5. Standardization of FMT
In addition to selecting appropriate patient populations for
treatment
with FMT, standardization of the procedure is critical for
its
continued use in RCDI and other diseases. For decades FMT was
practiced
rather crudely [38]. Typically, a small quantity of donor
fecal
material, ∼50 g, but rarely actually weighed, was suspended
in
a saline solution, usually with an aid of a blender. The suspension
was filtered to remove larger particles and administered into
the
patient via an enema, colonoscopy, nasoduodenal or nasogastric
tube, depending on available medical expertise [4]. This process
continues
to be the most common clinical practice of FMT today.
This
lack of standardization is one of the multiple practical
barriers
that prevent FMTs from becoming mainstream medicine.
Other
barriers include the effort required to identify willing donors,
esthetic
and safety concerns associated with material preparation
at a clinical site, and significant time demands on providers
associated
with each procedure. We have described protocols for
standardization
and cryopreservation of fecal microbiota that overcome
most of these practical difficulties [30]. It is now possible
to
acquire fecal microbiota material from the healthiest donors,
standardize
preparation and final unit dose, and store prepared
material
as any other human tissue in a dedicated bank. In our
institution
donors are selected following comprehensive screening,
physical
examination, and stool and blood testing. Individuals
with
any history or signs of metabolic syndrome, autoimmunity,
atopic disease, and neurologic and psychiatric problems are
excluded.
The microbiota material is produced according to current
good
manufacturing practice protocols in a dedicated, regularly
inspected
facility. Such production is essential for mainstream
clinical
practice, and should enable conduct of clinical trials and
development
of next-generation microbiota products [31].