Manipulation of the intestinal microbiome-a slow journey to primetime

Table 1 Summary of pre-stool donation screening requirements and exclusion criteria based on Medical Circular of the Ministry of Health, Israel, date December 2022[107]

Pre stool donation screening	Exclusion criteria for stool donation
Current illness or exposure to endemic illness in the last 6 mo	Viral or bacterial illness in the week prior to donation, persistent fever, a visit in the last 6 mo to a country with an endemic infectious disease including parasitic diseases and traveler’s diarrhea
Malignancy or gastrointestinal disease	Malignant disease (current or past), personal or family history of inflammatory bowel disease, personal history of IBS or symptoms of IBS, or celiac disease
Hepatitis risk and the risk of sexually transmitted infection	Tattoo or piercing or blood transfusion within 6 mo prior to donation, casual unprotected sexual intercourse within 3 mo prior to donation or previous sexual contact with an intravenous drug user or sex worker. Sexual contact with a person infected with HTLV or HIV or hepatitis in the previous 6 mo
Chronic disease	Chronic liver disease, neurological or autoimmune or rheumatological or hematological or metabolic or endocrine (aside from Hashimoto’s disease) or heart or lung or atopic disease. Chronic pain or chronic fatigue syndromes. Previous malaria diagnosis or rare infectious disease
Surgical history	Previous gastrointestinal surgery, recipient of transplanted tissue
Medication history	Any long-term medication use or short-term use of immunosuppressive medication or probiotics, antibiotics use within the previous 6 mo, current or previous chemotherapy, previous recipient of growth hormone or recipient of a live attenuated virus injection in the last 3 mo
Illicit drug history	Previous illicit drug use (mariuana is an exclusion only if used within 3 mo of donation)

HTLV: Human T lymphocytic virus; HIV: Human immunodeficiency virus; IBS: Irritable bowel syndrome.

Table 2 Summary of testing prior stool donation based on Medical Circular of the Ministry of Health, Israel, date December 2022[107]

Test type	Test name
Blood tests	Complete blood count
	Urea and electrolytes including calcium
	Glucose
	Liver function testing
	Lipid studies
	Thyroid stimulating hormone
	Hepatitis A, B and C, HTLV, HIV and cytomegalovirus serology
	Syphilis testing
	Strongyloides stercoralis serology
	Immunoglobulin A level and anti- tissue transglutaminase serology
	Antinuclear antibodies
Stool testing	Stool culture including bacteria, viruses and parasites
	CDI culture including vancomycin resistant CDI
	Calprotectin ESBL and cryptosporidium calprotectin
	Helicobacter antigen
Nasal swab	Methicillin resistant staphylococcus aureus and carbapenem resistant enterobacteriaceae screening
	EHEC
	ESBL EHEC

HTLV: Human T lymphocytic virus; HIV: Human immunodeficiency virus; CDI: Clostridium difficiles; ESBL: Expended spectrum beta lactamase; EHEC: Enterohemorrhagic escherichia coli.

Table 3 Factors influencing donor microbiome engraftment

Host-related factors	Donor-related factors	Procedure-related factors
Chronic dysbiosis state[94,95]	Donor genetics	Preconditioning of the gut: Various diets, fermented foods, prebiotics, probiotics, steroids and phage therapy[100]
Host immunity state, determined by the host genetics[98], creates a hostile "hostile" microbiota environment	‘Super-donors’[102]	Treatment-related protocols: Single donor vs multi-donors, route of administration of FMT (upper GI vs lower GI), the total number of FMT treatments administered (one to repeated), FMT preparation (anaerobic vs aerobic)[101]
	Donor species richness of microbiome[99]	Industry microbiota suspensions[106]
	Donor microbiota stability and species evenness[103]

FMT: Fecal microbiota transplantation; GI: Gastrointestinal.