Episode 151. Faecal Microbial Transplant for IBD

The use of faecal microbiota transplantation (FMT) to treat severe C. Difficile enterocolitis was visited in episode 14 of Everyday Medicine with Dr Darcy Holt as our guest. If you haven’t had an opportunity to listen to that conversation, please do and hopefully it will pique your interest. In this episode we invite a guest involved in active research at Melbourne’s St Vincent’s Hospital to discuss FMT in IBD broadly then more specifically as it applies to her current research project evaluating its efficacy in Crohn’s disease.

FMT is defined as the infusion of faeces from healthy donors into the gastrointestinal tract of recipients to treat disease associated with gut dysbiosis. Noting that the precise aetiology of IBD is unknown, a multifactorial pathogenesis is proposed influenced by genetic susceptibility, host mucosal immune responses and the environment including diet, the gut microbiome and smoking history. Particularly with both ulcerative colitis and Crohn’s disease a deficiency in Faecal bacterium prausnitzii recognised for its potential anti- inflammatory properties has raised interest in the FMT space.

To date FMT has been investigated in patients with inflammatory bowel disease (IBD) both in non- randomised and subsequently randomised controlled trials showing promising results although with significant differences in FMT protocols and procedures. The adoption of FMT for the treatment of IBD is compromised by recruitment of donors, preparation of faecal material, determination of the optimal route of administration and lack of established regulatory framework.

Establishing an optimal framework is essential for the future management of IBD should the merits of this therapy stand up to scrutiny. The first international Rome consensus conference on gut microbiota and faecal microbiota transplantation in inflammatory bowel disease, published in Gut.bmj this year has attempted to set this framework and is a very helpful publication.

In this episode we introduce Dr Sasha Fehily who is actively engaged in the MIRO study looking at FMT in Crohn’s IBD. The MIRO Study is a randomised, double-blind placebo-controlled trial where all recruited patients receive active standard IBD treatment and those on placebo who don't respond are administered active FMT therapy.

This is an excellent study with greatly anticipated results, and I was curious to learn more about the research directly from Sasha. Please welcome her to the podcast.

References :

Dr Sasha Fehily - St Vincent’s Hospital Melbourne - www.svha.org.au⁠

Guideline: The first international Rome consensus conference on gut microbiota and faecal microbiota transplantation in inflammatory bowel disease. Lopetuso et al. ⁠https://gut.bmj.com/content/72/9/1642⁠ https://www.gihealth.com.au/podcast/episode-151-faecal-microbial-transplant-for-IBD