 41 Dogs (mdpi.com)

[leedsomics]

Enhanced metagenomics-enabled transmission inference with TRACS

Coexisting strains of the same species within the human microbiota pose a substantial challenge to inferring the host-to-host transmission of both pathogenic and commensal microbes. Here, we present TRACS, a highly accurate algorithm for estimating genetic distances between strains at the level of individual SNPs, which is robust to intra-species diversity within the host. Analysis of well-characterised Faecal Microbiota Transplantation datasets, along with extensive simulations, demonstrates that TRACS substantially outperforms existing strain aware transmission inference methods. We use TRACS to infer transmission networks in patients colonised with multiple strains, including SARS-CoV-2 amplicon sequencing data from UK hospitals, deep population sequencing data of Streptococcus pneumoniae and single-cell genome sequencing data from malaria patients infected with Plasmodium falciparum. Applying TRACS to gut metagenomic samples from a large cohort of 176 mothers and 1,288 infants born in UK hospitals revealed species-specific transmission rates between mothers and their infants. Notably, TRACS identified increased persistence of Bifidobacterium breve in infants, a finding missed by previous analyses due to the presence of multiple strains. http://dlvr.it/TCBTRn

[biotech-news-feed]

Primary sclerosing cholangitis is estimated to affect one in 100,000 people worldwide annually #BioTech #science

[ramtracking]

Parkinson's: Single-dose stool transplant could improve symptoms [ Fecal microbiota transplant ]

Parkinson’s: Single-dose stool transplant could improve symptoms [News Summary] Parkinson’s disease is one of the leading causes of disability worldwide, and while treatment options are available, they can become less… A transfer of healthy bacteria from one person to another by way of a ‘fecal transplant’ could be used to improve Parkinson’s disease… Over a period of a year after the faecal…

[10minus6cosm]

RCPA microbiology training – resources and notes (Part 2)

Part II preparation

I approached this quite differently from Part I - I didn't really use textbooks but instead spent a lot of time going through guidelines and websites instead.

I continued to use my Anki study deck from Part I (which functioned as revision for Part I knowledge), and kept adding to it during this time.

My study group prepared for this in a similar way to Part I viva by running through questions with each other – by the time we got to the exam we were all very used to answering questions over Zoom in the viva format!

Book reviews

How to be a lab director (I used a version that was around 2014, updated version is https://www.amazon.sg/How-Be-Lab-Director-2023/dp/B0BR9CYH1C/)

This is the one book that really stood out to me for RCPA Part II preparation

Very frank account of managing a laboratory that includes talking about management, quality and EQAs. But because it is so frank - some of it is stuff that you can't use as an answer during exams! Very useful for thinking about various aspects of lab management that you might not have come across previously.

Websites and guidelines (Australian)

Part I websites/guidelines/alerts remain important, though I went into the websites in far more detail this round and read a lot more guidelines.

Additional websites and guidelines that may be more Part II related than Part I related as below. I generally just went to each website and kept clicking on links and documents that sounded potentially related to microbiology then read as much as I could around these.

RCPA website

As for Part I - webinars, policies, guidelines, position statements

Also has slides/information on

Management and clinical governance

2022 workshop slides

Laboratory informatics

Pathology informatics workshops 2019 and 2023 slides https://www.rcpa.edu.au/Library/Practising-Pathology/PTIS/APUTS-FAQ

NPAAC/NATA

2020 risk based NPAAC standards

2022 NATA RCPA accreditation assessors workshop

POCT elements of a quality framework (June 2014)

ACSQHC https://www.safetyandquality.gov.au

All of the NPAAC documents Also has a lot of other documents that are related to microbiology, including

Antimicrobial stewardship

C diff surveillance

CARAlert

CLABSI surveillance

CPE control

Cumulative antibiogram

Environmental cleaning

Infection prevention

Mycobacterium chimaera

National antimicrobial resistance strategy

Open disclosure

Preventing and controlling infections standard

Sepsis

Bloodstream infection surveillance

Surgical site infection surveillance

Multi-resistant organism surveillance

Best to browse around the site and have a look at anything that sounds related to microbiology. The site is quite broad so need to sieve out microbiology-related things (like the above list) from the ones that are very unlikely to be of relevance to microbiology.

NATA/RCPA accreditation

NATA https://nata.com.au

Human Pathology ISO15189 https://nata.com.au/accreditation/medical-laboratory-accreditation-iso-15189/

There is also this gap analysis document https://nata.com.au/files/2023/03/SAG_11_2_ISO_15189_2022_Gap_Analysis.pdf that analyses the differences between 2012 and 2022 versions of ISO15189.

NATA accreditation process

https://www.odwyeraccreditation.com.au/nata-accreditation/nata-accreditation-process/

TGA https://www.tga.gov.au

This has a lot of information on medical devices (IVDs), biologicals, etc. Again probably best to browse around the site and have a look for microbiology-related things.

Some of the information they have that is likely relevant to microbiology include

IVD standards https://www.tga.gov.au/how-we-regulate/manufacturing/manufacture-medical-device/manufacture-specific-types-medical-devices/vitro-diagnostic-ivd-medical-devices

Classification of IVD medical devices

Biologicals regulation https://www.tga.gov.au/resources/resource/guidance/australian-regulatory-guidelines-biologicals-argb

Faecal microbiota transplant standards

Clinical performance requirements and risk mitigation strategies for HIV tests

Chlamydia/gonorrhoea/syphilis IVD self tests

COVID-19 in vitro diagnostics

COVID-19 rapid antigen tests

Hepatitis B/C viruses IVD self tests

Seasonal influenza rapid antigen combination tests

Clinical performance requirements and risk mitigation strategies for HIV tests

Regulatory requirements for in house IVDs

Fairwork Australia

Information about employment in Australia and issues surrounding this https://www.fairwork.gov.au/tools-and-resources/best-practice-guides/managing-underperformance

Australian Privacy Principles

https://www.oaic.gov.au/privacy/australian-privacy-principles/australian-privacy-principles-quick-reference

Individual state department of health websites, health.gov.au website

I went through the websites and clicked on anything that sounded potentially relevant to ID or microbiology. There is quite a bit of good information on these websites so is useful to just click through them, and some states have nice guidelines for certain things.

As for Part I – also looked at current health alerts here.

Clinical incident management

WA guideline 2019 https://www.health.wa.gov.au/~/media/Files/Corporate/Policy-Frameworks/Clinical-Governance-Safety-and-Quality/Policy/Clinical-Incident-Management-Policy-2019/Supporting/Clinical-Incident-Management-Guideline-2019.pdf

Queensland guide https://clinicalexcellence.qld.gov.au/sites/default/files/docs/resourses/clinicalincidentguide.pdf

Other useful sites and documents

NT guidelines for management of people with infectious diseases who put others at risk of infection

https://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/976/1/Management%20of%20people%20with%20infectious%20diseases%20who%20knowingly%20put%20others%20at%20risk%20Guideline.pdf

Specific additional things to look up for Part II

Not comprehensive!

Business case proposal

New and emerging technologies

Total lab automation

Rapid blood culture diagnostics

AI in pathology

NGS and sequencing

New and emerging drugs e.g. olorofim, ibrexafungerp

OneHealth

Handling of risk group 4 agents

Workplace and policies - burnout, diversity/inclusion/equality, harassment/bullying, complaints policy

Privacy/confidentiality

Laboratory informatics and communication, including critical/high risk results

HIV testing algorithms

Outbreak investigation and management

Business continuity plan

Preparedness plan

Investigation of erroneous result/lab error

Introduction of new test

Quality system essentials

QC, QA, EQA, anything to do with quality

Centralisation/decentralisation of laboratories

Clinical governance pillars

Spill and hazard management

Laboratory safety

Risk management

Diagnostic stewardship

Deciding whether to send out a test or create an in house test

Molecular vs culture

Construction healthcare infection prevention

ISO15189

Open disclosure

POCT, self-testing, issues surrounding these

Additional notes about Part II preparation

I found it really useful to have definitions for various things e.g. privacy, confidentiality, bullying, harassment, discrimination, etc.

I also found it useful to have frameworks/templates for various topics

Outbreak investigation/management

Investigation of erroneous results, unexpected results, lab errors

Introduction of new test

Quality system essentials

Centralisation of laboratories

Dealing with staff problems

Clinical governance pillars

Spill/hazard management and risk

Business plan

Business continuity plan

Some buzzwords…

Multidisciplinary approach

Risk based approach

Risk vs benefit

Quality vs cost

Open disclosure

Preventing future incidents

[aangussca]

Research: My notes and thoughts on The Invisible Extinction (6.9.23-30.9.23)

This documentary alternated between three parts: 

Maria Gloria Dominguez-Bello travelling across the world (including the most remote) and collecting microbial samples to create a ‘seed bank/vault for microbiome species’.

Martin Blaser’s investigation into the relationship between the immune system and the gut microbiome, and its implications in the protection against and prevention of pandemics.

The recovery journey of three patients from gut dysbiosis using innovative treatments.

Martin Blaser’s “Theory of the Disappearing Microbiota”:

Cites the important contributions of the microbiomes (gut, skin, etc.) to our health: immune, metabolic, physiological, etc.

Warns that the biodiversity within them are currently declining.

Compares this to biodiversity being affected by environmental destruction and climate change: “What's happening to our internal ecology is very similar to what's happening to our climate. But unfortunately, this is happening even faster… We’re in the middle of an extinction crisis.” 

One cause for this microbial decline is poor diet, which cannot sustain many microbial species and is associated with multiple health issues.

Another factor is the overuse of antibiotics/antibacterial products, things that were initially created to prevent and treat diseases.

Blaser also proposed that, through this gut dysbiosis and the resulting decline in immune and metabolic function, antibiotics and poor diet have actively contributed to the rise of certain diseases:

Antibiotic-resistant bacterial strains

Viral diseases like Covid-19 and HIV

Asthma

Allergies (food and environmental)

Type-2 diabetes 

Obesity

A multitude of studies support Blaser’s theories, including one of his own involving mice: https://www.nature.com/articles/nrendo.2014.210

Gloria Dominguez-Bello’s ‘Microbial Vault’:

Note: A seed bank or seed vault is a place where plant seeds (from endangered and/or crucial species) are stored so people can study AND preserve the genetic diversity of those plant species. 

Dominguez-Bello’s project is essentially archiving bacterial species (microbiome) for the same purposes.

People in more remote places like the Venezuelan Amazon have more diverse gut microbiomes (see below) than urban populations because of their primarily plant-based diets and “low exposure to… antibiotics”.

According to the website regarding the project, the Vault currently sources and stores microbiomes from:

The human gut = Venezuela, Brazil, Ethiopia, Laos, Ghana and Switzerland

Fermented food = Ghana, Laos and Thailand

Website: https://www.microbiotavault.org/project/

Other details:

Babies born via C-section have been shown to have less diverse microbiomes compared to those born naturally.

“My hypothesis is that [this practice] puts [babies] at a disadvantage from day one.” - Dominguez-Bello

Gut dysbiosis has also been known to affect brain development (e.g. autism), cognitive function and mood regulation.

FMTs (faecal matter transplants) have been used as a treatment for gut dysbiosis, in turn aiding the recovery from some of these diseases.

This is why stool donations have become so important over the years (e.g. BiomeBank in Adelaide).

[adamfinchley]

Medical advances in the study of stools

The research into the microbiome has been called the most important human health care area of discovery, for many decades.

In recent years there have been huge leaps forward in cancer survivor rates, and the microbiome studies can arguably be called a spin off from all that research. And before all that began, we can thank the sensational discovery of DNA. DNA helped us realise how unique we all are. It also emphasises the huge differences in the immune system, and how that is a combination of hereditary traits and lifestyle, including diet.

We have got to a point where there is serious discussion about the possibility of some of our own intestinal viruses being used to track and destroy cancer cells. We are not only full of bacteria in our gut, but thousands of different virus types also live there. It has been discovered that many of these viruses are our friends. They devoir bad bacteria. A useful but simple way to look at gut bacteria is to consider them bad, good and commensal. The bad ones can promote disease and infections, if not protected by a strong immune system. The good ones are mostly the probiotics we get through eating yoghurt, cheese, pickled goods, salami and pickles, along with others. Much of this is packed with bifidobacterium and lactobacillus bacteria. Many years ago, specialist nutritionists found a way to grow these two in a laboratory environment and sell them commercially. A supplement like Fivelac contains five good gut bacteria. It provides a good way of ensuring a regular flow of digested food. One of the easiest ways of studying microbiota is by looking at excrement. This is such a new science that until very recently there was no technical term for this. But some researchers reckoned it should be a Latin term, as this seems to be the universal language of global medicine. So get used to it if someone at a party tells you he or she, is a 'In Fimo' consultant. They originally wanted to use the Roman word for excrement, but that is merda. And that may have offended the French.

The old expression that you are what you eat may be true, but it's also true to say, you are what you excrete. Stool samples, as any pensioner will tell, is one of the most cost effective ways of screening for colon cancer. But it is now being used for screening other potential medical problems. The future of this new science is suggesting it may result in discovering shortages of good gut bacteria that can be replenished with a faecal transplant. For all the latest information about the microbiome and the connection between this and brain activity, there are many regular publication available online. And it's almost impossible to pick up a daily newspaper without some new article about the subject.

[noisynutcrusade]

Autism Eye - Faecal transplants are safe and effective, according to new tests

Faecal transplants are safe and effective for treating autistic adults with gut problems, according to new tests. US researcher Professor James Adams reached the conclusion the transplants were safe after trialling them on 51 adults. Professor James Adams’s latest research on microbiota transplants suggests they are safe and effective for autistic adults with gut problems Arizona State…

[metodogolo]

El trasplante de microbiota fecal podría ser una nueva opción para tratar la depresión

Un estudio reciente ha encontrado que el trasplante de microbiota fecal es seguro y aceptable para pacientes con trastorno depresivo mayor, y que puede mejorar los síntomas gastrointestinales y la calidad de vida en esta población. Los investigadores recomiendan continuar con la investigación para evaluar su eficacia en el tratamiento de la depresión.

El estudio, publicado en  The Canadian Journal of Psychiatry, ha encontrado que el trasplante de microbiota fecal (FMT) es seguro y aceptable para pacientes con trastorno depresivo mayor (MDD). 

El trasplante de microbiota fecal (FMT) es un procedimiento médico en el cual se toma una muestra de heces de una persona sana y se administra a otra persona mediante enemas o suplementos. El objetivo de esta terapia es reponer o equilibrar la flora intestinal de la persona que recibe el trasplante. La flora intestinal es una comunidad de microorganismos que viven en el tracto digestivo y desempeñan un papel importante en la salud general. Se ha demostrado que ciertas perturbaciones en la flora intestinal pueden estar relacionadas con trastornos mentales y gastrointestinales, por lo que la FMT se ha propuesto como una terapia potencial para tratar estos trastornos.

Los investigadores llevaron a cabo un ensayo clínico controlado de 8 semanas con 15 participantes, donde 10 recibieron FMT y 5 recibieron un placebo. Los resultados del estudio mostraron que no se registraron eventos adversos graves o severos en ninguno de los grupos, y no hubo diferencias significativas en los eventos adversos leves a moderados entre los grupos. Además, los participantes encuestados mostraron una alta aceptación del procedimiento y expresaron su disposición a recibir nuevamente el trasplante si fuera necesario.

Los investigadores también observaron mejorías significativas en los síntomas gastrointestinales y en la calidad de vida en los participantes que recibieron FMT. Estos hallazgos sugieren que el trasplante de microbiota fecal podría ser una terapia potencial para tratar la depresión, ya que se ha demostrado que ciertas perturbaciones en la flora intestinal están relacionadas con trastornos mentales. Los investigadores recomiendan continuar con la investigación para evaluar la eficacia y seguridad del trasplante de microbiota fecal en pacientes con depresión.

Referencia:

Green JE, Berk M, Mohebbi M, et al. Feasibility, Acceptability, and Safety of Faecal Microbiota Transplantation in the Treatment of Major Depressive Disorder: A Pilot Randomized Controlled Trial. The Canadian Journal of Psychiatry. 2023;0(0). doi:10.1177/07067437221150508

[academiavet]

Efeitos terapêuticos do uso de transplante de microbiota fecal ("transplante de fezes") no manejo de Enteropatias Crônicas segundo Update do estudo de TORRENSSON et al (2023)

O estudo de TORESSON et al (2023) descreve os efeitos dos transplantes de microbiota fecal em 41 cães com enteropatia crônica, com tempo de acompanhamento de 3 a 41 meses.

Doze dos 41 cães puderam diminuir a dose de corticosteroides ou interromper os antibióticos após o Transplante de Microbiota Fecal ou Faecal Microbiota Transplantation (FMT). Em dez de doze cães, as doses de manutenção de corticosteroides puderam ser reduzidas gradualmente para doses que não eram possíveis antes do FMT. Os restantes dois cães tiveram crises frequentes, durante as quais apenas o metronidazol ou a tilosina conseguiram parar a diarreia. Ambos os cães conseguiram interromper o uso frequente de antibióticos após o FMT por 3 a 20 meses. Por último, nove dos quarenta e um cães tiveram crises menos frequentes ou crises mais leves após o FMT, oito cães anteriormente abaixo do peso ganharam peso após o FMT e seis cães com hiporexia no início do estudo apresentaram aumento do apetite após o FMT. Dez cães, dos quais sete responderam e três não responderam, apresentaram efeitos colaterais após o FMT. Sete cães tiveram diarreia ou agravamento da diarreia dentro de 48 horas após o FMT, que normalizou dentro de 2-3 dias sem intervenção em todos, exceto um não respondedor. Quatro desses cães reagiram apenas a um dos três FMTs. Dos três dos dez cães restantes, todos respondedores ao FMT, um teve um surto de diarreia e vômitos ocasionais 1 semana após três dos três FMTs, que duraram até 48 horas. O cão com HUC apresentou 2–3 dias de flatulência acentuada, fezes malcheirosas e vômitos leves após os TMF um e dois, mas não após o TMF três. Um cão apresentou intenso esforço e desconforto retal começando 2 horas após o primeiro FMT e durando 4 horas. Este cão foi pré-medicado com uma dose mais elevada de acepromazina e um supositório retal (Xyloproct, Aspen Nordic, Ballerup, Dinamarca) contendo hidrocortisona e lidocaína 10 minutos antes dos FMTs dois e três. Além disso, o transplante fecal foi misturado com uma quantidade menor de solução salina para diminuir o volume. Nenhum efeito adverso foi observado após o FMT dois e três neste cão. A melhoria da qualidade fecal foi um dos resultados esperados, com base em trabalhos anteriores em cães e humanos com diarreia crónica e inflamação gastrointestinal [6,8,9,14,15,16,17]. O aumento do nível de atividade em 24/41 cães foi um pouco mais surpreendente, especialmente em 8/24 cães que não foram descritos pelos donos dos cães como letárgicos ou menos ativos antes do FMT. As possíveis explicações para esse achado poderiam ser a redução da inflamação, associada à diminuição da fadiga e da dor crônica, doses reduzidas de corticosteróides ou outros medicamentos, uma modulação do metaboloma intestinal, alterações do eixo intestino-cérebro ou mesmo um efeito placebo impulsionado pelo cão. forte desejo do proprietário por um resultado positivo. Curiosamente, em estudos sobre os efeitos do TMF em pessoas com SII e DII, a qualidade de vida autoavaliada melhorou após o TMF durante 3 a 6 meses. Um efeito semelhante foi observado na fadiga pós-TMF, com melhora durando até 6 meses [29,30,31]. O efeito poupador de antibióticos do FMT em três dos quatro cães onde o FMT foi usado principalmente ou parcialmente para evitar o uso repetido ou redução do uso de antibióticos é encorajador. Os antibióticos, especialmente os antibióticos de amplo espectro, como a tilosina e o metronidazol, causam disbiose que pode durar várias semanas ou até meses em cães [36,37,38]. Embora não seja usada em pessoas, a tilosina induz resistência aos macrolídeos, e os macrolídeos são antimicrobianos extremamente importantes na saúde humana [43,44]. A boa resposta ao FMT no cão com HUC recidivante é ainda mais promissora. Cães com colite ulcerativa histiocítica recidivante (HUC) têm um prognóstico reservado e são frequentemente tratados com antibióticos cujo uso é proibido em animais na União Europeia [45,46]. Dois anos após o FMT, este cão ainda não teve nenhuma recaída de diarreia persistente.

Referência: Toresson, L.; Spillmann, T.; Pilla, R.; Ludvigsson, U.; Hellgren, J.; Olmedal, G.; Suchodolski, J.S. Clinical Effects of Faecal Microbiota Transplantation as Adjunctive Therapy in Dogs with Chronic Enteropathies — A Retrospective Case Series of 41 Dogs. Vet. Sci. 2023, 10, 271. https://doi.org/10.3390/vetsci10040271.

[cdifffoundation]

Risk Factors Following Successful FMT To Resolve a CDI; GI Symptoms

Risk Factors Following Successful FMT To Resolve a CDI; GI Symptoms

Risk Factors for Gastrointestinal Symptoms Following Successful Eradication of Clostridium difficile by Fecal Microbiota Transplantation (FMT) Jessica R Allegretti 1 2, Zain Kassam 3 4 5, Monika Fischer 6, Colleen Kelly 7, Walter W Chan 1 2 Affiliations expand Abstract Background: Fecal microbiota transplantation (FMT) is a promising therapy for recurrent Clostridioides difficile infection…

[frimleyblogger]

Donation Of The Week

Donation Of The Week - daughter's donation of faeces cures father's gut fermentaation syndrome

With the ‘rona hogging the headlines, it is easy to fall into the trap of thinking that all other forms of medical research have been put on hold for the foreseeable. Here, then, is some cheering news fresh from the pages of that indispensable if rather curiously titled organ, Annals of Internal Medicine.

I have written before about gut fermentation syndrome, a, thankfully, rare condition…

[biochemlover]

Healing the Gut with Faecal Matter

The human gut contains many species of microorganisms, many of which have a role in maintaining overall good health. The gut microbiota can be affected by diet, diseases, and drugs, specifically antibiotics. With the increasing interest in understanding the ability of the human gut microbiome to regulate overall health, new research is focused manipulating it through supplementation with probiotics, prebiotics, or faecal matter for health benefits. Faecal microbiota transplantation involves transplanting faecal material from a healthy person to a patient, with the aim of treating disease. Faecal microbiota transplantation is not a new practice; however, it has been getting more attention as of late as a possible solution to a deficient gut microbiome. It is a recommended treatment option for patients with recurrent Clostridium difficile infection that is resistant to treatment with antibiotics as it has a high cure rate. It is also suggested that it may be able to be offered as a treatment for many other conditions such as inflammatory bowel disease, obesity, and metabolic syndrome.

The microbiome refers to the trillions of microorganisms that live in the intestines and function in a commensal or symbiotic relationship. There has been increasing interest in understanding the specific roles of the human gut microbiome to be able to utilize it in therapeutic practices. Many studies have indicated that the diversity and composition of the bacterial species that live in the human gut is a potential indicator of overall health. Also, the presence of specific groups of bacteria such as Bacteroides, Bifidobacterium, Clostridium, and Lactobacillus may provide certain health advantages. These microbes have been shown to enhance metabolism, immune function, and brain function. Although, the gut microbiome tends to remain fairly consistent over an individual’s lifetime with some variation, specific things such as a drastic change in diet, antibiotic use, or a change in lifestyle that results in greater levels of stress and lower levels of sleep and can significantly impact its diversity.

Faecal microbiota transplantation is the administration of a solution of faecal matter from a donor to the intestinal tract of a recipient in order to alter the microbial composition of the individual. The process typically involves first selecting an appropriate donor without a family history of autoimmune or metabolic diseases. These individuals are recruited by stool banks and undergo a through screening process. The feces are then prepared by mixing with water or saline followed by a filtration step to remove any possible pathogenic material. This mixture is then typically administered through a nasogastric tube, colonoscopy, or retention enema. The majority of uses for faecal microbiota transplantation has been used for treating recurring infection with Clostridium difficile which has had great success in the past.

Clostridium difficile infection is a common complication with antibiotic therapy due to the stripping of healthy bacteria in the gut and may be associated with diarrhea and abdominal cramping. There are antibiotics that specifically target the Clostridium difficile organism; however, they are often ineffective, and patients must undergo multiple rounds in order to clear the infection. Faecal microbiota transplantation is found to be approximately 85-90% effective in patients with Clostridium difficile infection that have been unsuccessfully treated with antibiotics. It was previously considered to be a last resort therapy due to its unusual nature and invasiveness compared to antibiotics. However, due to the increasing awareness of the potential of the gut microbiome and the rising issue of antibiotic resistance, treatment with faecal transplantation is becoming much more common. A study by Hart et al., reviewed the recent evidence regarding the relationship between a dysbiosis of the human gut microbiota and the number of emerging gastrointestinal diseases as well as diseases beyond the gut. They then investigated and the treatment of these disorders with faecal transplantation. Looking at a total of 239 patients who has undergone faecal transplantation it was found that 87% of patients that received faecal transplantation recovered from Clostridium difficile infection.

Although the exact mechanism has yet to be determined, it is believed that faecal microbiota transplantation works by repopulating the patient’s microbiome with diverse microorganisms that competitively exclude Clostridium difficile. In a healthy gut microbial community, Clostridium difficile is outcompeted by many different bacterial species. However, when that ecosystem is disrupted, many of those protective bacteria are killed off and Clostridium difficile has the ability to cause infection. If it is no longer outcompeted, this pathogen is able to establish itself within the gut and produce toxins that cause many negative side effects such as diarrhea, abdominal pain, fever, etc. With supplementation of bacteria from a healthy donor’s stool, the Clostridium difficile organism is no longer out competed and cannot cause infection.

Although faecal microbiota transplantation is an effective treatment for Clostridium difficile infection, there are some risks associated with this procedure. While stool donors can be carefully screeded for pathogens, there is still the risk that some infectious agents may slip through the cracks as stool is a complex mixture of bacteria and other living organisms. Further research is also necessary to determine its potential use in the treatment of other gastrointestinal diseases.

Check out the links below for more information!

https://www.sciencedirect.com/science/article/pii/S0140673619312668

https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2011.04737.x

Allegretti, J. R., Mullish, B. H., Kelly, C., & Fischer, M. (2019). The evolution of the use of faecal microbiota transplantation and emerging therapeutic indications. The Lancet, 394(10196), 420-431.

Hart, A., Landy, J., Omar, H., Walker, A., Ciclitira, P., Nicholls, J., & Clark, S. (2011). Review article: Faecal transplantation therapy for gastrointestinal disease.

[bronva]

First ‘poo transplant’ approved in Australia to fight superbug

First ‘poo transplant’ approved in Australia to fight superbug

Feces from a healthy donor, which is then formulated into either capsules or enemas (Picture: L.A. Cicero) The first ‘poo transplant’ has been officially approved in Australia, to target serious bacterial infection. It’s the first time the procedure has been given regulatory approval anywhere in the world. A ‘poo transplant’ or faecal microbiota transplant (FMT) invloves transplanting gut…

[mondonews]

Poo transplants to be offered to hundreds with superbug

Poo transplants to be offered to hundreds with superbug

The section of faecal transplant from a healthy donor will be swallowed within a pill, or delivered through a tube inserted directly into the stomach, via the nose, or colon – and could save the NHS thousands of pounds. Hundreds of people with a hard-to-treat superbug are to be offered faecal transplants to tackle their infections. A faecal microbiota transplant (FMT) involves taking healthy…