Science of fecal microbiota transplant: From history to cutting-edge clinical practice

Abstract

Fecal microbiota transplantation (FMT) is a pioneering medical technique designed to re-establish a balanced gut microbiome by transferring processed stool from a rigorously screened donor into the gastrointestinal tract of a recipient. Initially conceived as a last-resort therapy for recurrent Clostridioides difficile (C. difficile) infections - a challenging condition frequently resistant to conventional antibiotics - FMT has achieved impressive clinical response rates, often surpassing 80% in resolving recurrent C. difficile infections. This remarkable success has generated significant enthusiasm for its potential use in addressing a broader spectrum of disorders linked to disrupted gut microbial populations, including inflammatory bowel disease, irritable bowel syndrome, metabolic syndrome, and various autoimmune and neurological conditions. However, the wider clinical integration of FMT is accompanied by several notable challenges. These include the need for optimal donor selection, comprehensive long-term follow-up of recipients, standardization of stool processing and delivery methods, and thorough economic evaluation to establish cost-effectiveness. Safety remains a top priority, with particular attention paid to minimizing the risk of infectious disease transmission and preventing unwanted immune responses. Regulatory standards for FMT vary internationally, with some nations categorizing it as a biologic therapy or experimental treatment, while others have established more formalized approval processes. This article offers a comprehensive examination of FMT, covering its historical evolution, underlying mechanisms, current clinical applications, safety protocols, and regulatory landscape. By consolidating the latest research and clinical guidelines, it aims to educate clinicians, researchers, and policymakers on the expanding role of FMT in modern healthcare.

Keywords: Fecal microbiota transplantation; Clostridioides difficile infections; Inflammatory bowel disease; Irritable bowel syndrome; Gut microbiome; Conventional antibiotics

Core Tip: Fecal microbiota transplantation (FMT) has evolved from an ancient remedy into a scientifically validated, high-efficacy treatment for recurrent Clostridioides difficile infection, with growing potential for managing other diseases linked to gut dysbiosis. This article explores FMT’s historical origins, mechanisms of action, clinical applications, safety concerns, and regulatory challenges. It emphasizes the need for standardized protocols, rigorous donor screening, and long-term monitoring to ensure safe and effective clinical integration. As microbiome science advances, FMT stands at the frontier of personalized, microbiota-based therapeutics.