“Fecal transplant”, “fecal transplant”, “fecal microbiota transplant”, “fecal bacteriotherapy”, “fecal therapy” - these are the names of the same process. The official name is fecal microbiota transplantation or FMT. This is the “transplantation” of a healthy ecosystem of bacteria into the intestines of a sick person.

Why and who needs a fecal transplant

Scientists have already realized that not all bacteria are bad, as previously thought. Moreover, a whole ecosystem lives in the human intestine, which is responsible for the health of the entire organism. A healthy intestinal microbiota is a balanced community of beneficial, neutral and pathogenic bacteria. Such a microbiota enhances the immune response, protects against inflammation, obesity, type 2 diabetes and ulcerative colitis, and regulates mood and behavior.

Studies have shown that transplanting a healthy microbiota can help treat certain inflammatory and infectious diseases. To date, intestinal microbiota transplantation is only a recognized and effective method of treating pseudomembranous colitis. This is an acute disease of the large intestine caused by a violation of the intestinal microflora and the bacterium Clostridium difficile.

History of fecal transplantation

The first mention of fecal transplantation occurs in a 4th-century Chinese medical treatise - the author recommends eating "yellow soup" to treat food poisoning and diarrhea.

Bedouin recommended taking "warm camel feces" as a treatment for bacillary dysentery. Later, the effectiveness of this method was confirmed by German soldiers of the Africa Corps during World War II. Camel feces contain Bacillus subtilis. This bacterium is not dangerous to humans and produces the enzyme subtilisin, which copes with dysentery.

In modern medicine, intestinal microbiota transplantation in the form of an enema was first used in 1958 by the American doctor Ben Iseman for the treatment of pseudomembranous colitis. This is an acute disease of the large intestine caused by a violation of the intestinal microflora and the bacterium Clostridium difficile.

Today, intestinal microbiota transplantation is a recognized and effective method of treating only pseudomembranous colitis. For the treatment of other conditions, FMT is used only according to strict indications and is selected individually.

How does intestinal microbiota transplantation work?

Fortunately, modern doctors are unlikely to recommend “yellow soup” or camel feces to work the digestive tract. Doctors and researchers have several ways to “transplant” healthy bacteria into a person with the disease, but for any of them you first need to get donor material. To do this, a person with a healthy microbiota collects biomaterial (feces) in a sterile container. Doctors who use FMT follow strict procedures for preparing and evaluating the sample. Both fresh and frozen feces are used. Then the biological material is cleaned - experts remove all unnecessary substances (food debris and cellulose), add saline and filter.

The resulting "cocktail" of bacteria can be introduced into the body in several ways:

1. Through a colonoscope into the large intestine.

2. Through a tube through the mouth or nose.

3. In the form of tablets - orally.

Directly into the large intestine. This method is considered the most effective. A sample from a healthy donor is emulsified with saline and a colonoscope is inserted into the rectum into the intestine, and the liquid is sprayed onto the lining of the organ. The procedure will not be effective if the patient has severe intestinal damage.

Nasal. A tube is inserted through the nose, through which, bypassing the stomach acid barrier, a liquid solution of feces and saline is delivered through a tube into the small intestine. Care must be taken during the procedure, as it can sometimes cause vomiting and particles can enter the lungs and cause bacterial pneumonia, which is life-threatening.

Tablets (capsules). The fecal solution is administered in capsules with a special coating that protects it from gastric juice. In April 2023, the FDA approved the first fecal tablet to prevent relapse of C. difficile infection.

How safe is intestinal microbiota transplantation?

There is a known case when a woman underwent a fecal transplant to treat C. difficile. The treatment was considered successful until the patient gained excess weight in a short time, which raised questions about the quality of the biomaterial used. As a result, doctors determined that the fecal sample was from an obese person.

This case not only shows how the gut microbiome can affect the body, but also how important it is to choose a healthy donor when performing a transplant. Each person’s microbiota can contain pathogenic and drug-resistant strains of bacteria, diseases, and viruses. Even minor infections in healthy people can put people with weakened immune systems at risk. The United States