{"id":6868,"date":"2015-11-30T06:34:51","date_gmt":"2015-11-30T06:34:51","guid":{"rendered":"http:\/\/revoscience.com\/en\/?p=6868"},"modified":"2015-11-30T06:34:51","modified_gmt":"2015-11-30T06:34:51","slug":"why-poo-transplants-are-nothing-to-be-sniffed-at","status":"publish","type":"post","link":"https:\/\/www.revoscience.com\/en\/why-poo-transplants-are-nothing-to-be-sniffed-at\/","title":{"rendered":"Why Poo Transplants are Nothing to Be Sniffed At"},"content":{"rendered":"

\"ddd1511_c_diff\"<\/a>Most of us will have experienced diarrhoea or Delhi Belly and spent an unpleasant 48 hours in bed or on the toilet, often while traveling. Studies show that if severe, these infections\u00a0can sometimes change<\/span><\/a>\u00a0your gut microbes permanently. And rather than sitting it out we are increasingly turning to powerful broad spectrum antibiotics that kill the infectious bug \u2013 but these\u00a0can also cause collateral damage<\/span><\/a>\u00a0and weaken our resistance to recurrences.<\/span><\/p>\n

Five years in the future we could be popping capsules to cure us and reboot our healthy gut community made up of our frozen poo we stored when we were healthy.<\/span><\/p>\n

Last week I visited the labs of the world\u2019s biggest poo bank run by a not-for-profit company\u00a0OpenBiome<\/span><\/a>\u00a0in Boston. They currently ship out more than 50 frozen poo samples a week to 430 US centres for treating a life threatening infection called recurrent\u00a0Clostridium difficile<\/span><\/a>, also known as\u00a0C.diff<\/em>\u00a0infection or CDI, caused by antibiotics\u00a0that affects<\/span><\/a>\u00a0about 100,000 Americans and kills 14,000. CDI is usually caused by an initial mild infection followed by recurrence in one in four patients, because of treatment with antibiotics that destroy the diversity of the normal gut microbes and allow the\u00a0C. diff<\/em>\u00a0to flourish.<\/span><\/p>\n

The traditional treatment for CDI is usually powerful antibiotics. However,\u00a0a summary of three randomised control trials<\/span><\/a>\u00a0and more than 500 treated patients, and a resulting\u00a0commentary in the BMJ<\/span><\/a>, concluded that poo transplants \u2013 where liquidized stool (or its frozen microbial content) from a healthy donor is used in the colon of the patient to introduce healthy microbes \u2013 had more than an 85% success rate, compared to only 20-25% for the antibiotics.<\/span><\/p>\n

One study stopped early as they viewed it unethical to continue with antibiotics. So far from more 6,500 supervised transplants in the US very few adverse events have been reported even in the very ill,\u00a0immune deficient<\/span><\/a>\u00a0or\u00a0very elderly<\/span><\/a>.<\/span><\/p>\n

Fecal opportunity<\/span><\/h2>\n

Poo transplants have been around since\u00a04th century China<\/span><\/a>\u00a0but most doctors had not heard of them until the first trial was published two years ago. Faecal Microbial Transplantation (FMT), the official name of the treatment, and the process is quite simple.<\/span><\/p>\n

[pullquote]At large centers like Openbiome, risk of infection is minimized by lab screening and keeping samples for three months and checking donor health again before use, however there are other potential risks.[\/pullquote]<\/p>\n

At Openbiome, a healthy donor is chosen after a rigorous series of questionnaires and clinical tests on volunteers that eliminates 97% of candidates hoping to make easy money. So the dozen or so super-donors are in high demand. Their stools are diluted and a cryopreservative added so it can be safely frozen. It is then packaged three ways: either for a concentrated mixture to send down a tube through the nose into the stomach; a larger amount for use during a colonoscopy or enema to introduce via the rectum; and finally a new product being launched this week \u2013 30 acid resistant capsules (nicknamed crapsules \u2013 which\u00a0appear to work nearly as well<\/span><\/a>) and reduce medical procedures.<\/span><\/p>\n

Fecal microbial transplantation for\u00a0C.Diff<\/em>\u00a0infection has now been cautiously endorsed by medical specialist groups and in the UK\u00a0by the National Institute for Clinical <\/span><\/a>Excellence<\/span><\/a>\u00a0although national regulatory bodies have struggled with how to classify it. Are the microbes in our stool a tissue a medical device or a medicine? As our bowels contains ten times more microbial cells and 150 times more genes than in our bodies \u2013 is it really ours to begin with?<\/span><\/p>\n

In the US and UK it is not being classed as a tissue (like blood transfusions) but as a medicine with a series of discretionary exemptions to allow it to be used.<\/span><\/p>\n

Other countries are way behind the US. In the UK there are only around seven centres\u00a0(including one private) and current regulations strangely prevent the import of frozen US samples. The demand from clinicians and public for FMT is growing for other common diseases and traits linked to altered gut microbes, and clinical trials are already ongoing\u00a0for Crohn\u2019s Disease<\/span><\/a>, Colitis, Irritable Bowel Syndrome,\u00a0and autism<\/span><\/a>. It may also be useful in severe allergies and other immune diseases and even has potential in assisting chemotherapy.<\/span><\/p>\n

Probably the number one question is whether FMT could treat obesity. The only proven long-term treatment for severe obesity and diabetes is bariatric surgery where pieces of the intestine are removed and reattached. There is increasing evidence that change in microbes could be responsible for\u00a0its rapid clinical benefits<\/span><\/a>. There is now\u00a0clear evidence<\/span><\/a>\u00a0that FMT can treat and prevent obesity in lab animals but preliminary trials in obese humans have been disappointing: although FMT improved insulin sensitivity,\u00a0weight didn\u2019t change much<\/span><\/a>. So far we still lack good evidence from proper trials for all these other common diseases and the consensus is that they will be much harder to treat than for\u00a0C.Diff<\/em>.<\/span><\/p>\n

At large centers like Openbiome, risk of infection is minimized by lab screening and keeping samples for three months and checking donor health again before use, however there are other potential risks. There are a handful of reports of FMT recipients for severe infections who recovered and then gained substantial weight,\u00a0possibly transferred<\/span><\/a>\u00a0from their overweight donors. Nowadays obese donors are excluded. Our gut feelings and anxieties may come from a range of key neurochemicals that our microbes produce, including dopamine, and serotonin. Studies have shown in mice that\u00a0anxiety can be transferred by microbes<\/span><\/a>. Mental health checks may need to mandatory for future donors.<\/span><\/p>\n

There is a worry that fecal transplantation could\u00a0now be seen as a cure-all<\/span><\/a>\u00a0for every human ailment. We are still ignorant about doses and timing and our ability to change a stable well-balanced gut environment. We may also need to match up donors and recipients as for other transplants, because our gut microbes are to some extent influenced by our own genes and our microbe community is\u00a0unique to each individual<\/span><\/a>.<\/span><\/p>\n

In the future we will probably be using much safer donors \u2013 ourselves. We will be banking our own stool samples when we are healthy for later use. These are now being used in high-risk patients\u00a0prior to bone marrow transplants<\/span><\/a>. However bizarrely although it is legal in the US to store your own samples, you can\u2019t re-implant them into yourself without a complicated medical trial exemption certificate.<\/span><\/p>\n

This is a rapidly moving field that is no longer just a joke for thousands of patients whose lives have been saved, and we urgently need more studies, experts and sensible but flexible regulations. The public is increasingly skeptical of drug-driven cures and urgently need access\u00a0to good advice<\/span><\/a>, reliable microbial testing and safe alternatives.<\/span><\/p>\n

DIY transplant procedures with instructions on the internet\u00a0are proliferating rapidly<\/span><\/a>\u00a0as alternatives to traditional medicine, and without reliable data on safety and efficacy this is likely to muddy the murky waters even further. In the meantime, perhaps we should all be freezing some of our poo while we are healthy and storing it for a rainy day.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Studies show that if severe, the infections can sometimes change your gut microbes permanently. <\/p>\n","protected":false},"author":6,"featured_media":6869,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[17],"tags":[],"class_list":["post-6868","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-research"],"featured_image_urls":{"full":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff.jpg",500,334,false],"thumbnail":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff-150x150.jpg",150,150,true],"medium":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff-300x200.jpg",300,200,true],"medium_large":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff.jpg",500,334,false],"large":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff.jpg",500,334,false],"1536x1536":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff.jpg",500,334,false],"2048x2048":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff.jpg",500,334,false],"ultp_layout_landscape_large":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff.jpg",500,334,false],"ultp_layout_landscape":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff.jpg",500,334,false],"ultp_layout_portrait":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff.jpg",500,334,false],"ultp_layout_square":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff.jpg",500,334,false],"newspaper-x-single-post":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff.jpg",500,334,false],"newspaper-x-recent-post-big":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff.jpg",500,334,false],"newspaper-x-recent-post-list-image":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff.jpg",95,63,false],"web-stories-poster-portrait":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff.jpg",500,334,false],"web-stories-publisher-logo":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff.jpg",96,64,false],"web-stories-thumbnail":["https:\/\/www.revoscience.com\/en\/wp-content\/uploads\/2015\/11\/ddd1511_c_diff.jpg",150,100,false]},"author_info":{"info":["Amrita Tuladhar"]},"category_info":"Research<\/a>","tag_info":"Research","comment_count":"1","_links":{"self":[{"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/posts\/6868","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/comments?post=6868"}],"version-history":[{"count":0,"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/posts\/6868\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/media\/6869"}],"wp:attachment":[{"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/media?parent=6868"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/categories?post=6868"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.revoscience.com\/en\/wp-json\/wp\/v2\/tags?post=6868"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}