Pooled fecal microbiotherapy demonstrates superior efficacy and similar safety compared to single-donor products in ulcerative colitis

Fecal Microbiota Transfer (FMT) is a procedure that has proven to be highly effective and safe for the treatment of recurrent or refractory Clostridioides difficile infection (CDI). FMT also emerges as a promising approach in other indications such as ulcerative colitis (UC) or acute graft-versus-host disease (aGvHD). However, translatability and reproducibility of studies using single-donor FMT remain limited due to the intrinsic variability in taxonomic composition of donors-derived products. Accumulating evidence suggests that by increasing microbial richness and standardizing taxonomic composition, pooled FMT can increase microbial engraftment, and improve treatment efficacy in receiving patients. Recent research has highlighted the advantages of pooled donor strategies over single-donor approaches in UC. The recent success of MaaT013, a standardized allogeneic fecal microbiotherapy derived from pooled healthy human fecal microbiota, in aGvHD underscores its potential across different indications associated with gut dysbiosis. Future research directions include developing standardized protocols for donor screening, product manufacturing, administration procedures, as well as harmonized regulatory framework.