#6 Fecal Microbiota Transplantation


Many hospitalized patients develop hospital-acquired infections, oftentimes due, paradoxically, to broad-spectrum and fluoroquinolone antibiotic therapy used for medical treatment. Antibiotics, which are supposed to kill bacteria, can also increase the odds of some people developing a dangerous and potentially lethal infection  from rod-shaped bacteria called Clostridium difficile, or C. diff.

C.diff infections, and the infectious diarrhea that it causes, are a major reason for sickness and increased health care costs for hospitalized patients. According to the U.S. Centers for Disease Control and Prevention, the number of C. diff infections have increased significantly in recent years, with 500,000 cases reported each year in the United States, and 15,000 deaths annually, usually after recurrences of the infection.

Gut microbiota, previously known as gut flora, is the name given today to the microbe population living in the human intestine. C. diff is just one of the hundreds of different microbial species found there, and, like the other intestinal bacteria, it is typically harmless. When antibiotics are used, however, aggressive and friendly bacteria in the gut are often killed together by the drugs. This can cause a gastrointestinal imbalance, which then allows for abnormal C. diff growth. Once passed through the feces, C. diff is tough and persistent and can survive on dry surfaces for months.

C.diff spores can inadvertently be transmitted to hands, food, utensils, sheets, countertops, and curtains. When transferred and swallowed by another person, these spores multiply, and produce toxins that lead to inflammation of the lining of the intestine, diarrhea, nausea, vomiting, and abdominal pain. Symptoms range from moderate to severe, and some are at serious risk of death when people don’t respond to standard therapy.

C. diff is typically combatted with one of two antibiotics, vancomycin or metronidazole. However, many gastroenterologists are now employing fecal microbiota transplantation—the use of human stool transplants—to battle C.diff in those patients who do not respond to standard drug therapy. This novel bacteriotherapy typically entails  a colonoscopy or enema to transfer a liquid suspension made from a healthy person’s fecal matter into a sick person’s colon in order to restore bacterial balance and cure a specific disease.

Human stool is biologically active and it contains a rich mix of living organisms with great therapeutic potential for use against C. diff infection. The clinical study results to date have been extraordinary, with the stool proving to be a safe and effective treatment that alters the fecal microbiota to resemble that of their donors with no more than two transplantations. Some people who have had multiple episodes of C.diff have realized benefits from the therapy hours later, have been cured of their symptoms within 24 hours, and have had no recurrences.

As more research continues in the microbiota and how bacteria can actually make people healthier, it’s expected that fecal microbiota transplants could become a primary mode of therapy not only for patients with multiple recurrences of C.diff. but for treating inflammatory bowel disease and non-gastrointestinal medical conditions as well, such as rheumatoid arthritis and Parkinson’s disease.

A recent Dutch pilot study reported that obese patients with symptoms known as metabolic syndrome improved their insulin sensitivity and lowered triglyceride levels six weeks after receiving a fecal transplant from thin, healthy relatives. A 2013 study involving the transfer of gut bacteria from obese and lean human twins to mice reported that mice receiving the bacteria from fat twins grew 15 percent fatter while those with the bacteria from lean twins remained lean.


Where Are They Now

Fecal transplants have had huge successes as treatment for C. Diff. with cure rates of over 90%, and now more research is being conducted to evaluate the efficacy of fecal transplants for a multitude of other gastrointestinal problems, such as Irritable Bowel Syndrome and Crohn’s Disease. In a recent study, the first multi-centered trial to use an intense therapy of FMT infusions, results showed 27% of participants achieved the study’s two main goals: relief of symptoms and signs of healing within the digestive tract. Data released in 2017 shows the long term benefits of fecal microbiota transplantation, as doctors were able to accurately identify transplanted donor microbes in the recipient up to two years after transplantation.

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