Methodological insights into fecal microbiota transplantation: Dissecting key approaches for success

Abstract

Fecal microbiota transplantation (FMT) has emerged as a revolutionary treatment strategy for restoring gut microbiota in recurrent Clostridioides difficile infection and has also been explored across a broader range of dysbiosis-related diseases such as inflammatory bowel disease where it has demonstrated promising results and potential therapeutic benefits. The success of FMT largely depends on the careful implementation of best practices, which include selecting appropriate donors, preparing the stool properly, and choosing the right delivery methods. This mini-review explores the evolution of FMT methodologies, including donor screening protocols, advances in stool preparation, and innovations in administration routes. We also discuss emerging approaches, such as synthetic microbiota and microbiome engineering, alongside the challenges and future directions for standardizing FMT. These methodological advancements aim to enhance safety, efficacy, and accessibility of FMT, establishing it as a key player in microbiome-based therapies.

Keywords: Fecal microbiota transplantation; Microbiome; Fecal microbiota transplantation methodology; Fecal microbiota transplantation challenges; Standardization of fecal microbiota transplantation

Core Tip: Fecal microbiota transplantation (FMT) is a promising therapy for restoring gut microbiota, with established success in recurrent Clostridioides difficile infection and emerging potential in dysbiosis-related diseases. Key methodological advancements, including improved donor screening, stool processing, and novel delivery methods like capsule-based formulations and live biotherapeutic products, have improved FMT’s safety and accessibility. Despite ongoing concerns about long-term safety and efficacy, future directions such as personalized FMT, synthetic microbiota, and microbiome engineering hold significant promise.