Episode 002 - Dr Benjamin Mullish - faecal microbiota transplantation, donor selection, the microbiome in immuno-oncology.
Dr Mullish discusses the microbiome, the evolution of faecal microbiota transplantation (‘FMT’ also known as intestinal microbiota transfer ‘IMT’) including donor selection, novel microbial therapies, developing consensus guidelines for the benefit of patients and his involvement in exciting cutting-edge research into immuno-oncology.
Dr Mullish is a pioneer in the application of IMT to treat and prevent disease. He is the co-first author on the joint UK BSG/HIS consensus guideline guidance that defined best practices in all aspects of an IMT service. Dr Mullish has also published research that outlines the mechanism of action of IMT in recurrent C.difficile infection and is actively involved in several other research studies, trials and projects.
00:00 Intro
03:21 How Did Dr Mullish Get Started with FMT?
07:15 What Happened Next?
09:45 Were you convinced that FMT was going to be big?
10:30 When Was the First Time Dr Mullish Saw FMT With His Own Eyes?
13:43 Further Exploring the journey into FMT and its Expansion
16:34 In the Early Days What Guidance was there For Doing FMT Correct
20:01 What Evidence Suggested that Frozen Samples Were Just as Good as Fresh Samples?
22:25 Are We Still of the View that Frozen and Fresh are as Good as Each Other?
23:52 Is it Fair to Say that there was no Guidance From Formal Agencies on FMT in the Beginning?
25:59 How Did You Make Sure all Key Elements were Contained Within Guideline Documents Sent Out to Interested Parties?
27:30 Within the Document Which Areas Were Contentious?
29:00 Should Hospitals Always Maintain an FMT Practice?
31:26 Revisiting FMT Guidelines in 2012 in Regards to Today
32:42 Conversation on Do-It-Yourself FMT
34:52 Do We Have Somewhere for DIY People to go for FMT?
37:03 Discovering Better Ways for FMT
39:31 Conversation on Donor Screening
46:48 Interesting and Cool Aneqdotes / Observations
47:54 What Makes a Good Donor?
50:09 FMT and Weightloss
53:05 What is a Metabalone and Picking Donors Based on Metabalones
54:43 Non-Digestible Components and How they Affect Bugs Which Affect Us
56:35 Selecting a Donor Based on Short Chain Fatty Acids
57:55 Should We be Asking Donors to Eat Specific Foods?
59:37 Is There a Shift Towards a Particular Type of Donor? And are there Elements to the Metabalones that We Haven't Characterised?
1:03:55 How Do We Identify What We Don’t Know About Metabalones?
1:06:49 Elderly Donors (100+ Years)
1:08:51 Microbiome Promoting Health in Specific Cases of those Living Long Healthy Lives
1:09:53 Would these People Make Good Donors?
1:11:15 Alcohol Craving Post FMT
1:12:52 If Someone Has Used Alcohol Heavily but all Tests Show Good Signs, Could Their Microbiome be Protecting them? And Make Them a Good Donor? 
1:15:16 Bariatric Surgery Changing the Anatomy and Changing Microbes
1:17:15 Dr Mullish’s Experience in Trying to Enhance the Probability of Success with FMT
1:18:21 Potentially 1 in 3 People Have Non-Alcoholic Fatty Changes Which May Progress in Some People to Cirrhosis 
1:24:26 Is there Any Argument in Looking at a Donors Healthy Metabolic Profile?
1:25:57 Mixing Together the Starting Material Between Different Donors
1:30:14 Do we Know Why Lower Diversity Has an Impact on the Success of Stem Cell Transplants?
1:31:11 Dr Mullish’s Experience with Stem Cell Transplants Within FMT
1:37:37 Are Your Team Strong in the Conviction that Microbiome Therapies are Going to have an Impact on Cancer Patients?
1:40:46 There are Various Different Types of Responses, With There Being Full Response in Non-Responders Post FMT Which Offers Hope
1:42:19 With the Available Tool Kit Teams will be able to Decipher What Element of the Microbiome is Driving Response
1:43:45 How is the Tool Kit for FMT Going to Evolve in the Next 5 Years?
1:47:33 The Cure for many Ailments May be Living Inside Us
1:48:48 How Does Dr Mullish Respond to Questions on