We carry around vast numbers of bacteria in our gastrointestinal tract, and that community of microbes, the gut microbiome, can be very important to our health. Imbalances in the gut microbiome can also cause problems. One way to fix it is fecal transplantation, in which fecal material is transferred from a healthy donor to a person with gut microbiome dysfunction. The 'healthy' fecal material carries microbes that can restore the health of the problematic microbiome. Researchers at the University of Adelaide have now demonstrated that this process can successfully treat patients suffering from ulcerative colitis. The findings have been reported in the Journal of the American Medical Association (JAMA).
Ulcerative colitis is a disease in which the lining of the rectum and large intestine becomes inflamed. That inflammation causes pain, blood in the stool, and an increase in the risk of colon cancer.
In this study, scientists from the University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), CSIRO and CALHN (SA Health) enrolled 73 patients with mild to moderate cases of ulcerative colitis. Those patients received either their own stool in a placebo transplant or donor fecal material that had been processed in an environment free of oxygen (anaerobically) for transplant.
"The most important difference in this trial compared to previous studies is the use of anaerobic (oxygen-free) stool processing," explained the study leader Dr. Sam Costello, a gastroenterologist at the University of Adelaide's Medical School. "Many gut bacteria die with exposure to oxygen, and we know that with anaerobic stool processing a large number of donor bacteria survive so that they can be administered to the patient. We believe that this may be the reason that we had a good therapeutic effect with only a small number of treatments."
The team found that this low-intensity fecal microbiota transplantation (FMT) with the anaerobically-processed donor microbes relieved ulcerative colitis. There was a 32 percent remission rate compared with only nine percent in the placebo. Those results are similar to what’s seen with current colitis treatments — however, those therapeutics work by suppressing the immune system, which can cause many dangerous side effects.
The researchers are already working to bring this new treatment, which is considered to be much safer, to patients. The UK company Microbiotica is involved in commercializing the therapy.
"Our long-term aim is to develop rationally designed microbial therapies that can replace FMT,'' said Costello. "These will have bacteria in a pill that can carry out the therapeutic effect without the need to take whole feces; this is obviously a better and less smelly option."
The researchers are planning to follow up on this work to see if the FMT keeps patients free of colitis over the long-term.