Transition of stool microbiota ( FMT ), also known as stool transplant , is the process of transplanting fecal bacteria from healthy individuals to recipients. FMT involves recovery of colonic microflora by introducing healthy bacterial flora through stool infusion, for example by colonoscopy, enema, orogastric tube or by mouth in capsule form containing frozen-dry ingredients, obtained from healthy donors. Numerous studies have shown that this is an effective treatment for people with Clostridium difficile (CDI) infections, whose effects can range from diarrhea to pseudomembranous colitis.
Because of the CDI epidemic in North America and Europe, FMT has become increasingly well known, with some experts calling for it to be first-line therapy for CDI. In 2013, randomized controlled trials of FMT from healthy donors showed it was very effective in treating recurring C. difficile in adults, and was more effective than vancomycin alone. FMT has been used experimentally to treat other gastrointestinal diseases, including colitis, constipation, irritable bowel syndrome, and neurological conditions such as multiple sclerosis and Parkinson's. In the United States, the Food and Drug Administration (FDA) has been managing human waste as a trial drug since 2013.
Video Fecal microbiota transplant
Definisi
Transplantation of stool microbiota or FMT is the transfer of fecal material containing bacteria and antibacterial naturally from healthy individuals to sick recipients. Previous terms for the procedure include fecal bacteriotherapy, fecal transfusion, fecal transplant, stool transplant, fecal enema, and human probiotic infusion (HPI). Since this procedure involves the complete restoration of all stool microbiota, not just a single agent or combination of agents, these terms have now been superseded by a new long-term microbiota fecal transplant.
Maps Fecal microbiota transplant
Medical use
Clostridium difficile infection
Stool microbiota transplantation is about 85% to 90% effective in those who have not been successful in getting antibiotics or recurrent diseases after antibiotics. Most people with CDI recover with one FMT treatment.
A 2009 study found that stool microbiota transplantation is a more effective and simple procedure that is more cost-effective than administering advanced antibiotics and reduces the incidence of antibiotic resistance.
Having been considered the "last resort therapy" by some medical professionals due to its unusual and invasive nature compared to antibiotics, the possible risk of transmission of infection, and the lack of Medicare coverage for donor bench, position statements by specialists in infectious diseases and other communities. has moved towards FMT reception as a standard therapy for CDI relapse as well as Medicare coverage in the United States.
It has been recommended that endoscopic FMT be upgraded to first-line treatment for people with clinical damage and severe recurrence of C. difficile infection.
ulcerative colitis and other gastrointestinal conditions
While C. difficile is easily eradicated by a single FMT infusion, this is generally not the case in ulcerative colitis. The published experience regarding the treatment of ulcerative colitis with FMT suggests that multiple and repeated infusions are required to achieve prolonged remission or healing.
Adverse effects
Side effects are poorly understood by 2016. They include bacterial blood infections, fever, exacerbation of inflammatory bowel disease in people who also have the condition, and mild GI disorders that are generally resolved immediately after the procedure including abdominal bloating, diarrhea, irregular bowel movements. , abdominal distension/bloating, abdominal pain/tenderness, constipation, cramps, and nausea.
Technique
An international team of gastroenterologists and infectious disease specialists has published a formal standard practice guide for FMT that outlines detailed FMT procedures, including materials preparation, donor selection and screening, and FMT administration.
Donor selection
Preparation procedures require careful selection and screening of potential donors. Although close relatives are often the easiest to get and have been tested, they may be a disadvantage because they may be asymptomatic carriers of
Specimen preparation
There is no agreed laboratory standard, so recommendations vary for sample sizes to be prepared, ranging from 30 to 100 grams (1.1 to 3.5 ounces) of fecal matter for effective treatment. Fresh stools are used to increase bacterial viability in the stool and samples are prepared in 6-8 hours. The sample was then diluted with 2.5 to 5 times the sample volume with normal salt water, sterile water, or 4% milk. Some locations mix samples and solvents with dimples and pestle, and others use blenders. There is concern with the use of blenders due to the introduction of air which can decrease the effectiveness as well as the aerosolization of impurities that contaminate the preparation area. The suspension is then filtered through the filter and transferred to the administration container. If the suspension is to be used later, it can be frozen after diluted with 10% glycerol, and is used without loss of efficacy compared to fresh samples. The stool transplant material is then prepared and administered in a clinical setting to ensure that precautions are taken.
Administration
Once made into a suspension, the fecal material may be administered via a nasogastric and nasoduodenal tube, or reserve through a colonoscope or as a retention enema.
Action mechanism
The hypothesis behind transplantation of sterile microbiota lies in the concept of bacterial interference, ie using harmless bacteria to replace pathogenic organisms. In the case of CDI, C. difficile pathogens can be identified. However, in the case of other conditions such as ulcerative colitis, no single cause is identified.
History
The concept of treating faecal diseases with feces originated in China thousands of years ago. Chinese fourth-century medical literature mentioned it to treat food poisoning and severe diarrhea. 1200 years later, Li Shizhen uses a "yellow soup" (aka "golden syrup") containing fresh, dried or fermented benches to treat stomach ailments. "Yellow soup" is made of dirt and water, drunk by that person.
The consumption of warm and warm camel faeces has been recommended by the Bedouin as a drug for bacterial dysentery, its efficacy probably caused by anecdotal subtilisin produced by Bacillus subtilis anecdotically confirmed by the German army of the African Corps during World War II ".
The description of FMT was published in 1958 by Ben Eiseman and colleagues, a team of Colorado surgeons, who treated four critically ill people with fulminant pseudomembranous colitis (before C. difficile was the known cause) using feces. enema, which results in a rapid return of health. In 2003, a series of cases involving 18 people were published. Fecal transplants are about 90 percent effective in those with severe cases of severe colonization, where antibiotics are not yet functioning.
A randomized controlled trial published in January 2013.
Since then various agencies have offered FMT as a therapeutic option for various conditions.
Society and culture
Rule
FMT's interest is soaring in 2012 and 2013, as measured by the number of clinical trials and scientific publications.
In the United States, the FDA announced in February 2013 that it will hold a public meeting entitled "Fecal Microbiota for Transplantation" held on May 2-3, 2013. In May 2013 the FDA also announced that it has regulated human feces. material as a medicine. The American Gastroenterological Association (AGA), the American College of Gastroenterology (ACG), the American Society for Gastrointestinal Endoscopy (ASGE), and the North American Pediatric Nuclear Pediatric, Hepatology and Nutrition Association (NASPGHAN) seek clarification, and the FDA Center for Biological Evaluation and Research ) states that FMT is included in the definition of biological products as defined in the Public Health Services Act and the definition of drugs in the sense of the Federal Food, Drug and Cosmetic Act. This is debatable because FMT is used to prevent, treat, or cure diseases or conditions, and is intended to affect the structure or function of the body, "products for such use" will require Investigational New Drug (IND) applications.
In July 2013, the FDA issued a policy of enforcement ("guidance") on the IND requirements to use FMT to treat C. difficile unresponsive infections against standard therapy (78 FR 42965, 18 July 2013).
In March 2014, the FDA issued a proposed update (called a "draft guide") which, when completed, is intended to replace the July 2013 enforcement policy for FMT to treat C. difficile unresponsive infections against standard therapy. This suggests an interim law enforcement period, if 1) informed consent is used, mentioning aspects of investigation and risks, 2) fecal donors known to either persons with condition or doctor, and 3) if the stool donors and benches are screened and tested under the direction of the physician (79 FR 10814, February 26, 2014). Some doctors and people who want to use FMT fear that the proposal, if completed, will close a handful of stool banks emerging, using anonymous donors and sending to providers hundreds of miles away.
In 2015 FMT for recurrent C. difficile infection may be performed without mandatory donors and stool screening, whereas FMT for other indications can not be done without IND.
Stool banks
In 2012, a team of researchers from the Massachusetts Institute of Technology founded OpenBiome, the first public bench bank in the United States
Across Europe, many bank benches appear to cater for increased demand. Although a consensus report card exists, standard operating procedures are still different. Institutions in the Netherlands have published their protocols for managing FMT, and in Danish institutions managing FMT in accordance with the European Tissue and Cell directive.
Research
Intestinal bacteria are being studied as an alternative to transplantation of fecal microbiota. Research has also been conducted to identify the most relevant microbes in fecal transplants, which can then be isolated and produced through industrial fermentation; such standardized products will be more measurable, will reduce the risk of infection from undesirable microbes, and will enhance the scientific study of the approach, since the same substance will be given each time.
Veterinary use
Elephants, hippos, koalas, and pandas are born with sterile intestines, and to digest plants requires the bacteria they get by eating their mother's excrement, a practice called coprophagia. Other animals eat dirt.
In transplantation of fecal microbiota animal treatment has been known as "transfaunation" and is used to treat contemplative animals, such as cattle and sheep, by feeding healthy rumen animal contents to other individuals of the same species to colonize the digestive tract with normal bacteria
References
External links
- Video: ABC TV Catalyst, July 14, 2011 - Fecal Bacteriotherapy for Clostridium difficile infection
Further reading
- BibbÃÆ'² S, Ianiro G, Gasbarrini A, Cammarota G (December 2017). "Transplantation of stool microbiota: past, present and future perspective". Minerva Gastroenterologica E Dietologica . 63 (4): 420-430. doi: 10.23736/S1121-421X.17.02374-1. PMIDÃ, 28927251. Ã,
Source of the article : Wikipedia
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