The Promise of Fecal Microbiota Transplant

Over the weekend, I read a great little article about the potential applications of fecal microbiota transplant (FMT) in treating a huge variety of diseases.[i]  Of course, we are sorely lacking in clinical trials for almost all but still, there is hope to be had in this treatment for illnesses for which there is precious little now.  So, it’s still worth writing about where the science is at present.

Before I tell you about all these potentials though, I just want to share a sentence in the introduction that really struck me and I think will resonate with you too.  It sums up what we currently know about the role the gut bacteria play in the human body:  “In addition to breaking down foods and synthesizing nutrients, microbiota play an important role in the immune system, provide colonization resistance [to pathogens], protects against epithelial [the intestinal wall] injury, promotes both angiogenesis [development of new blood vessels] and fat storage, modulates human bone mass density, modifies the nervous system, and metabolizes therapeutic agents into active compounds.”   Reading that list, it really hit home: there is truly astounding just how much our gut bacteria do for us!  (And we probably only know the half of it right now.)

So, back to the treatment potential of FMT, I’ll write this in the form of a list to make it easy for you to scan.  I’m not going to go into detail for some of these as there’s apparently not a huge amount of data right now – only common sense and science suggesting that more research should be done because of the known relationship of the bacterial microbiome to that disease. But I’ll list everything, nonetheless, as it’s still exciting to contemplate just how much FMT may help in the future with “incurable” illnesses.

1. Clostridium difficile infection:  “Increasing evidence, including meta-analyses, systematic reviews, and randomized controlled trials, has confirmed that FMT is effective for the treatment of recurrent Clostridum difficile.”  Currently, this is the only truly accepted use of FMT.
2. Inflammatory bowel diseases:
   1. Ulcerative Colitis: There is some clinical trial data supporting use in ulcerative colitis. For example, one study showed that 6 patients with relapsing UC experienced, “…complete clinical, colonoscopic, and histological improvement after FMT,” and another meta-analysis study showed that 63% of patients with UC achieve remission, while 76% could at least stop taking medications for IBD.  However, other studies have been less convincing so that, to date, it is difficult to definitively determine efficacy.
   2. Crohn’s: Case reports support the efficacy of FMT in Crohn’s.  However, there are no clinical trials as yet.  (There are many articles on The Biome Buzz that talk about the microbiome’s connection to IBD.  Here is just one example.)
3. Irritable Bowel Syndrome: Studies on mice are positive, as was a clinical study on 12 patients with IBS (intermittent diarrhea and severe bloating).  9 (75%) responded positively, and improvements were sustained upon being reexamined a year later.  However, much more work needs to be done in this.  (Just one example here of one of my posts on IBS and the microbiome.)
4. Liver diseases: Very, very early results look very promising for illnesses like non-alcoholic fatty liver, alcoholic fatty liver, etc.  (A related post here on non-alcoholic fatty liver and gut bacteria.)
5. Metabolic diseases: I already wrote about the first clinical trial using FMT to treat obesity here.
6. Chronic kidney diseases
7. Neuropsychiatric disorders:
   1. Parkinson’s disease: I’ve written about the connection of the gut biome to PD many times. (This is just one example. ) Dr. Borody, an Australian researcher and the father of modern FMT, treated a male PD patient with constipation (common in this disease) with FMT and found that the symptoms of PD improved.  Mouse models also support the theoretical use of FMT in this illness.
   2. Alzheimer’s disease: I’ve also written about the connection of the gut biome to AD. (Here, for example.) Again, animal models suggest that FMT may help.
   3. Epilepsy: There is a published case study of a girl with Crohn’s and a 17 year history of seizures who was treated with FMT:  “During a 20 month follow-up, FMT proved its effectiveness on preventing the relapse of seizures after withdrawal of antiepileptic medications.”  (You can read more about the  microbiome/seizure connection here, for example.)
   4. Autism: I’ve already written about the first, and very successful, clinical trial using FMT to treat autism.
   5. Depression: There is good reason to believe FMT will be successful in treating this, and this is also supported by animal models, but thus far, no human clinical trials have taken place.  (I’ve covered the biome/mental health topic extensively on The Biome Buzz.  Here is one example.)
   6. Multiple sclerosis:   (I’ve also written about the microbiome connection to this illness:  here for example.)
   7. ME/CFS: Myalgic encephalomyelitis/chronic fatigue syndrome  very likely have their etiology in the gut biome. A study was recently conducted on 60 CFS patients with GI symptoms.  70% (so 40 of the 70) responded positively to FMT.  7 of 12 patients who were followed after a 15-20 year follow up had achieved and sustained complete remission.  (The connection of the microbiome to ME/CFS is also covered frequently on The Biome Buzz, like here for example. )
8. Autoimmune disease: with the incredible wealth of information relating gut biome alterations to these illnesses (including lupus, rheumatoid arthritis, Hashimoto’s thyroiditis, etc.), there is good reason to believe FMT will prove very beneficial.
9. Allergic disorders: there have been no clinical trials, but again, the known relationship between the microbiome and these illnesses suggest that FMT will be effective.  (Another topic covered in depth on The Biome Buzz.  One example here.)
10. Hematological diseases: Ditto
11. Tumors and Cancers:  There is a definite connection between the gut bacteria, inflammation and the development of some cancers. More than that, we also know now that the gut bacteria affect how people will respond to cancer treatments, including radiation.  (There is more info on The Biome Buzz on the gut bacteria/cancer connection.  One example, here.)

To conclude then, we need WAY more clinical trials, and these trials need to be better standardized in terms of the screening of donors, the preparations of the donations, frequency of dosing, delivery  methods of doses, and so on.  The great news though is that, “…increasing studies have shown that FMT also presents potential and promising clinical indications for the treatment of many other disorders related to gut microbial dysbiosis.”  And actually, if you think about it, there are probably many, many more illnesses that could be added to this list.  Fibromyalgia, perhaps?  Spondyloarthritis? Post-traumatic stress disorder?   ALS? Celiac?…and the possibilities list goes on and on and on.

Considering the total lack of effective treatment for pretty much everything on the above list, this is at least a spot of light at the end of a very long and dark tunnel.

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[i] Zhou, Y, et. al. Are there potential applications of fecal microbiota transplantation beyond intestinal disorders?  Biomed Research International. 2019. Article ID 3469754. https://doi.org/10.1155/2019/3469754