Washed microbiota transplantation improves sleep quality in patients with sleep disorder by the gut-brain axis (Jun 2024, n=63) FMT
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Fecal Microbiota Transplants
What would it take to implement something like this at HMorg? They used a sophisticated filtration device for the medical laboratory environment that is likely far too expensive for the average donor to acquire, but something similar to the filtration bags used by OpenBiome (https://pubmed.ncbi.nlm.nih.gov/33937092/, see section "Manufacturing") are available for use in making nut milks among other things.
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Michael Harrop
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1. There's no evidence that it's beneficial or necessary, so I wouldn't be interested.
2. If I were processing donor's stool in a central location it would turn me into a stool bank instead of a source of stool donors. Regulatory requirements would likely be drastically different. I would likely have to rent a laboratory and the costs for recipients would increase dramatically.
3. If "filtration bags" are available and affordable, recipients can request that the donor use one. They may need to purchase it similarly to how in the past when a recipient wanted the donor to use vacuum seal bags, they purchased the equipment for the donor.
4. Creating a mixture watery enough to easily filter may be another issue. The capsules we use would melt, and you also end up with a heavily diluted mixture.
2. If I were processing donor's stool in a central location it would turn me into a stool bank instead of a source of stool donors. Regulatory requirements would likely be drastically different. I would likely have to rent a laboratory and the costs for recipients would increase dramatically.
3. If "filtration bags" are available and affordable, recipients can request that the donor use one. They may need to purchase it similarly to how in the past when a recipient wanted the donor to use vacuum seal bags, they purchased the equipment for the donor.
4. Creating a mixture watery enough to easily filter may be another issue. The capsules we use would melt, and you also end up with a heavily diluted mixture.
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"1. There's no evidence that it's beneficial or necessary, so I wouldn't be interested."
In the companion paper where they define what a "washed FMT" is, they claim a significant reduction (almost a halving) in rate of adverse effects. That's the basis on which they chose to even do the washing for the study you directly linked--they wouldn't continue to do a work-intensive step if they didn't have data showing it seems to help.
The other points you make are valid. Though as for the last one, OpenBiome both filters and makes capsules. Maybe they use different capsules, but somehow they make it work.
In the companion paper where they define what a "washed FMT" is, they claim a significant reduction (almost a halving) in rate of adverse effects. That's the basis on which they chose to even do the washing for the study you directly linked--they wouldn't continue to do a work-intensive step if they didn't have data showing it seems to help.
The other points you make are valid. Though as for the last one, OpenBiome both filters and makes capsules. Maybe they use different capsules, but somehow they make it work.
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Michael Harrop
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Yeah, I shouldn't have used that wording. Thank you for correcting me. I have so much on my plate and mind, plus low brain function generally, all contributing to a bad statement like that 
Washed microbiota transplantation vs. manual fecal microbiota transplantation: clinical findings, animal studies and in vitro screening (Jan 2020) https://academic.oup.com/proteincell/article/11/4/251/6746748
However, their report of "toxic reactions that include death" seems to conflict with the vast majority of the FMT literature showing that FMT from healthy donors is safe. It also conflicts with case reports (including my own) indicating that "reactions from FMT" are often signs of an effective donor that "triggers the immune system and turns it back on".
So there is support that WMT is safer than FMT, without a loss in efficacy. Personally, I'm not convinced that it's worth the trouble, or that there is definitely no loss in efficacy in all cases.
In my experience, "true" adverse events (not beneficial stimulation of the immune system, etc.) come from certain stool characteristics and donors. Can you take a "bad stool" and wash/filter it to make it safer? Probably. I still wouldn't recommend using that stool. It's better to discard it. But if you don't know how to identify bad stools, or if you don't have a donor who produces good stools, then you can probably get a safer result by washing/filtering it.
When it comes to AEs from donors, the main AE is their stool seemingly displacing or suppressing beneficial microbes from a previous donor. Is WMT going to prevent that? I highly doubt it.
Washed microbiota transplantation vs. manual fecal microbiota transplantation: clinical findings, animal studies and in vitro screening (Jan 2020) https://academic.oup.com/proteincell/article/11/4/251/6746748
Interesting that it was done in mice, thus you can't simply say "Well they used low-quality human donors".
However, their report of "toxic reactions that include death" seems to conflict with the vast majority of the FMT literature showing that FMT from healthy donors is safe. It also conflicts with case reports (including my own) indicating that "reactions from FMT" are often signs of an effective donor that "triggers the immune system and turns it back on".
So they are losing viruses in the process. That could be detrimental.
They are losing metabolites. I looked through to paper to confirm that there is no way to selectively decide what to remove or not remove. Merely, "we removed a bunch of stuff and the outcome was that there were fewer adverse events".
As noted above, the vast majority of FMT literature shows that FMT from healthy donors is safe, and thus there is no need to remove anything. I would be concerned that removing things likely results in lower efficacy, but they say it doesn't:
So there is support that WMT is safer than FMT, without a loss in efficacy. Personally, I'm not convinced that it's worth the trouble, or that there is definitely no loss in efficacy in all cases.
In my experience, "true" adverse events (not beneficial stimulation of the immune system, etc.) come from certain stool characteristics and donors. Can you take a "bad stool" and wash/filter it to make it safer? Probably. I still wouldn't recommend using that stool. It's better to discard it. But if you don't know how to identify bad stools, or if you don't have a donor who produces good stools, then you can probably get a safer result by washing/filtering it.
When it comes to AEs from donors, the main AE is their stool seemingly displacing or suppressing beneficial microbes from a previous donor. Is WMT going to prevent that? I highly doubt it.
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This is absolutely NOT MY personal experience. The FMT that had the most beneficial effects caused no temporary flaring of anything. In fact, this is my personal experience of medical treatments of ALL kinds--to the point where I've concluded that "die off reactions" are mostly a myth. The treatments that caused what seemed to be "die off reactions" ended up to be just sub-par treatments overall.
The toxic reactions that include death likely resulted from the intraperitoneal injection, which is not a particularly safe means of restoring the microbiome. In fact it's often how exaggerated negative responses or infections are provoked intentionally to then test treatments designed to ameliorate them.
It COULD be, in theory, but they show no evidence it actually does.
The majority of the FMT literature (in humans) DOES seem to use some kind of purification step other than merely freezing stool and then administering it unaltered.
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Michael Harrop
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I agree and have said as much in various places, including:
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Michael Harrop
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From a related thread with more discussion:
Partial success with UT-AW-1998 for gut pain, food intolerances, and cognitive/mood symptoms (PANS-like)
From what I recall, the ASU autism team filtered the stool solely for the purpose of removing the taste and odor so that it could be drunk by the children. You could check their paper to verify.
The referenced paper is fairly recent (2020), and I had seen many instances of filtering occurring without a justified scientific reason. Clinics with low donor quality and other major deficiencies (including scientific) would cite some vague "we filter out the 'bad' stuff", without any proof that there is anything "bad" in stool. It seemed like they were doing it to make FMT more acceptable/less repugnant to their customers.
I still think there is likely nothing "bad" in high-quality stools.
Partial success with UT-AW-1998 for gut pain, food intolerances, and cognitive/mood symptoms (PANS-like)
This is one reason for my initial poor statement of "there's no evidence for it". I have seen lots of "disgust" around FMT, from patients, researchers, and physicians. So up until now, it has largely seemed like it was being done due to disgust. There have even been efforts to rename "FMT" due to the disgust of "fecal".
From what I recall, the ASU autism team filtered the stool solely for the purpose of removing the taste and odor so that it could be drunk by the children. You could check their paper to verify.
The referenced paper is fairly recent (2020), and I had seen many instances of filtering occurring without a justified scientific reason. Clinics with low donor quality and other major deficiencies (including scientific) would cite some vague "we filter out the 'bad' stuff", without any proof that there is anything "bad" in stool. It seemed like they were doing it to make FMT more acceptable/less repugnant to their customers.
I still think there is likely nothing "bad" in high-quality stools.
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Michael Harrop
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Filtered:
FMT helps half of patients with GI cancers overcome immunotherapy resistance (Jul 2024) Fecal microbiota transplantation improves anti-PD-1 inhibitor efficacy in unresectable or metastatic solid cancers refractory to anti-PD-1 inhibitor (2024)
Not filtered:
Efficacy of faecal microbiota transplantation for patients with irritable bowel syndrome in a randomised, double-blind, placebo-controlled study (2020)
Don't just read the titles; click on the links and see the outcomes. Of course, those are only 2, hardly a good sample size. You're welcome to look up more.
FMT helps half of patients with GI cancers overcome immunotherapy resistance (Jul 2024) Fecal microbiota transplantation improves anti-PD-1 inhibitor efficacy in unresectable or metastatic solid cancers refractory to anti-PD-1 inhibitor (2024)
Not filtered:
Efficacy of faecal microbiota transplantation for patients with irritable bowel syndrome in a randomised, double-blind, placebo-controlled study (2020)
Don't just read the titles; click on the links and see the outcomes. Of course, those are only 2, hardly a good sample size. You're welcome to look up more.