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We talk with Dr Gianluca Ianiro about the concept of the microbiome clinician, intestinal microbiota transfer, and the future of microbial therapeutics
Dr Gianluca Ianiro, is a gastroenterologist at the Digestive Disease Center of the Fondazione A. Gemelli IRCCS and an adjunct professor in gastroenterology at the Università Cattolica del Sacro Cuore in Rome, Italy.
Dr Ianiro’s research focuses on clinical and translational studies on intestinal microbiota. He has established himself as a leading clinical and translational investigator focusing mainly in the field of intestinal microbiota with more than 180 peer reviewed publications including some of the best referral journals in Gastroenterology and Internal Medicine, including NEJM, Nature Medicine, Lancet Infectious Disease, and has received several research grants in support of his innovative research.
Dr Ianiro has been the secretary or the leader of several international consensus conferences on fecal microbiota transplantation. He was in the Young Talent Group and in the Research Committee, of the UEG (United European Gastroenterology), and has been awarded as UEG Rising Star in 2020. His current research is focused mainly on disentangling the rules of donor microbiome engraftment and on investigating FMT in other indications beyond C. difficile.
Intestinal microbiota transfer, also known as IMT, FMT, or a stool transplant, is a medical procedure that involves the transfer of microorganisms from a healthy donor into the intestinal tract of a recipient. IMT is an established treatment for recurrent C.difficile infection, with the first randomised controlled clinical trial published in 2013.
Since the first landmark clinical trial was published, there have been additional RCTs published in ulcerative colitis (a form of inflammatory bowel disease), irritable bowel syndrome, and metabolic syndrome. Other pilot studies have been conducted on patients suffering from cancer and who are undergoing immune system-stimulating treatment (immunotherapy). More research is required before IMT becomes an established therapy in these patient populations. 
We do not fully understand how IMT works. The available evidence suggests that in successful IMT’s, donor microorganisms persist in the intestinal tract of the recipient after IMT. This process is called engraftment. The determinants of engraftment are an area of active scientific research. 
Dr Ianiro and colleagues are pioneering the concept of a microbiome clinic in which doctors use microbiome data to inform clinical decision-making for patients. He believes that clinics like these are the future of modern medicine. 
Dr Ianiro recommends diets that contain minimally processed and micronutrient-dense foods for the microbiome and gut health. Fruits, vegetables, and high fibre. He does not recommend probiotics for members of the general population.