In recent days, a 62-year-old woman from Foggia, as part of a controlled clinical study, benefited from the first fecal microbiota transplant (FMT) performed in Southern Italy. This procedure was performed at the Gastroenterology and Digestive Endoscopy Unit of the IRCCS Casa Sollievo della Sofevole in San Giovanni Rotondo.
The human intestinal microbiota, often improperly defined as intestinal bacterial flora, is a community of bacteria, fungi and protozoa that reside in our organism in conditions of symbiosis and which, in conditions of equilibrium (“eubiosis”), performs various functions: it hinders colonization of external pathogens; participates in metabolism through the digestion of complex sugars; contributes to the development of the immune system; affects intestinal motility; modifies the efficacy and toxicity of the drugs taken.
In recent years, an ever-increasing number of diseases have been linked to “dysbiosis”, that is to an alteration of the composition and functions of the intestinal microbiota which, due to environmental factors, such as the use of antibiotics, is subject to an impoverishment of the richness and microbial diversity. With the advent of advanced molecular techniques and increasingly sophisticated analyzes, for some years now we have been able to characterize in detail the bacterial component of the intestinal microbiota, obtaining data that allow us to establish whether the microbiota is “healthy” (eubiosis) or “sick” (dysbiosis).
At the same time, studies have begun with the aim of modulating the intestinal microbiota to re-establish eubiosis in established conditions of intestinal dysbiosis. The attention of researchers and clinicians has focused on fecal microbiota transplantation (FMT, in English Faecal Microbiota Transplantation), an innovative technique that consists in the transplantation of feces from a healthy donor to a sick recipient with the aim of treating a disease. associated with an alteration of the microbiota.
“The woman who received the microbiota transplant – explains Giuseppe Biscaglia, doctor of the Gastroenterology Unit of Casa Sollievo – had developed, following an allogeneic hematopoietic stem cell transplant performed at the Hematological Intensive Care and Cellular Therapy Unit , a complication known as GVHD, Graft Versus Host Disease, or acute rejection disease, caused by an immunological reaction of the donor cells to the recipient’s tissues. very debilitating and some tests had shown an alteration in the intestine. The patient had already been subjected to other therapies which however had not proved effective. Several studies have shown that in patients with GVHD there is a marked imbalance of the intestinal microbiota This was also due to the heavy therapies we had to deal with, so we thought – concludes Biscay – to include this patient in a controlled clinical trial in progress at our hospital with the aim of correcting this imbalance with a microbiota transplant from a healthy donor “.
There is now a lot of evidence on the effectiveness of fecal microbiota transplantation, which becomes a usable weapon when other approaches do not seem to work. For example, in cases of recurrent Clostridioides difficile infection (rCDI), a very serious pathological condition caused by prolonged or inappropriate use of antibiotics, the effectiveness of the procedure exceeded 90% of cases. Furthermore, it is a treatment that begins to be used, in selected cases, even in patients with chronic inflammatory bowel diseases, hepatic encephalopathy and irritable bowel syndrome.
“We have chosen our microbiota donors – underlines Orazio Palmieri, biologist of the Gastroenterology Laboratory of Casa Sollievo – among the usual blood donors of the Transfusion Center of our hospital, who, due to the frequency of donations and the accuracy of the analyzes to which they undergo, guarantee good reliability in lifestyle and healthy behaviors. Only people who test negative for blood tests, and suitable for the quality and safety requirements of blood and blood components, are invited to donate their fecal material . Then in the Laboratory of Microbiology and Virology the donated material is subjected to further very accurate tests aimed at excluding the presence of any pathogenic elements in order to be then used in the recipients “.
“The actual transplant – reiterates Giuseppe Biscaglia – is performed in the Digestive Endoscopy Service through a normal colonoscopy, coordinated by a gastroenterologist assisted by the laboratory staff and, if necessary, by an anesthetist. The only difference is the purpose of the procedure. colonoscopy: from a cognitive investigation it also becomes a vehicle for transplantation in the intestine “.
“This treatment – explains Francesco Perri, director of the Gastroenterology Unit and Laboratory of the San Giovanni Rotondo Hospital – allows us to be at the moment the only hospital in Southern Italy able to give answers to all those patients who, in a condition of ascertained dysbiosis, despite suffering from important intestinal pathologies, they do not benefit from traditional approaches and are forced to identify structures in the North Center to perform the method. It should be emphasized that transplantation – concludes Perri – is a therapeutic procedure that requires considerable organizational commitment and a complex multidisciplinary approach, with the involvement of various professional figures. It is safe, effective, inexpensive and repeatable several times in the same patient without significant side effects “.
In the video, the interviews with the gastroenterologist Giuseppe Biscaglia and the biologist Orazio Palmieri
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