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Searching for superstool: maximizing the therapeutic potential of FMT

Faecal microbiota transplantation (FMT), a highly effective treatment for Clostridium difficile infection, is now being explored for complex diseases, but innovative trial design and collaborative approaches are essential for unlocking its therapeutic potential. If ‘superstool’ capable of treating a complex disease exists, then FMT trials should aim to find and use it.

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References

  1. 1.

    Kassam, Z. et al. Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. Am. J. Gastroenterol. 108, 500–508 (2013).

  2. 2.

    Allegretti, J. et al. The current landscape and lessons from fecal microbiota transplantation for inflammatory bowel disease: past, present, and future. Inflamm. Bowel Dis. 23, 1710–1717 (2017).

  3. 3.

    Ott, S. J. et al. Efficacy of sterile fecal filtrate transfer for treating patients with Clostridium difficile infection. Gastroenterology 152, 799–811.e7 (2017).

  4. 4.

    Turnbaugh, P. J. et al. The human microbiome project. Nature 449, 804–810 (2007).

  5. 5.

    Narula, N. et al. Systematic review and meta-analysis: fecal microbiota transplantation for treatment of active ulcerative colitis. Inflamm. Bowel Dis. 23, 1702–1709 (2017).

  6. 6.

    Moayyedi, P. et al. Fecal microbiota transplantation induces remission in patients with active ulcerative colitis in a randomized controlled trial. Gastroenterology 149, 102–109.e6 (2015).

  7. 7.

    Olesen, S. W., Gurry, T. & Alm, E. J. Designing fecal microbiota transplant trials that account for differences in donor stool efficacy. Stat. Methods Med. Res. https://doi.org/10.1177/0962280216688502 (2017).

  8. 8.

    Berry, S. M., Connor, J. T. & Lewis, R. J. The platform trial: an efficient strategy for evaluating multiple treatments. JAMA 313, 1619–1620 (2015).

  9. 9.

    Woodcock, J. & LaVange, L. M. Master protocols to study multiple therapies, multiple diseases, or both. N. Engl. J. Med. 377, 62–70 (2017).

  10. 10.

    Crum-Cianflone, N. F., Sullivan, E. & Ballon-Landa, G. Fecal microbiota transplantation and successful resolution of multidrug-resistant-organism colonization. J. Clin. Microbiol. 53, 1986–1989 (2015).

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The authors declare no competing interests.

Correspondence to Stacy A. Kahn.

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Fig. 1: Model of donor stool heterogeneity in treating complex diseases.