{
  "abstract": "Faecal microbiota transplantation (FMT) has emerged as a transformative therapy for Clostridioides difficile infections and shows promise for various GI and systemic diseases. However, the poor patient acceptability and accessibility of ‘conventional’ FMT, typically administered via colonoscopies or enemas, hinders its widespread clinical adoption, particularly for chronic conditions. Oral administration of FMT (OralFMT) overcomes these limitations, yet faces distinct challenges, including a significant capsule burden, palatability concerns and poor microbial viability during gastric transit. This review provides a comprehensive analysis of emerging strategies that aim to advance OralFMT by: (1) refining processing technologies (eg, lyophilisation) that enable manufacturing of low-volume FMT formulations for reducing capsule burden and (2) developing delivery technologies that improve organoleptic acceptability and safeguard the microbiota for targeted colonic release. These advancements present opportunities for OralFMT to expand its therapeutic scope, beyond C. difficile infections, towards chronic GI conditions requiring frequent dosing regimens. While this review primarily focuses on optimising OralFMT delivery, it is important to contextualise these advancements within the broader shift towards defined microbial consortia. Live biotherapeutic products (LBPs) offer an alternative approach, yet the interplay between OralFMT and LBPs in clinical practice remains unresolved. We postulate that continued innovation in OralFMT and LBPs via a multidisciplinary approach can further increase therapeutic efficacy and scalability by enabling disease site targeting, co-delivery of therapeutic compounds and overcoming colonisation resistance. Realising these goals positions OralFMT as a cornerstone of personalised care across a range of diseases rooted in microbiome health.",
  "authors": [
    {
      "affiliations": [
        "UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia"
      ],
      "name": "Srinivas Kamath"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia",
        "Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia"
      ],
      "name": "Robert V Bryant"
    },
    {
      "affiliations": [
        "Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia",
        "The University of Adelaide, Adelaide, South Australia, Australia"
      ],
      "name": "Samuel P Costello"
    },
    {
      "affiliations": [
        "Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia",
        "Gastroenterology, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia"
      ],
      "name": "Alice S Day"
    },
    {
      "affiliations": [
        "King’s College London, London, UK"
      ],
      "name": "Ben Forbes"
    },
    {
      "affiliations": [
        "Department of Gastroenterology, St Vincent’s Hospital Sydney, Darlinghurst, New South Wales, Australia",
        "School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "Craig Haifer"
    },
    {
      "affiliations": [
        "Microbiome Research Centre, University of New South Wales, Sydney, New South Wales, Australia"
      ],
      "name": "Georgina Hold"
    },
    {
      "affiliations": [
        "Harvard Medical School, Boston, Massachusetts, USA",
        "Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Colleen R Kelly"
    },
    {
      "affiliations": [
        "Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia"
      ],
      "name": "Anna Li"
    },
    {
      "affiliations": [
        "Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia"
      ],
      "name": "Evance Pakuwal"
    },
    {
      "affiliations": [
        "UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia"
      ],
      "name": "Andrea Stringer"
    },
    {
      "affiliations": [
        "Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia",
        "Infectious Diseases Unit, Central Adelaide Local Health Network, Adelaide, South Australia, Australia"
      ],
      "name": "Emily C Tucker"
    },
    {
      "affiliations": [
        "Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia",
        "Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia"
      ],
      "name": "Hannah Rose Wardill"
    },
    {
      "affiliations": [
        "University of South Australia, Adelaide, South Australia, Australia"
      ],
      "name": "Paul Joyce"
    }
  ],
  "title": "Translational strategies for oral delivery of faecal microbiota transplantation",
  "uid": "e19bc528-654a-5c7a-bc4b-75a1b56aecb2"
}