Transplanting Fecal Matter

The human body has many hidden surprises. One of which is the power fecal matter in the form of a donor gut microbiome. Many patients that have undergone antibiotic therapy to achieve remission from a particular infection can have severe side effects. Opportunistic infections, such as those caused by a particularly nasty bacterium called, Clostridium difficile, can take over a patients gut. When this occurs, more antibiotic therapy can be a potential solution, but, can a donor, fecal microbiome transplant, offer better outcomes for these patients?

A study published in the New England Journal of Medicine provides insight into the effectiveness of a fecal microbiome transplant when compared to antibiotic therapy.

But first, what is it we are talking about here? Poop. Yes, this may seem like a terrible way to overcome a medical situation; however, the science behind the therapy checks out and can even provide a quick recovery.

A fecal transplant is a form of bacteriotherapy where a transfer of stool from a healthy individual is provided to an ill individual. The transfer can be conducted directly via the colon or large intestine making use of colonoscopy, tube insertion into the stomach, or in some cases via pill-form.

In healthy individuals, our gut microbiome is a population of commensal bacteria that aids in our overall digestion. Some of the bacteria are good, and some are considered dangerous. The good bacteria out-compete the bad to a level that the bad does not cause any issue. But when an individual takes antibiotics, the harmful bacteria can sometimes gain advantage and overtake the gut. Fecal microbiome transplants are one of the ways to reconstitute homeostasis.

The observations from the clinical trial in Norway compare 20 adult C. difficile infected patients. One group of 11 patients underwent antibiotic treatments with metronidazole while another group of 9 patients received fecal microbiome transplants.

If the outcome of the method of treatment revealed a clinical cure with no evidence of C. difficile infection or reoccurrence, it was deemed a primary success. If the treatment resulted in the need for further treatment before clearance of C. difficile, it was considered to be to be a secondary success.

Of the 11 patients that received antibiotic treatment, 5 had a full recovery while the remaining six did not experience primary or secondary recovery. Of the nine patients that received a fecal transplant, five experienced full primary recovery, 2 experienced secondary recovery.

These results suggest that a fecal microbiome transplant may be an alternative to antibiotic therapy in C. difficile infection. The team has since moved this therapy to phase three clinical trials to test for efficacy, effectiveness, and safety.

More research is still required to determine the parameters for what makes an ideal donor, however, for now, fecal microbiome transplants are a promising alternative to combat bacterial infections like those caused by c. difficile.

Sources: QDT, Scientific American, MayoClinic, NEJM