Gut Check

About AMILI: Setting Up Singapore’s First Stool Bank

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AMILI set up Singapore’s first stool bank in 2019, providing easy, reliable access to safe stool samples. We spoke with Toh Kai Yee, our Laboratory and Operations Manager, to find out more about Faecal Microbiota Transplants (FMTs) and the AMILI stool bank – from setting it up, to why it’s important.

AMILI: For the benefit of our readers, what is a Faecal Microbiota Transplant (FMT)?

KY: Many of us are familiar with organ transplants, where you take an organ from a healthy donor and surgically put it into a patient’s body. Likewise, an FMT is a process where we take prepared faecal material, or stool, from a healthy donor and put it into a patient via a colonoscopy. Fun fact: the gut microbiome is now considered a new organ of the body.

Like any transplant donor, our FMT donors undergo very rigorous blood and stool tests for a number of known pathogens like E.coli. In fact, it is more challenging to find an eligible FMT donor than a kidney or liver donor! Since setting up the stool bank, we have found that there are many healthy, otherwise-eligible individuals who eventually test positive for the pathogenic E. coli in their stool sample, despite being asymptomatic.

FMTs are currently used to treat Clostridium difficile infections, which cause severe gastrointestinal discomfort. 

AMILI: Why was it important to set up a stool bank in Singapore? 

KY: While FMT is not something new (the earliest versions of the process date back to centuries ago in Chinese medicine), virtually all FMT clinical trials over the past 10 years have been conducted in European countries and the USA, simply because researchers have easy, reliable access to stool samples via a stool bank. There have been literally no human FMT clinical trials in South East Asia in the past 5 years. One of the main reasons for this is a lack of sustainable access to safe stool samples for clinicians and researchers to conduct studies into the possibilities of FMT beyond the treatment of Clostridium difficile infections.

Apart from its strategic geographical location and good relationships with our neighbouring countries in the region, Singapore is also well-recognised for the high-quality standards of its processes and products. We hope that we will be able to facilitate advances in research for treatment of other diseases such as Inflammatory Bowel Disease and autism via FMT – an idea that has been causing a lot of buzz in the other parts of the world.

We are also hopeful that providing easy and reliable access to high-quality FMT preparations via the AMILI stool bank will encourage the uptake of FMTs in Singapore and the region. An estimated 48,000 FMTs are performed yearly in the USA, with success rates of over 85%. Singapore’s first FMT was performed in 2014 (by our co-founder, Dr David Ong), but the treatment has yet to become mainstream here.

AMILI: How do you obtain samples for the stool bank? 

KY: We first recruit and assess potential FMT donors through a survey (check out www.poopsaveslives.com if you’d like to be a donor!) in accordance with international guidelines as our first filter. Potential donors are then invited for a face-to-face clinician interview for in-depth medical history taking, followed by blood and stool tests performed by accredited diagnostic laboratories.

Once the donors have met all our criteria and are deemed healthy, they are officially welcomed to our FMT donor programme. FMT donors regularly give us their stool samples from the comfort of their home or workplace – we arrange for courier services to pick up the sample within 2 hours. After reaching our laboratory (built under GLP standards), the sample is examined for its physical appearance and weight before our lab team processes it in an anaerobic chamber.

AMILI's custom-built lab for processing stool samples

AMILI: What do you think the future holds for the applications of FMT?

KY: Other than the conventional administration via colonoscopy, many researchers and medical professionals are looking to oral administration of FMT preparations through capsules. At AMILI, we are working closely with various academic partners and clinicians to formulate our “crapsules” that could be easily given to patients with different conditions such as Alzheimer’s disease, allergies, and other gastrointestinal-related diseases with the aim of managing these conditions and improving overall health with more personalisation and precision.

Ofosu A. (2016). Clostridium difficile infection: a review of current and emerging therapies. Annals of gastroenterology29(2), 147–154. https://doi.org/10.20524/aog.2016.0006

Thomas, Liji. (2018, August 23). History of Fecal Transplant. News-Medical. Retrieved on November 12, 2020 from https://www.news-medical.net/health/History-of-Fecal-Transplant.aspx.

Mamoon, L., & Olesen, S. W. (2020). Fecal Microbiota Transplants Annually and Their Positive Clinical Impact. Clinical and Translational Gastroenterology11(11), e00247. https://doi.org/10.14309/ctg.0000000000000247

About the Author

Kai Yee is AMILI’s Laboratory and Operations Manager. 

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