Fecal Microbiota Transplantation (FMT) has become a revolutionary treatment for rebalancing the gut microbiome, especially in patients with recurrent Clostridioides difficile infection (CDI). This comprehensive review delves into the evolution, methodologies, clinical applications, and future directions of FMT. Initially developed as a solution to combat severe gastrointestinal dysbiosis, FMT has demonstrated significant efficacy in treating CDI, with cure rates surpassing 80% in numerous studies. The review examines various FMT delivery methods, including oral capsules, colonoscopic infusion, and enema administration, each with distinct benefits and challenges. Recent advances in the understanding of gut microbiota's role in health and disease have broadened FMT's potential applications beyond CDI. New studies indicate that FMT could offer therapeutic benefits for various conditions, including inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and metabolic disorders such as obesity and diabetes. Despite promising results, FMT is not without risks, including potential transmission of infectious agents and the challenge of ensuring donor safety and stool quality. The review also explores regulatory and ethical considerations surrounding FMT, highlighting the need for standardized protocols and guidelines to ensure patient safety and treatment efficacy. Additionally, the review addresses the scientific and logistical hurdles that must be overcome for FMT to achieve broader acceptance and application. In conclusion, while FMT represents a significant advancement in microbiome-based therapies, ongoing research is crucial to fully elucidate its benefits, risks, and optimal usage. Future studies should focus on refining treatment protocols, improving donor screening processes, and expanding the range of treatable conditions to maximize the therapeutic potential of FMT.

Keywords:Fecal Microbiota Transplantation (FMT), Clostridioides difficile infection (CDI), Gut microbiota, Therapeutic applications, Microbiome-based therapies

1. Bajaj JS, Khoruts A. Microbiota changes and intestinal microbiota transplantation in liver diseases and cirrhosis. J Hepatol. 2020 May;72(5):1003-1027. doi: 10.1016/j.jhep.2020.01.017. Epub 2020 Jan 28. PMID: 32004593. 2. EISEMAN B, SILEN W, BASCOM GS, KAUVAR AJ. Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis. Surgery. 1958 Nov;44(5):854-9. PMID: 13592638. 3. Haifer C, Paramsothy S, Kaakoush NO, Saikal A, Ghaly S, Yang T, Luu LDW, Borody TJ, Leong RW. Lyophilised oral faecal microbiota transplantation for ulcerative colitis (LOTUS): a randomised, double-blind, placebo-controlled trial. Lancet Gastroenterol Hepatol. 2022 Feb;7(2):141-151. doi: 10.1016/S2468-1253(21)00400-3. Epub 2021 Dec 2. PMID: 34863330. 4. Kelly CR, Yen EF, Grinspan AM, Kahn SA, Atreja A, Lewis JD, Moore TA, Rubin DT, Kim AM, Serra S, Nersesova Y, Fredell L, Hunsicker D, McDonald D, Knight R, Allegretti JR, Pekow J, Absah I, Hsu R, Vincent J, Khanna S, Tangen L, Crawford CV, Mattar MC, Chen LA, Fischer M, Arsenescu RI, Feuerstadt P, Goldstein J, Kerman D, Ehrlich AC, Wu GD, Laine L. Fecal Microbiota Transplantation Is Highly Effective in Real-World Practice: Initial Results From the FMT National Registry. Gastroenterology. 2021 Jan;160(1):183-192.e3. doi: 10.1053/j.gastro.2020.09.038. Epub 2020 Oct 1. PMID: 33011173; PMCID: PMC8034505. 5. Kim KO, Gluck M. Fecal Microbiota Transplantation: An Update on Clinical Practice. Clin Endosc. 2019 Mar;52(2):137-143. doi: 10.5946/ce.2019.009. Epub 2019 Mar 26. PMID: 30909689; PMCID: PMC6453848. 6. Mcilroy JR, Nalagatla N, Hansen R, Hart A, Hold GL. Faecal microbiota transplantation as a treatment for inflammatory bowel disease: a national survey of adult and paediatric gastroenterologists in the UK. Frontline Gastroenterol. 2018 Oct;9(4):250-255. doi: 10.1136/flgastro-2017-100936. Epub 2018 Apr 29. PMID: 30245786; PMCID: PMC6145431. 7. Kassam Z, Lee CH, Yuan Y, Hunt RH. Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol. 2013 Apr;108(4):500-8. doi: 10.1038/ajg.2013.59. Epub 2013 Mar 19. PMID: 23511459. 8. Martins C, Piontkivska D, Mil-Homens D, Guedes P, Jorge JMP, Brinco J, Bárria C, Santos ACF, Barras R, Arraiano C, Fialho A, Goldman GH, Silva Pereira C. Increased Production of Pathogenic, Airborne Fungal Spores upon Exposure of a Soil Mycobiota to Chlorinated Aromatic Hydrocarbon Pollutants. Microbiol Spectr. 2023 Aug 17;11(4):e0066723. doi: 10.1128/spectrum.00667-23. Epub 2023 Jun 7. PMID: 37284774; PMCID: PMC10434042. 9. Webb BJ, Brunner A, Ford CD, Gazdik MA, Petersen FB, Hoda D. Fecal microbiota transplantation for recurrent Clostridium difficile infection in hematopoietic stem cell transplant recipients. Transpl Infect Dis. 2016 Aug;18(4):628-33. doi: 10.1111/tid.12550. Epub 2016 Jul 5. PMID: 27214585. 10. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, Pepin J, Wilcox MH; Society for Healthcare Epidemiology of America; Infectious Diseases Society of America. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol. 2010 May;31(5):431-55. doi: 10.1086/651706. PMID: 20307191. 11. Hatton G, Shawcross DL. Is treating the gut microbiome the key to achieving better outcomes in cirrhosis? Expert Rev Gastroenterol Hepatol. 2019 Jan;13(1):1-2. doi: 10.1080/17474124.2019.1543587. Epub 2018 Nov 13. PMID: 30791837. 12. Caldeira LF, Borba HH, Tonin FS, Wiens A, Fernandez-Llimos F, Pontarolo R. Fecal microbiota transplantation in inflammatory bowel disease patients: A systematic review and meta-analysis. PLoS One. 2020 Sep 18;15(9):e0238910. doi: 10.1371/journal.pone.0238910. PMID: 32946509; PMCID: PMC7500646. 13. Kelly CR, Ihunnah C, Fischer M, Khoruts A, Surawicz C, Afzali A, Aroniadis O, Barto A, Borody T, Giovanelli A, Gordon S, Gluck M, Hohmann EL, Kao D, Kao JY, McQuillen DP, Mellow M, Rank KM, Rao K, Ray A, Schwartz MA, Singh N, Stollman N, Suskind DL, Vindigni SM, Youngster I, Brandt L. Fecal microbiota transplant for treatment of Clostridium difficile infection in immunocompromised patients. Am J Gastroenterol. 2014 Jul;109(7):1065-71. doi: 10.1038/ajg.2014.133. Epub 2014 Jun 3. PMID: 24890442; PMCID: PMC5537742. 14. Quraishi MN, Widlak M, Bhala N, Moore D, Price M, Sharma N, Iqbal TH. Systematic review with meta-analysis: the efficacy of faecal microbiota transplantation for the treatment of recurrent and refractory Clostridium difficile infection. Aliment Pharmacol Ther. 2017 Sep;46(5):479-493. doi: 10.1111/apt.14201. Epub 2017 Jul 14. PMID: 28707337. 15. Narula N, Kassam Z, Yuan Y, Colombel JF, Ponsioen C, Reinisch W, Moayyedi P. Systematic Review and Meta-analysis: Fecal Microbiota Transplantation for Treatment of Active Ulcerative Colitis. Inflamm Bowel Dis. 2017 Oct;23(10):1702-1709. doi: 10.1097/MIB.0000000000001228. PMID: 28906291.