MICROBIAL ALTERATIONS AND DYSBIOSIS: The composition and diversity of gut microbiota is an indicator of health and various groups of commensal bacteria provide health advantages as they enhance metabolism, the immune system, cancer resistance, endocrine signaling and brain function. In general, the gut microbiome remains relatively resilient over time, however, antibiotic use, erratic diet, illness and other factors can lead to alterations and dysbiosis, which weaken various elements of the barrier, causing collapse of the mucus layer that separates epithelial cells and microbiota and reduced expression of antimicrobial peptides which control bacteria including C. difficile.

FMT - INVASIVE GUT MICROBIAL MANIPULATION: FMT is administration of a form of fecal material from the donor into the intestinal tract of the recipient in

FUTURE DIRECTIONS AND DEVELOPMENTS: There is increasing acceptance for the therapeutic use of FMT. However, the risks and benefits remain poorly defined because the published FMT experience remains limited. In future, FMT can be a pauci-strain type or multi-strain type depending on the fecal microbiota analysis of the recipient. The suitable strains can be picked-up from donor fecal sample, grown in cultures and transplanted through an appropriate route. Depending on the recipients’ microbiota diagnostic analysis, the FMT using suitable pauci-strains may be a promising development in near future. FMT using frozen sample is another prospective development and may lead to autologous FMT using the sample preserved from the healthy state in a microbiota bank similar to the stem cells bank.

MECHANISMS AND EFFECTS OF FMT: FMT involves administration of the whole microbiota from healthy donor stool into the recipient’s intestinal tract to normalize or modify intestinal microbiota composition and function. FMT has restorative potential for both composition and functionality of gut microbiota and results in normalization of microbial diversity and community profile in patients by multiple mechanisms including competition for nutrients among C. difficile and other microbiota, direct suppression by antimicrobial peptides, bile- acid-mediated inhibition of spore germination and vegetative growth; and activation of immune-mediated colonization resistance.