Therapeutics and Fecal Transplant

Tatiana Bogdanovich, MD, PhD, MSc |

Fecal Microbiota Transplant Laboratory

Dysbiosis of the gut microbiome has been linked to many aspects of human disease, including recurrent Clostridium difficile infection. Fecal Microbiota Transplantation (FMT) is a novel therapeutic approach to repopulate the patient’s microbiome with diverse microorganisms that re-establishes a healthy microbiome and alleviates disease symptoms. FMT involves delivery of specially prepared stool (fecal) material from a healthy donor to a patient recipient. In patients with recurrent C.difficile infection who had previously failed to recover following antibiotic therapy, FMT has been shown to be highly effective, and this procedure is now recommended in national and international guidelines.

The FMT program at the University of Pittsburgh Medical Center (UPMC) is a joint initiative between the Divisions of Infectious Diseases and Gastroenterology, which was founded in 2013 with a primary clinical mission of providing treatment for patients with recurrent C. difficile infections. We have utilized two main routes for FMT delivery depending on the patient’s preference: colonoscopy or naso-duodenal tube (NDT) delivery. Since 2013, our program has successfully performed 19 transplants, with an aggregate success rate of 89 %. The primary focus of our FMT program is the short- and long-term safety for prospective recipients. This is accomplished through careful and extensive screening of both donors and recipients, and by handling fecal matter as pharmaceutical substance in a dedicated PA Department of Health-approved FMT Laboratory. The manipulation of fecal material is performed in a biological safety cabinet using steam-sterilized, or single use sterile, equipment/reagents approved for patient care. Utmost care is invested to prevent contamination of the donor stool material with other microorganisms, including environmental contamination and contamination from the personnel processing specimens. In April of 2016, we have launched a Volunteer Frozen Stool Bank, which is similar to the blood bank concept, and would make stool “treatment doses” available on demand from “elite” healthy volunteer donors and offer additional safety for recipients.

All of our donors and recipients are requested to participate in the FMT Registry (UPMC IRB# PRO14060081), a repository of stool from the health donors and from the recipients both pre- and post the FMT procedure. We expect that this repository will provide an important resource for researchers interested in the gut microbiome. Additionally, we are interested in expanding our FMT service beyond recurrent C. difficile infection, such as Inflammatory Bowel Disease, cancer and HIV. In this regard, the FMT program offers investigators interested in including FMT in their research or clinical care expertise in: (i) development of research proposals and/or protocols; (ii) laboratory evaluation of donors and recipients; (iii) preparation and storage of stool “doses” for transplantation; (iv) clinical support for FMT procedures; (v) and access to our research repository.

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