5 WORLD GASTROENTEROLOGY NEWS JULY 2014 Editorial | Expert Point of View | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events FMT: Quality Control and Feasibility It would be ideal to standardize FMT. If the purification of fecal micro-biota can be technically controlled it might be more available; otherwise its application in the world would be restricted by health policy if there is no quality control. The best solution for this prob-lem is to allow the procedures to be performed automatically with machines, GenFMTer. The latest news, from my team cooperating with Dr. Youquan Zhao and Dr. Huiquan Wang at Tianjin University Preci-sion Instrument College in China, is the successful development of a new automatic system for purification of fecal microbiota from fresh feces. This will advance the standardized FMT from a bio-safety cabinet to automatic instruments. The operator only needs to press the buttons related to the designated processes and all proce-dures can be done in less than a half an hour. Since we do not know the changing of fecal viable organism after the feces is expulsed from the colon, it may be the best way to transplant those microbiota back to the gut as soon as possible. What Will We Do in the Future? FMT has been used as a rescue ther-apy for refractory IBD in our center, treating patients from all over China. These patients generally had compli-cated IBD. However FMT should not be regarded as a pure technology when it is used for patients with se-vere diseases. Additionally, it remains unclear why some cases with IBD did not response to FMT. Our clinical pilot demonstrates that FMT through the mid-gut may be a safe, feasible and efficient rescue therapeutic option for refractory IBD. In the future, multi-center random-ized clinical trials should be done. Also, more studies are needed to focus on mechanisms, indications, method-ology, cost-effectiveness analysis and long-term safety. As an effective, safe and economic therapy, FMT may be moved into the mainstream of IBD treatment sometime in the future. References 1. Zhang F, Luo W, Shi Y, Fan Z, Ji G. Should we standardize the 1,700-year-old fecal microbiota transplantation. Am J Gastroen-terol. 2012;107:1755; author reply p.1755-1756. 2. Eiseman B, Silen W, Bascom GS, Kauvar AJ. Fecal enema as an ad-junct in the treatment of pseudo-membranous enterocolitis. Surgery. 1958;44:854-859. 3. Hamilton MJ, Weingarden AR, Sadowsky MJ, Khoruts A. Stan-dardized frozen preparation for transplantation of fecal microbiota for recurrent Clostridium diffi-cile infection. Am J Gastroenterol. 2012;107:761-767. 4. Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH, McFarland LV, Mellow M, Zuckerbraun BS. Guidelines for diagnosis, treatment, and prevention of Clostridium dif-ficile infections. Am J Gastroenterol. 2013;108:478-498; quiz 499. 5. Damman CJ, Miller SI, Surawicz CM, Zisman TL. The microbiome and inflammatory bowel disease: is there a therapeutic role for fecal microbiota transplantation. Am J Gastroenterol. 2012;107:1452-1459. 6. Smits LP, Bouter KE, de Vos WM, Borody TJ, Nieuwdorp M. Thera-peutic potential of fecal microbiota transplantation. Gastroenterology. 2013;145:946-953. 7. Zhang FM, Wang HG, Wang M, Cui BT, Fan ZN, Ji GZ. Fecal mi-crobiota transplantation for severe enterocolonic fistulizing Crohn’s disease. World J Gastroenterol. 2013;19:7213-7216. 8. Kao D, Hotte N, Gillevet P, Mad-sen K. Fecal Microbiota Trans-plantation Inducing Remission in Crohn’s Colitis and the Associated Changes in Fecal Microbial Profile. J Clin Gastroenterol. 2014. Epub ahead of print. 9. Sha S, Liang J, Chen M, Xu B, Liang C, Wei N, Wu K. Systematic review: faecal microbiota transplan-tation therapy for digestive and nondigestive disorders in adults and children. Aliment Pharmacol Ther. 2014;39:1003-1032. An automatic system called GenFMTer was used to isolate fecal microbiota from stool.
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