Ryan Eliott1, Pratik Panchal2,3, Shrish Budree1,4, Alex Scheeler1, Geraldine Medina1, Monica Seng1, Wing Fei Wong1, Thomas Mitchell5, Zain Kassam5, Jessica R Allegretti6,7, Majdi Osman1,6. 1. OpenBiome, Somerville, MA, USA. 2. OpenBiome, Somerville, MA, USA. pratik@mail.harvard.edu. 3. Harvard University T.H. Chan School of Public Health, Boston, MA, 02115, USA. pratik@mail.harvard.edu. 4. University of Cape Town, Rondebosch, Cape Town, 7700, South Africa. 5. Finch Therapeutics Group, Somerville, MA, USA. 6. Harvard Medical School, Boston, MA, 02115, USA. 7. Brigham and Women's Hospital, Boston, MA, 02115, USA.
Abstract
PURPOSE OF REVIEW: Universal stool banks (USBs) have emerged as a potential model for scaling access to fecal microbiota transplantation (FMT) for Clostridium difficile infection (CDI). In this review, we outline the historical barriers constraining access to FMT, the evidence on methods and outcomes of USBs, and potential future directions for expanding access. RECENT FINDINGS: Key historical barriers to FMT access include regulatory uncertainty, operational complexity of sourcing screened donor material, and logistical challenges of delivering fresh treatment preparations. USBs have demonstrated that FMT can be delivered safely at scale by centralizing donor selection, material processing, and safety monitoring. More evidence is needed to optimize USB methods, including for donor screening, material processing, and novel delivery modalities. USBs have catalyzed broad access to FMT in North America and Europe. Future directions include developing evidence regarding oral preparations, harmonizing guidelines, disseminating best practice protocols, establishing long-term safety profiles, and expanding access to geographic areas of unmet need.
PURPOSE OF REVIEW: Universal stool banks (USBs) have emerged as a potential model for scaling access to fecal microbiota transplantation (FMT) for Clostridium difficile infection (CDI). In this review, we outline the historical barriers constraining access to FMT, the evidence on methods and outcomes of USBs, and potential future directions for expanding access. RECENT FINDINGS: Key historical barriers to FMT access include regulatory uncertainty, operational complexity of sourcing screened donor material, and logistical challenges of delivering fresh treatment preparations. USBs have demonstrated that FMT can be delivered safely at scale by centralizing donor selection, material processing, and safety monitoring. More evidence is needed to optimize USB methods, including for donor screening, material processing, and novel delivery modalities. USBs have catalyzed broad access to FMT in North America and Europe. Future directions include developing evidence regarding oral preparations, harmonizing guidelines, disseminating best practice protocols, establishing long-term safety profiles, and expanding access to geographic areas of unmet need.
Authors: Sudarshan Paramsothy; Alissa J Walsh; Thomas Borody; Douglas Samuel; Johan van den Bogaerde; Rupert Wl Leong; Susan Connor; Watson Ng; Hazel M Mitchell; Nadeem O Kaakoush; Michael A Kamm Journal: World J Gastroenterol Date: 2015-10-14 Impact factor: 5.742
Authors: Manasi Agrawal; Olga C Aroniadis; Lawrence J Brandt; Colleen Kelly; Sarah Freeman; Christina Surawicz; Elizabeth Broussard; Neil Stollman; Andrea Giovanelli; Becky Smith; Eugene Yen; Apurva Trivedi; Levi Hubble; Dina Kao; Thomas Borody; Sarah Finlayson; Arnab Ray; Robert Smith Journal: J Clin Gastroenterol Date: 2016 May-Jun Impact factor: 3.062
Authors: Jonathan Samuel Zipursky; Tivon I Sidorsky; Carolyn A Freedman; Misha N Sidorsky; Kathryn B Kirkland Journal: Can J Gastroenterol Hepatol Date: 2014-04-09
Authors: Amoe Baktash; Elisabeth M Terveer; Romy D Zwittink; Bastian V H Hornung; Jeroen Corver; Ed J Kuijper; Wiep Klaas Smits Journal: Front Microbiol Date: 2018-06-12 Impact factor: 5.640
Authors: Gianluca Ianiro; Benjamin H Mullish; Colleen R Kelly; Zain Kassam; Ed J Kuijper; Siew C Ng; Tariq H Iqbal; Jessica R Allegretti; Stefano Bibbò; Harry Sokol; Faming Zhang; Monika Fischer; Samuel Paul Costello; Josbert J Keller; Luca Masucci; Joffrey van Prehn; Gianluca Quaranta; Mohammed Nabil Quraishi; Jonathan Segal; Dina Kao; Reetta Satokari; Maurizio Sanguinetti; Herbert Tilg; Antonio Gasbarrini; Giovanni Cammarota Journal: Gut Date: 2020-07-03 Impact factor: 23.059