Developing novel gut microbiome therapies using faecal microbiota transplantation

There is a growing clinical burden caused by disruption of the gut microbiome (“dysbiosis”), particularly recurrent Clostridioides difficile infection (CDI). Broad-spectrum antibiotics can destroy beneficial gut bacteria, allowing C. difficile to proliferate and cause severe inflammation, prolonged illness and sometimes death. Standard antibiotic treatment fails in around 40% of recurrent cases, leaving >2000 NHS patients annually with limited treatment options, repeated hospital admissions and reduced quality of life.  

Microbiome imbalance contributes to other chronic inflammatory diseases, including inflammatory bowel disease (IBD), creating an urgent need for new microbiome-based therapies that avoid prolonged antibiotic exposure or immune suppression. 

Since establishing the Birmingham faecal microbiota transplantation (FMT) service in 2017, Birmingham BRC-supported researchers have developed one of Europe’s largest NHS FMT services, benefiting more than 1,500 patients across over 150 NHS Trusts. The service, delivered through a unique partnership with the National Blood Transfusion Service, now treats more than 300 patients annually and contributed to NICE approval of FMT for recurrent CDI in 2022. 

The facility supports trials in IBD, development of novel treatment to patients and yielding important insights into underpinning mechanisms. The programme has also enabled major multi-centre clinical trials investigating FMT in ulcerative colitis and liver disease-associated IBD, with the £3.4M NIHR-funded HALT-Colitis trial launching in 2026. 

This work has transformed access to microbiome-based therapies within the NHS and strengthened the UK’s leadership in microbiome science and translational medicine.

Researchers are now developing the UK’s first GMP-licenced lyophilised FMT capsules (with demonstrated benefit in CDI and IBD), which could move treatment from inpatient to outpatient settings, reducing hospital admissions and associated NHS costs.

The programme has also stimulated national and international collaborations, supported industry partnerships with SALTS Healthcare, and created opportunities for scalable next-generation microbiome therapeutics for diseases beyond CDI, including IBD and pancreatic cancer.