Clinical Guidelines for Fecal Microbiota Transplantation in Companion Animals

The Companion Animal FMT Consortium aims to increase accessibility of FMT as a microbial-directed therapeutic for dogs and cats by simplifying and demystifying the process of performing FMT in clinical practice. These FMT clinical guidelines are intended for veterinarians in a variety of clinical practice types and can be modified and adapted as needed to align with financial and technical resources available to individual practitioners.

Fig. 1 Overview of FMT product preparation and processing. After a fecal donor screening and selection is complete, naturally voided feces can be used for FMT preparation and processing. Freshly void feces is ideal for FMT administration. If use of fresh feces is not feasible, then feces can be stored until processing and/or use (Step 1). Processing steps for fresh feces and/or frozen feces including making a fecal slurry and filtering the FMT product (Step 2). Once the FMT product is prepared, it can be used immediately or can be stored (Step 3). If the FMT product is to be stored, a cryopreservative can be added. FMT capsules can be administered orally and processed fecal slurries can be administered via rectal enema.

Key Takeaways

FMT has broad clinical indications across multiple conditions.

While FMT is most commonly used to treat chronic gastrointestinal disorders like IBD, chronic colitis, and diarrhea resistant to conventional therapy, it has emerging potential in other areas, including: acute hemorrhagic diarrhea syndrome, parvoviral enteritis, antibiotic-induced dysbiosis, and extra-GI conditions such as canine atopic dermatitis.

FMT is safe and well-tolerated in veterinary patients.

The guidelines report FMT to be safe, minimally invasive, and well tolerated in companion animals with only mild and self-limiting side effects in most cases (e.g., soft stools, flatulence, or transient vomiting).

Donor screening is key to a well-established FMT protocol.

The donor microbiome acts as a template for the recipient’s gut ecosystem. Selecting a healthy donor with a diverse, stable, and well-characterized microbiota increases the chances of restoring gut balance, improving clinical outcomes, and sustained microbial engraftment.

Citations

Winston, J. A., Suchodolski, J. S., Gaschen, F., Busch, K., Marsilio, S., Costa, M. C., Chaitman, J., Coffey, E. L., Dandrieux, J. R. S., Gal, A., Hill, T., Pilla, R., Procoli, F., Schmitz, S. S., Tolbert, M. K., Toresson, L., Unterer, S., Valverde-Altamirano, É., Verocai, G. G., … Ziese, A.-L. (2024). Clinical guidelines for fecal microbiota transplantation in companion animals. Advances in Small Animal Care, 5(1), 79–107. https://doi.org/10.1016/j.yasa.2024.06.006