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The poo panacea: inside the strange, surprising world of faecal transplants

by Ace Damon
The poo panacea: inside the strange, surprising world of faecal transplants

The man and the woman are wearing blue aprons and light shields. James Sones and Indu Srinivasan are in a room in the Division of Digestive Diseases at the University of Mississippi Medical Center in Jackson. They are about to create something that has spread through medicine like, well, a shit storm.

Sones takes a brown gloopy material and places it in what appears to be an ordinary kitchen blender. The camera approaches a tag: fecal mixer. The brown gloopy material is, depending on your profession and level of politeness, fecal matter, feces, excrement or poop. It was donated by a generous volunteer and will certainly transform the life of the person who will receive it.

Once mixed and mixed with saline, the brown material is poured into large syringes and infused into a colonoscopic patient. (Nasogastric tubes and enemas are other methods of administration.) In the UK, this treatment is available to patients suffering from repeated infections of Clostridium difficile or C diff.

These bacteria can live harmlessly within us. But in patients who receive strong antibiotics, C diff can survive, overwhelm a clean gut in its microbiome and secrete a toxin that causes horrible pain, diarrhea and vomiting. In the worst cases, it can be fatal. Even when defeated by antibiotics, he can return, unless the patient receives an infusion of poo, a procedure known as fecal microbiota transplantation (FMT).

Human waste is an inappropriate name. What we excrete contains nutrients and bacteria, and can be a useful fertilizer or fuel. The fact that the bacteria contained can also cure diseased guts was known to ancient Chinese writers, who wrote about "yellow soup" (supposedly as liquefied excrement), used to treat food poisoning and bad diarrhea.

An American surgeon, Ben Eiseman, resuscitated the procedure in 1958, but the antibiotic vancomycin was discovered and became the standard treatment for C diff. However, when antibiotics started to fail, enterprising doctors began to try FMT to restore a damaged microbiome. The success rates were surprising: about 90% of patients with recurrent C diff were cured.

In 2013, Dutch researchers stopped a randomized control test – the gold standard for medical testing – because FMT was much more effective than vancomycin. In 2014, the procedure was accepted enough that the UK National Institute of Excellence in Health and Care issued guidelines that would allow fecal transplants for use in clinical practice, but only for C diff.

Even so, says Professor Tariq Iqbal, from the University of Birmingham's Microbioma Treatment Center (MTC), “it was very badly accepted. Only about 30 hospitals (in the UK) have had a fecal transplant. Only four made 10 or more.

In part, there was a supply problem: where would the poop come from? In the early years of FMT, patients were often infused with fecal material donated by a relative or close friend. Slowly, however, the concept of a stool donor emerged. The MTC is now one of only two stool banks licensed in the UK and, in its first year of operation, has sent 150 samples at a cost of £ 650 per 50ml.

Donors are recruited through posters and word of mouth. Iqbal says they need to leave their stools for 10 days in a row before 11am (so they have to be regular in a number of ways). Although the MTC is close to the Queen Elizabeth hospital, healthcare professionals are excluded because they are exposed to many bugs.

The screening is rigorous: it must be when each sample can be different. Over 90% of volunteers are rejected. For safety reasons, each sample is kept for three months before use, if a donor is incubating something. A sample will also be maintained indefinitely. Screening tests are as severe as donor questionnaires: all samples are tested for a wide range of pathogens.

How is a final FMT sample? Smells? Iqbal looks at my coffee cup. "It's the color of coffee with milk". And yes, of course it does. "Sucks." Patients, he says, have no problem accepting the procedure. They won't smell it, for a start, on a nasogastric tube or colonoscopy. And you cannot afford to be sick when you are desperately ill.

Adrienne Grierson: "In the third treatment of FMT, it was as if my brain was on". Photograph: David Levene / The Guardian

James Elliot, 50, director of Dudley's company, developed ulcerative colitis at age 30. He took antibiotics and was fine, then relapsed. His diarrhea was so bad that he needed to go to the bathroom 50 times a day. So Iqbal told him about FMT. Although he did not have C diff, he could do the procedure as part of a planned clinical trial on colitis and FMT.

He had an FMT enema once a week for eight weeks. “After six weeks, there was a dramatic improvement. After the course, I was well between 90% and 95%. ”He clearly remembers that it was during the World Cup two years ago, because when he went to make a final assessment through an internal camera,“ the room was applauded. I remember comparing it to watching England playing the night before and these people were rooting for my colon.

Because it is so simple and widely available and seems so miraculous, the use of FMT has long since gone from sterile medical facilities to home bathrooms and YouTube. If it transforms the microbiome so well for C diff, why shouldn't it do it for other conditions? If the microbiome participates in all types of bodily functions, from mood to metabolism, such as search it seems to show, why shouldn't a dose of healthy poop solve other problems too?

There are more than 300 clinical trials listed in clinictrials.gov who use FMT to treat a variety of conditions, including autism, dementia, anorexia and obesity. The latest wants to explore FMT as a treatment for fecal incontinence (the inability to control bowel movements) in women.

But Mark Wilcox, a professor of medical microbiology at the University of Leeds, is cautious. "What is common at FMT is that wherever you are, there are enthusiasts in particular, and in the USA in particular. It is a great opportunity to earn fees in the USA. But it is, like it or not, an experimental procedure."

Animal testing has shown that conditions and preconditions can be transmitted with the fecal material. “There is data that intestinal bacteria play a role in intestinal cancers, blood pressure, diabetes and obesity. You can make fat mice thin and fat by transplanting their intestinal bacteria. Since we don't know all the roles of the gut microbiome, you are potentially transferring bacteria from someone who has something to do with cancer, diabetes, obesity, and so on. "

Last year, two people who participated in tests in the United States contracted fecal transplant E Coli – one died – because the samples had not been tested for this pathogen. But even this news doesn't stop people who can't get FMT on the NHS or can't afford to pay in the US (where it can cost $ 1,000) to do their own thing. Adrienne Grierson, an Australian filmmaker based in London, describes herself as "an antibiotic child". Since then, she has suffered "terrible stomach problems", including "cramps, vomiting, diarrhea, hot flushing, sweating, agony".

In 2015, trapped in bed, she turned to Google and discovered fecal transplants and the microbiome. "I thought, my God, I've been playing here with half a deck of cards. There's a lot I can do with what I destroyed." She paid 10 FMTs from a private clinic and "on the third day, it was like someone called me brain, like antibiotics used to do. And that was a shock. I hadn't thought so far. I just wanted my courage not to fall.

Since then, Grierson has had fecal transplants every three months or so, although now he does it at home. When we talked, she had had a fecal infusion two days earlier, thanks to a friend. “She poops in a bag and I put her in a colander, a few spoons. Then, pour saline solution and knead, so as not to get all the large particles. Then I suck it out with a syringe and pretend I'm in a clinic. "

Grierson paid for her friend to be examined comprehensively when she started donating. Now, she trusts that she is healthy. "If you take other people's characters and personalities, I really hope I can get hers because she is really adorable. I have no history of cancer in my family. I am not a sick person. The concerns are: what if I can all this from someone? You have to decide: do you want to take a risk and live very well or do you want to continue living like this?

Iqbal has a reaction from the clinician to DIY fecal transplants. “I think doing it yourself really needs to be a thing of the past. Because we don't really know what we're doing. ”Although metagenomic tests to analyze bacteria are now much more accessible, there are countless unknowns about FMT and the microbiome. “When you do metagenomics in stool samples,” says Iqbal, “you still find a lot of things that are not in the databases. It's too early. "

FMT reached popular culture with a mention in an episode of South Park. But it is exciting enough that serious money is invested in improving it. Vedanta Biosciences, a large pharmaceutical company, is one of several companies working on the development of “rationally defined consortia of bacteria derived from human microbiomes”. In other words, distilling useful poop stuff into a safe commercial product that is unlikely to be the color of coffee with milk or mixed in a blender.

Iqbal is convinced that this will happen sooner or later. "FMT is very empirical," he says. “We need to understand the mechanisms. I hope that in five years we will not be able to do FMT anymore. "

. (tagsToTranslate) Health and well-being (t) Digestive disorders (t) Microbiology (t) Biology (t) Life and style (t) Science (t) Society

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