Taking the “Yuck” Out of Fecal Microbial Therapy

Fecal microbial therapy (FMT), or fecal transplant, involves the transfer of stool from a healthy donor (usually a family member) to the intestines of an individual suffering from an illness—usually Clostridium difficile infection, although other conditions have been treated with FMT, including ulcerative colitis, autism, and even obesity.

One of the hurdles the medical establishment faces when deciding on the use of FMT is the “yuck” factor. The idea of transplanting poop from one person to another is not exactly charming. That may be, in part, why the therapy is being resisted in some circles. But when you consider that over 90% of the people with recurrent C. difficile infection who are treated with FMT completely recover—some within 24 hours—even the yuck factor starts to fade.

FMT involves the delivery of fecal bacteria either via an enema, during a colonoscopy, or via a naso-gastric tube. None of these methods is comfortable, however. Thomas Louie, MD, of the University of Calgary, has developed a work around for the delivery of fecal bacteria without use of these invasive methods.1 He has been treating patients with FMT for a number of years, and when he encountered a patient who did not respond to enemas and for medical reasons could not receive a nasogastric tube, “a bright light went on,” he said. He decided to figure out how to put the fecal bacteria into pill form that the patient could take orally with no problem.

He designed a process that isolates the bacteria from feces, separating bacteria from fecal matter. The bacterial concentrate is then placed inside three layers of gelatin capsule so that the capsules do not open until they are in the small intestine. Dr. Louie began doing this therapy in 2010, and has since treated 31 other patients. He says the therapy has been effective in eliminating the C. difficile infection in all but one patient, who experienced a slight recurrence. “It seems to be a convenient way for the patient,” he noted.

Talk about a super probiotic. The rich diversity of bacteria found in the stool of healthy people is likely what makes this therapy so effective. We will certainly hear more about the progression of this therapy in the near future. C. difficile infection claims 14,000 lives each year, and that number continues to rise. If FMT has a cure rate of over 90 percent, think of how many lives could be saved.

I think we will soon see “designer super probiotics” derived directly from healthy donors’ stool and that contain strains that are not currently available as probiotics. The type and amounts of bacteria will be studied to see which are the best individual bacteria strains, and what specialized combinations are most effective to help treat many disease conditions. The combinations can then be saved and stored to create products that do not come directly from the stool, but have been grown in special microbiology labs.

 

References

  1. O’Connell PM, “Fecal transplantation pills show promise for treatment of C. difficile.” The American Academy of Pediatrics. 4 Oct 2013.
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