Catalonia creates the first public fecal microbiota bank to treat serious intestinal infections.

Donating feces, like donating blood, can save lives, but it's not as easy as it seems. The Department of Health has launched the Fecal Microbiota Bank of Catalonia, a pioneering initiative in Spain with limited experience in Europe. This initiative will allow fecal microbiota transplants to more than 200 patients each year.

Currently, this treatment is used almost exclusively in patients with recurrent Clostridioides difficile infections, an intestinal inflammation caused by a microbe that primarily affects people whose microbiota is altered by antibiotic use. These patients are usually hospitalized and debilitated, with approximately 2,500 cases occurring annually in Catalonia.

“The standard treatment for C. difficile is antibiotics, which is somewhat paradoxical: a disease caused by antibiotics must be treated with antibiotics,” explains Jordi Guardiola, head of the digestive system department at Bellvitge Hospital. The risk of relapse is very high (20-25% the first time, 40% the second time, and very likely the third time), and the patient enters a vicious cycle of cure-relapse due to antibiotics. This is extremely debilitating and puts the lives of patients who may be undergoing cancer treatment or in the ICU at risk.

In these cases, fecal microbiota transplantation (FMT) offers practically miraculous results. While the cure rate with standard treatment is around 30%, with the new therapy it exceeds 90%, according to Guardiola.

Since 2014, 171 FMTs have been performed at Bellvitge and Clínic Hospitals, the two leading centers for preparing the product from microbiota donations. The administration of fecal microbiota restores the balance of the intestinal microbiome and eliminates the activity of pathogenic bacteria.

The procedure involves extracting a concentrate of live microorganisms from the feces, which are then transmitted to the patient to restore the balance of their microbiota. The main routes of administration are oral capsules (67.8%) and colonoscopy (32.1%).

In Guardiola's words, this represents "a revolution in the treatment of this disease in our country." However, numerous ongoing studies are working on applying FMT to other disorders linked in some way to microbiota alterations, such as inflammatory disease, cancer, or metabolic disorders. The Fecal Macrobiota Bank of Catalonia aims to contribute to this research.

To do this, they seek out stool donors. But it's not as simple as it seems. Of every 100 volunteers, only 5 manage to become donors, says Begoña González, of the Gastroenterology Department at Clínic. "The degree of altruism required to be a stool donor is greater than that of a blood donor because a series of parameters must be strictly adhered to, and it requires a very high level of commitment from the donor to respect a series of rules," she explains.

Who can be a fecal microbiota donor? Individuals aged 18 to 60 with healthy lifestyle habits, who are free of any medical conditions, have not taken antibiotics in the past three months, and have not traveled in the previous six months. Applicants must undergo a thorough interview and a battery of tests.

If deemed suitable, a person can donate their stool for a period of two months. This can be done every day, if desired. A company will collect the samples from the home and transport them to Bellvitge and the Clínic for storage and processing.