The next big thing in medical science: POO TRANSPLANTS

Your brother's gonna die, kid, unless we can give him your, well ...

Oral fecal delivery mechanism (belp)

Gut dysbiosis (unbalanced or skewed bacterial ecology) is associated with more than obesity, it appears to have a role in a range of other conditions: metabolic syndrome, type II diabetes, inflammatory bowel disease, Crohn’s disease, colorectal cancer, irritable bowel syndrome. It’s also being investigated in depression, rheumatoid arthritis, asthma and … well, you get the picture.

There are some, like Susannah Salter and Alan Walker of the Wellcome Trust Sanger Institute, who are openly wondering whether some of these results are down to bacterial contamination of lab kit. This is possible in some cases but it is also becoming clear that there’s something significant we’re learning about ourselves.

Now, what about the yuck factor? While all of this is very interesting in an academic kind of way, it starts to get interesting, and messy, when we look at what we can do clinically with this new knowledge. It happens that one of the simplest ways to transfer the effects of the “good bacteria” is to just transfer the bacteria from one individual to another.

Welcome to the world of the fecal transplant.

If we go back to our mousey models of cancer, scientists have transplanted poo from the mice with the “good bacteria” into mice without and have found that the immune defences against cancer have been boosted. Same for mice with a tendency to obesity – a poo transfer into tubby mice fed a “fast food” diet has seen them continue on the same diet and not put on the pounds (OK, grams – they don’t ever get that big).

Multiple experimental models have shown the same thing in multiple health conditions – fecal transplants are an effective mechanism for transferring entire ecosystems of good bacteria and with them the positive effects they engender.

And it’s more than mouse models. Poo transplants (more politely known as fecal microbiota transplants) have also been tried, successfully, in people. The process is not for the squeamish. Basically it consists of finding a healthy donor (often a relative or partner), screening for diseases and the presence of pathogens in the stool and then taking a fresh stool sample. This is processed, normally turned into a solution with saline, and then infused into the recipient (usually via enema).

One approach has been to use frozen poop – it’s easier to deal with and appears to be as medically efficacious. Ideally of course doctors and patients would rather not have to deal with fecal material at all.

It’s not nice, but the process has been used successfully to treat people with life-threatening C. Difficile infections. Positive results have also been reported in severe Crohn’s disease, ulcerative colitis and other inflammatory bowel conditions, even in cases that have been resistant to all of the standard treatments.

Some of the results have been so positive that desperate patients who have been unable to get access to a clinical trial or treatment at a hospital have opted to go the DIY route. In fact there’s a whole subculture emerging of patients who are doing this at home as a way of alleviating a wide variety of medical conditions. Obviously the DIY approach is fairly low tech but it does appear to work in many cases. As you would expect, this is really a last resort and is not recommended by us here on the Reg medical desk.

From DIY to over-the-counter

Of course the positive results that have been reported in small clinical trials and by doctors have spurred on efforts to come up with a mechanism a bit less vile and smelly. One approach has been to use frozen poop – it’s easier to deal with and appears to be as medically efficacious. Ideally, of course, doctors and patients would rather not have to deal with fecal material at all. To that end the race is on to come up with capsules that contain the right mix of bacteria and give the same outcome.

There are already plenty of probiotic tablets and capsules on sale in pharmacies and health food shops, but these tend to be limited to one or two specific species of bacteria (usually varieties of lactobacilli or bifidobacteria, the sort of bacteria you’ll find in live yoghurt). In practice these don’t have the same effect as the complex mix of bacterial populations that are found in the gut, hence the research efforts to come up with the right combination for a pill to replace the poop.

It’s relatively early days in all of this, but I for one fully expect to see more use of bacterial transplants (whether by pill or raw material) in additional medical indications. It may well be that the day will come when we treat colorectal cancer patients with bacteria as well as drugs, and when the clinically obese take full spectrum probiotics as well as changing their diets.

In the meantime just having the occasional live yoghurt or trendy lactofermented juice could well be worth doing. ®

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