Faecal Microbiota Transplantation (FMT) Platform
Significant alterations in the intestinal microbiota have been described in a number of intestinal and extraintestinal diseases, and the Faecal Microbiota Transplantation platform exploits that phenomenon for both clinical therapy and as a discovery tool.
The condition known to respond best to FMT is recurrent Clostridium difficile infection (rCDI). This infection often manifests as antibiotic associated diarrhoea, and may proceed to pseudomembranous colitis. It typically results from a fulminant Clostridium difficile infection following prolonged or repeated broad spectrum antibiotic treatment, leading to a severe reduction in the number and range of the species constituting the normal intestinal microbiota. This can lead to unchecked outgrowth of Clostridium difficile spores, and recurrent infection. In Ireland, 1500-2000 cases of Clostridium difficile infection are reported annually. FMT is recognized as an effective therapy for severe rCDI, and is a procedure recommended by national and European clinical guidelines when antibiotic treatment has failed. Since 2014, the APC Microbiome Institute has been supporting application of FMT for patients suffering from rCDI in Cork hospitals, collaborating with local gastroenterologists and clinical microbiologists under Standard of Care. We have achieved a cure rate of >90%.
- The FMT platform is based largely upon our experience in the successful treatment of Clostridium difficile.We have investigated the microbiota composition of the patient and donor pre-FMT, and the patient after FMT, to identify effective taxa or other microbiota properties.
- We have extended the FMT platform to a registered clinical trial of FMT aimed at alleviating symptomology in a functional gastrointestinal disorder, and registered trials of FMT in other diseases are planned.
- Establishing safe FMT is technically challenging and expensive for smaller centres, especially the rigorous screening of donors for infectious diseases and other risk factors. We have a collaboration with OpenBiome, a non-profit stool bank and microbiome research group in Boston USA, to facilitate clinicians’ access to OpenBiome stool products in Europe. We are also jointly working with OpenBiome towards a clear regulatory framework for performing FMT safely in Europe, aided by colleagues in other European clinical and research centres, and regulatory agencies.
We have also cultured representatives of the major phyla, genera and species that constitute the core microbiota of healthy subjects, and we aim to produce artificial consortia of cultured microbes for safer second-generation FMT products.