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Gut microbiota
Original article
Scientific frontiers in faecal microbiota transplantation: joint document of Asia-Pacific Association of Gastroenterology (APAGE) and Asia-Pacific Society for Digestive Endoscopy (APSDE)
  1. Siew C Ng1,2,
  2. Michael A Kamm3,
  3. Yun Kit Yeoh1,4,
  4. Paul K S Chan1,4,
  5. Tao Zuo1,2,
  6. Whitney Tang1,2,
  7. Ajit Sood5,
  8. Akira Andoh6,
  9. Naoki Ohmiya7,
  10. Yongjian Zhou8,
  11. Choon Jin Ooi9,
  12. Varocha Mahachai10,11,
  13. Chun-Ying Wu12,13,
  14. Faming Zhang14,15,
  15. Kentaro Sugano16,
  16. Francis K L Chan1,2
  1. 1 Center for Gut Microbiota Research, The Chinese University of Hong Kong, Hong Kong, China
  2. 2 Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
  3. 3 St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia
  4. 4 Department of Microbiology and LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
  5. 5 Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
  6. 6 Department of Medicine, Shiga University of Medical Science, Otsu, Japan
  7. 7 Department of Gastroenterology, Fujita Health University School of Medicine, Toyoake, Japan
  8. 8 Department of Gastroenterology and Hepatology, Guangzhou Digestive Disease Center, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
  9. 9 Gleneagles Medical Centre and Duke-NUS Medical School, Singapore, Singapore
  10. 10 Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  11. 11 National Gastric Cancer and Gastrointestinal Diseases Research Center, Pathumthani, Thailand
  12. 12 Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
  13. 13 Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
  14. 14 Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
  15. 15 Division of Microbiotherapy, Sir Run Run Shaw Hospital, Nanjing Medical University, Nanjing, China
  16. 16 Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
  1. Correspondence to Professor Siew C Ng, Center for Gut Microbiota Research, Chinese University of Hong Kong, Hong Kong, China; siewchienng{at}cuhk.edu.hk

Abstract

Objective The underlying microbial basis, predictors of therapeutic outcome and active constituent(s) of faecal microbiota transplantation (FMT) mediating benefit remain unknown. An international panel of experts presented key elements that will shape forthcoming FMT research and practice.

Design Systematic search was performed, FMT literature was critically appraised and a 1-day round-table discussion was conducted to derive expert consensus on key issues in FMT research.

Results 16 experts convened and discussed five questions regarding (1) the role of donor and recipient microbial (bacteria, viruses, fungi) parameters in FMT; (2) methods to assess microbiota alterations; (3) concept of keystone species and microbial predictors of FMT, (4) influence of recipient profile and antibiotics pretreatment on FMT engraftment and maintenance and (5) new developments in FMT formulations and delivery. The panel considered that variable outcomes of FMT relate to compositional and functional differences in recipient’s microbiota, and likely donor-associated and recipient-associated physiological and genetic factors. Taxonomic composition of donor intestinal microbiota may influence the efficacy of FMT in recurrent Clostridioides difficile infections and UC. FMT not only alters bacteria composition but also establishes trans-kingdom equilibrium between gut fungi, viruses and bacteria to promote the recovery of microbial homeostasis. FMT is not a one size fits all and studies are required to identify microbial components that have specific effects in patients with different diseases.

Conclusion FMT requires optimisation before their therapeutic promise can be evaluated for different diseases. This summary will guide future directions and priorities in advancement of the science and practice of FMT.

  • faecal microbiota transplantation
  • donor
  • recipient
  • bacteria
  • virus
  • fungi

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/gutjnl-2019-319407

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    Footnotes

    • Contributors SCN, MAK, FKLC planned the meeting and established the main topics. WT and TZ performed the systematic search. All panel members were involved in presenting the literature in a Frontiers meeting in Hong Kong in June 2018. All panel members provided supporting evidence and drafted the text of discussion relevant to their topic. SCN, TZ and YKY wrote the initial draft of the manuscript. All panel faculties read and revised the manuscript for important intellectual content and approved the final manuscript. CJO, VM and KS are representatives of APAGE and NO is representative of APSDE.

    • Funding Funding from the Center for Gut Microbiota Research, Faculty of Medicine, The Chinese University of Hong Kong to support the Frontiers Meeting in Hong Kong, and Martin Ho (Imperial College London) for his input in the section on new deliveries of FMT.

    • Competing interests FZ invented the concept of GenFMTer and TET and devices related to it.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.