Respice, Adspice, Prospice, look to the past, look to the present, look to the future, is one of life’s valuable axioms; for it is only if one knows where one has been can one intelligently prepare for the future. I have used this approach here to review fecal microbiota transplant (FMT). First used in fourth-century China to treat an assortment of gastrointestinal (GI) symptoms, today FMT is primarily used for recurrent Clostridium difficile infection (RCDI). In the future, however, it is likely that microbiotic therapy will be extended beyond treatment of RCDI. Early on, fresh feces from patient-identified donors was used and administered by several routes. FMT cure rates for RCDI remain approximately 82% and 91% when fresh stool is given by the upper GI and lower GI routes, respectively, but now we are moving in the direction of using carefully vetted volunteers whose stool is processed into a variety of formulations including lyophilized material and even capsules. It is very likely that an array of products derived from feces or based on specific microbiotic profiles and commercially prepared in a controlled environment will be available to restore eubiosis to a dysbiotic intestinal microbial community, and thereby correct a variety of GI and non-GI disorders. We are witnessing a paradigm shift in therapeutics. Previously, bacteria were thought of only as potential pathogens, whereas now we appreciate that a diverse community of bacteria is crucial to the health of the host. We are now learning that to restore such diversity once it has been interrupted can result in miraculous cure. The future of microbiotic therapy is bright.
Department of Medicine, Division of Gastroenterology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
Research supported by OpenBiome.
L.J.B. is an advisor for CIPAC and Cubist Pharmaceuticals.
Reprints: Lawrence J. Brandt, MD, MACG, AGAF, FASGE, Department of Medicine, Division of Gastroenterology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467 (e-mail: firstname.lastname@example.org).