Episode 006 - Dr Gianluca Ianiro – Concept of a Microbiome Clinician, Intestinal Microbiota Transfer

Learn more about the podcast - https://insidematters.health/ We talk with Dr Gianluca Ianiro about the concept of the microbiome clinician, intestinal microbiota transfer, and the future of microbial therapeutics Dr Gianluca Ianiro, is a gastroenterologist at the Digestive Disease Center of the Fondazione A. Gemelli IRCCS and an adjunct professor in gastroenterology at the Università Cattolica del Sacro Cuore in Rome, Italy. Dr Ianiro’s research focuses on clinical and translational studies on intestinal microbiota. He has established himself as a leading clinical and translational investigator focusing mainly in the field of intestinal microbiota with more than 180 peer reviewed publications including some of the best referral journals in Gastroenterology and Internal Medicine, including NEJM, Nature Medicine, Lancet Infectious Disease, and has received several research grants in support of his innovative research. Dr Ianiro has been the secretary or the leader of several international consensus conferences on fecal microbiota transplantation. He was in the Young Talent Group and in the Research Committee, of the UEG (United European Gastroenterology), and has been awarded as UEG Rising Star in 2020. His current research is focused mainly on disentangling the rules of donor microbiome engraftment and on investigating FMT in other indications beyond C. difficile. Intestinal microbiota transfer, also known as IMT, FMT, or a stool transplant, is a medical procedure that involves the transfer of microorganisms from a healthy donor into the intestinal tract of a recipient. IMT is an established treatment for recurrent C.difficile infection, with the first randomised controlled clinical trial published in 2013. Since the first landmark clinical trial was published, there have been additional RCTs published in ulcerative colitis (a form of inflammatory bowel disease), irritable bowel syndrome, and metabolic syndrome. Other pilot studies have been conducted on patients suffering from cancer and who are undergoing immune system-stimulating treatment (immunotherapy). More research is required before IMT becomes an established therapy in these patient populations. We do not fully understand how IMT works. The available evidence suggests that in successful IMT’s, donor microorganisms persist in the intestinal tract of the recipient after IMT. This process is called engraftment. The determinants of engraftment are an area of active scientific research. Dr Ianiro and colleagues are pioneering the concept of a microbiome clinic in which doctors use microbiome data to inform clinical decision-making for patients. He believes that clinics like these are the future of modern medicine. Dr Ianiro recommends diets that contain minimally processed and micronutrient-dense foods for the microbiome and gut health. Fruits, vegetables, and high fibre. He does not recommend probiotics for members of the general population. Time Codes: 0:00 Intro 2:11 Dr Ianiro’s journey into the microbiome 5:42 Systematic reviews and meta analyses 7:16 Establishing an FMT service 08:33 The evolution of FMT 12:00 FMT in C.diff (good clip) 14:35 Moving beyond C.diff 19:39 FMT and immunotherapy 20:30 Autologous FMT 23:00 FMT and immunotherapy 27:22 Developing consensus guidelines 32:04 Capsules vs other routes of delivery 33:16 Ulcerative colitis and IBD 37:40 Engraftment 44:58 Antibiotic before FMT 46:00 Rural donors and the Amazon 49:00 Donor screening and donor qualification 50:35 Rationale donor selection 51:58 Ulcerative colitis and FMT 54:28 The Virome 56:16 Emerging indications for FMT, including IBS 59:15 Best diet for the microbiome (good clip) 1:01:19 Microbiota clinic (good clip, love this one) 1:04:20 Probiotics and prebiotics 1:08:40 The future of microbiome therapeutics