Fecal microbiota transplant

FMT for short, the goal is to transfer the beneficial microbes from one person to another for the sake of reversing all kinds of diseases. To reverse disease caused by the gut microbiome, you’ll need to make a dent into the gut microbiome’s foundation. It is one of the known treatments that is capable of making a dent into the gut microbiome’s foundation, though it may require multiple transplants for a lasting effect. The mode of transfer is typically either oral or anal, with more intrusive methods available.

The stool donor is screened and tested to determine their health and the safety of transfer. While there exists guidelines by major governing agencies (.e.g. FDA, EU, Korean, et al.) for finding potential stool donors, they are generally not exhaustive enough for finding the ideal stool donor. They are to be used as a starting point, but you’ll need more to find the ideal donor. Next to testing for known pathogens, the questionnaire is equally—if not more—important. Since the questionnaire is used to weed out low-quality donors, it is to be performed first before any testing.

The ideal donor

While antibiotics can impact the gut microbiome, they do not so easily impact the foundation. As such, you’ll often find a person’s gut microbiome returning to baseline after stopping antibiotic use. This explains why stool donor screening typically allow for some history of antibiotics. While it may be fine to accept such a donor, I wouldn’t consider it ideal.

Here is a list of things to keep an eye out for the ideal donor.

DIY procedure

For the most viable diversity you’ll need to prepare the sample under anaerobic conditions. An anaerobic chamber is useful here. However, since an anaerobic chamber is fairly expensive, depending on the method of entry, you’ll likely have to risk losing viability to an aerobic environment. Preparing the sample for anal entry via an enema will likely result in the most loss in viability. Less viability also means less diversity. For that reason, we recommend oral entry through capsules.

Best case scenario, you’ll want to prepare the stool sample within 15 minutes after exiting the donor’s body. If this is not possible, we recommend storing the stool sample within a vacuum-sealable ziploc-like bag. For good measure you can toss in an oxygen absorber packet prior to sucking the air out of the bag.

Enema

To prepare the stool sample for an enema you’ll have to blend it in a blender with a saline solution. A phosphate-buffered saline (PBS) solution is recommended. Once blended, you’ll want to strain out any potential solids with a sieve. Because the entire process significantly exposes the microbes to oxygen, you should only prepare the sample if you plan on performing the enema immediately thereafter. As such, it should be expected to require multiple enemas to see significant changes to the recipient’s microbiome.

Capsules

Because the blending part is unnecessary for oral administration, we recommend capsule preparations over an enema. Given correct applications of a protectant medium, oral administration is likely to yield better results when using samples from a healthy donor since it is assumed to have greater viability. The protectant medium can likely be used as a way to soften the stool.

Storage

For the most viable diversity you’ll need to use some kind of protectant medium. Something as simple as skim milk and sugar (e.g. sucrose, trehalose, etc) can be used for storing in fridge (4°C). If storing in the freezer (-20°C), you’ll want to use an antifreeze protectant medium (e.g. maltodextrin). The protectant medium should allow for fairly long storage durations with very little loss in viability. Do note that each method has its pros and cons, and long-term storage could lead to an adjustment in microbiome ratios (i.e. loss of diversity).

Transportation

The goal is to maintain viability with as much diversity as possible. The ones to worry about the most are anaerobic microbes.

Safety and efficacy

When dealing with microbes of all kinds there will always be the potential for problems. The gut itself harbors at least 100 trillion different microbes. There’s a chance of getting better. There’s a chance of nothing happening, whether good or bad. There’s a chance of getting worse. There’s a chance of death. And there’s a chance of acquiring things that you didn’t have before. One should not so blindly entertain fecal microbiota transplants. We have not yet identified all the microbes in existence, and we likely never will since the task is too great. This is all a game of chance, that some of us are desperate enough to take.

Blood in the stool can cause diseases to spread. Pathogenic viruses, fungi, parasites, and other pathogens need to be tested for. Sexually transmitted diseases will also need to be tested for. Food allergies, liver insufficiencies, white blood cell count, etc, should also be tested for. In the US, all of these tests combined can cost over one thousand dollars per donor. Over three thousand dollars per donor if you try to cover for every recommendation. Exhaustive questionnaires will help to significantly reduce the number of potential donors.

In cases where there exists no ideal donors, you can work with close-to-ideal potential donors to get them as close to ideal as possible. In any case, one transplant may not be sufficient to reverse disease, especially when stools are prepared in aerobic environments and undergo much processing. The more severe and chronic the disease, the more transplants you’ll likely need. It is a good idea to have multiple donors at your disposal. You never know which one will be most effective for you.