Eseguito in Casa Sollievo il primo trapianto di microbiota fecale (FMT) del Sud Italia

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Nei giorni scorsi una donna di 62 anni di Foggia, nell’ambito di uno studio clinico controllato, ha beneficiato del primo trapianto di microbiota fecale (FMT) eseguito nel Sud Italia. Tale procedura è stata effettuata presso l’Unità di Gastroenterologia ed Endoscopia Digestiva dell’IRCCS Casa Sollievo della Sofferenza di San Giovanni Rotondo.

 

Il microbiota intestinale umano, spesso impropriamente definito come flora batterica intestinale, è una comunità di batteri, funghi e protozoi che risiedono nel nostro organismo in condizioni di simbiosi e che, in condizioni di equilibrio (“eubiosi”) svolge diverse funzioni: ostacola la colonizzazione di agenti patogeni esterni; partecipa al metabolismo attraverso la digestione di zuccheri complessi; contribuisce allo sviluppo del sistema immunitario; influisce sulla motilità intestinale; modifica l’efficacia e la tossicità dei farmaci assunti.

 

Negli ultimi anni un numero sempre crescente di malattie sono state collegate alla “disbiosi”, ovvero ad un’alterazione della composizione e delle funzioni del microbiota intestinale che, a causa di fattori ambientali, come ad esempio l’uso di antibiotici, è soggetto ad un impoverimento della ricchezza e della diversità microbica. Con l’avvento di tecniche molecolari avanzate e di analisi sempre più sofisticate, già da qualche anno si è in grado di caratterizzare nel dettaglio la componente batterica del microbiota intestinale ottenendo dati che ci consentono di stabilire se il microbiota è “sano” (eubiosi) o “malato” (disbiosi).

 

Di pari passo sono iniziati studi con l’intento di modulare il microbiota intestinale per ristabilire l’eubiosi in condizioni accertate di disbiosi intestinale. L’attenzione dei ricercatori e dei clinici si è focalizzata sul trapianto fecale di microbiota (FMT, in inglese Faecal Microbiota Transplantation), una tecnica innovativa che consiste nel trapianto di feci da un donatore sano ad un ricevente malato con lo scopo di trattare una malattia associata ad un’alterazione del microbiota.

 

«La donna che ha ricevuto il trapianto di microbiota ‒ spiega Giuseppe Biscaglia, medico dell’Unità di Gastroenterologia dell’IRCCS Casa Sollievo della Sofferenza ‒ aveva sviluppato, a seguito di un trapianto allogenico di cellule staminali emopoietiche eseguito presso l’Unità di Terapia Intensiva Ematologica e Terapie Cellulari, una complicanza nota come GVHD, Graft Versus Host Disease, o malattia acuta da rigetto, causata da una reazione immunologica delle cellule del donatore nei confronti dei tessuti del ricevente. In particolare la donna lamentava da mesi episodi ricorrenti di diarrea, gonfiori e dolori addominali molto debilitanti ed alcuni esami avevano evidenziato un’alterazione a carico dell’intestino. La paziente era stata già sottoposta ad altre terapie che tuttavia non si erano dimostrate efficaci. Diversi studi hanno dimostrato che in pazienti con GVHD si ha un marcato squilibrio del microbiota intestinale dovuto anche alle pesanti terapie affrontate. Abbiamo pertanto pensato ‒ conclude Biscaglia ‒ di inserire questa paziente in uno studio clinico controllato in corso presso il nostro Ospedale con lo scopo di correggere tale squilibrio col trapianto di microbiota da donatore sano».

 

Esistono ormai numerose evidenze sull’efficacia del trapianto fecale di microbiota, che diventa un’arma utilizzabile quando altri approcci non sembrano funzionare. Ad esempio, nei casi di infezione ricorrente da Clostridioides difficile (rCDI), una condizione patologica molto seria causata dall’uso prolungato o inappropriato di antibiotici, l’efficacia della procedura ha superato il 90% dei casi. Inoltre, è un trattamento che inizia ad essere utilizzato, in casi selezionati, anche in pazienti con malattie infiammatorie croniche intestinali, encefalopatia epatica e sindrome dell’intestino irritabile.

 

«Abbiamo scelto i nostri donatori di microbiota ‒ sottolinea Orazio Palmieri, biologo del Laboratorio di Gastroenterologia dell’IRCCS Casa Sollievo della Sofferenza ‒ tra i donatori abituali di sangue del Centro Trasfusionale del nostro Ospedale, i quali, per la periodicità delle donazioni e per l’accuratezza delle analisi a cui si sottopongono, garantiscono buona affidabilità nello stile di vita e nei comportamenti sani. Solo le persone che risultano negative ai test ematici, e idonei per i requisiti di qualità e sicurezza del sangue e degli emocomponenti, vengono invitati a donare il loro materiale fecale. Quindi nel Laboratorio di Microbiologia e Virologia il materiale donato viene sottoposto a ulteriori test molto accurati volti ad escludere la presenza di eventuali elementi patogeni per poter essere poi utilizzato nei soggetti riceventi».

 

«Il trapianto vero e proprio – ribadisce Giuseppe Biscaglia – viene eseguito nel Servizio di Endoscopia Digestiva attraverso una normale colonscopia, coordinata da un medico gastroenterologo coadiuvato dal personale del Laboratorio e, se necessario, da un anestesista. L’unica differenza è la finalità della colonscopia: da indagine conoscitiva diventa anche veicolo del trapianto nell’intestino».

 

«Questo trattamento – spiega Francesco Perri, direttore dell’Unità e del Laboratorio di Gastroenterologia dell’Ospedale di San Giovanni Rotondo – ci permette di essere al momento l’unico Ospedale del Sud Italia in grado di poter dare risposte a tutti quei pazienti che, in condizione di disbiosi accertata, pur soffrendo di patologie intestinali importanti, non traggono benefici dagli approcci tradizionali e sono costretti ad individuare strutture del Centro Nord per eseguire la metodica. È bene sottolineare che il trapianto ‒ conclude Perri ‒ è una procedura terapeutica che richiede un notevole impegno organizzativo ed un approccio multidisciplinare complesso, con il coinvolgimento di diverse figure professionali. Essa è sicura, efficace, poco costosa e ripetibile più volte nello stesso paziente senza significativi effetti collaterali».

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