Are You Full of Crap? How a Fecal Matter Transplant Could Save Your Life

Poop – it’s not exactly a topic intended for dinner conversation. In fact, it’s a byproduct of a bodily function so disgusting that society avoids talking about it all together. But for many people suffering from pseudomembranous colitis, a painful condition characterized by inflammation of the colon, a conversation about excrement could actually be a lifesaver. This is because medical professionals have started treating this condition with controversial fecal matter transplants. Formally called fecal microbiota transplantation, the procedure involves removing feces from a donor and reinserting it into a patient.

For years, pseudomembranous colitis (PMC) was a mystery. The symptoms were evident- severe watery diarrhea, abdominal cramps and discomfort, vomiting, and malaise [1]. However, the cause was unknown. It was not until 1978 that researchers from the Nottingham University Hospitals in England linked the disease with a bacterium called Clostridium difficile, or C. diff [2]. C. diff is a strain of anaerobic bacterium that was discovered in 1935 by researchers at the University of Colorado [3]. It inhabits the gastrointestinal tracts of about 2-5% of the adult population and is harmless until overgrowth occurs following the use of antibiotics. This sensation is referred to as colonization resistance, in which the body’s good bacteria that normally resists the colonization of bad bacteria is killed by antibiotics, leaving the body susceptible to harmful infection [4].

As C. diff grows, it releases two types of toxins that in turn damage the tissue of the large intestine [5]. Infections range in severity and only the most extreme cases result in PMC. For a long time, treatment options were limited to antibiotic drugs such as metronidazole and vancomycin. These medications are expensive, but what’s worse is that they have proven less effective in recent years [6]. When PMC goes untreated, the symptoms become unbearable or even fatal. The body fails to properly absorb nutrients, which leads to severe malnutrition, dehydration, and weight loss. It is estimated that between 15,000 and 20,000 people died from persistent C. diff infection in 2010 alone [7].Kathryn1

The need for a new type of treatment is clear. But why fecal matter transplant? According to Dr. Lawrence J. Brandt, a professor of Medicine and Surgery at the Albert Einstein College of Medicine in Bronx, New York, the answer to that question is clearer:

“Physicians are beginning to recognize that one of the reasons why C. difficile infection may occur and recur is because antibiotics perturb patients’ intestinal microflora, now called the microbiome… By reintroducing a healthy diversity of bacteria, fecal transplantation can re-establish colonization resistance to prevent C. difficile from gaining a foothold and becoming a dominant organism in the environment of the gut” [8].

Feces are collected from a screened donor of the patient’s choosing and reinserted into the bowels through a method similar to colonoscopy [9]. When feces from a healthy individual are introduced to the patient, the patient’s body is able to restore fecal microbiota equilibrium [10]. With a little bit of help, the body is able to correct the problem without long-term doses of medication. Brandt notes the procedure’s remarkable success: “On average, fecal transplantation yields a cure rate of 91—93%” [11].

While many people can’t stomach the idea of having such a foreign substance in their bodies, others can’t imagine life without it. In 2012, CNN reported the story of twenty-year-old Kaitlin Hunter who was diagnosed with PMC after being placed on antibiotics following a car accident that lacerated her colon. After months of vomiting and diarrhea, 5 foot 7 Kaitlin weighed only 85 pounds. Her quality of life was ravaged until she elected to try a fecal matter transplant that used her mother as a donor. After one round, Kaitlin was cured [12].

Kaitlin Hunter

Kaitlin Hunter

Although fecal matter transplant has proven to be successful and inexpensive, researchers continue to pursue other treatment options. The most recent advance can best be described as a fecal matter transplant in a pill. Researchers at Massachusetts General Hospital conducted trials testing the efficacy of frozen poop capsules in curing C. diff infection[13]. While additional studies are still underway, the pills showed promising results. An oral capsule would provide the benefits of GI microbiota rebalance without the mess or equipment.

Poop may not be pleasant, but it certainly has its purpose in the medical field. Just ask the experts at MicroBiome Therapeutics, the billion dollar pharmaceutical company whose “products [are] designed to alter bacterial populations and their environment in the gastrointestinal (GI) tract to prevent or treat serious health conditions [14].” Certainly, treatments such as fecal matter transplants could be the future.

References:

[1] Aberra, Faten N., and Jennifer A. Curry. “Clostridium Difficile Colitis.” Edited by BS Anand. MedScape. Last modified December 18, 2014. Accessed December 22, 2014. http://emedicine.medscape.com/article/186458-overview.

[2] Bartlett, John G., TE Wen Chang, Marc Gurwith, Sherwood L. Gorbach, and Andrew B. Onderdook. “The New England Journal of Medicine.” The New England Journal of Medicine 298 (March 9, 1978): 531. Accessed December 21, 2014. DOI: 10.1056NEJM197803092981003.

[3] Hall, Ivan C., and Elizabeth O’Toole. “Intestinal Flora in New-born Infants with a Description of a New Pathogenic Anaerobe, Bacillus Difficilis.” The American Journal of Diseases of Children 49, no. 2 (February 1935): 390. Accessed December 21, 2014. DOI: 10.1001/archpedi.1935.01970020105010.

[4] Ryan KJ, Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 322–4.

[5] Borriello, S.P. “Pathogenesis of Clostridium Difficile Infection.” Journal of Antimicrobial Chemotherapy 41 (1998): 13-19. Accessed December 22, 2014. http://jac.oxfordjournals.org/content/41/suppl_3/13.full.pdf.

[6] Bakken, Johan S., Thomas Borody, Lawrence J. Brandt, Joel V. Brill, Daniel C. Demarco, Marc Alaric Franzos, Colleen Kelly, Alexander Khoruts, Thomas Louie, Lawrence P. Martinelli, Thomas A. Moore, George Russell, and Christina Surawicz. “Treating Clostridium Difficile Infection with Fecal Microbiota Transplantation.” Clinical Gastroenterology and Hepatology 9, no. 12 (August 24, 2011): 1044-49. Accessed December 22, 2014. DOI: 10.1016/j.cgh.2011.08.014.

[7] Heinlen, Latisha, and Jimmy D. Ballard. “Clostridium Difficile Infection.” The American Journal of the Medical Sciences 340`, no. 3 (September 1, 2011): 247-52. Accessed December 22, 2014. DOI: 10.1097/MAJ.0b013e3181e939d8.

[8] Brandt, Lawrence J. “Fecal Transplantation for the Treatment of Clostridium Difficile Infection.”Gastroenterology and Hepatology 8, no. 3 (March 2012): 191-94. Accessed December 22, 2014. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3365524/.

[9] Ibid.

[10] Rohlke, Faith, and Neil Stollman. “Fecal Microbiota Transplantation in Relapsing Clostridium Difficile Infection.” Therapeutic Advances in Gastroenterology 5, no. 6 (November 2012): 403-20. Accessed December 22, 2014. DOI: 10.1177/1756283X12453637.

[11] Brandt, Lawrence J. “Fecal Transplantation for the Treatment of Clostridium Difficile Infection.”Gastroenterology and Hepatology 8, no. 3 (March 2012): 191-94. Accessed December 22, 2014. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3365524/.

[12] Hudson, William. “Little-known Fecal Transplant Cures Woman’s Bacterial Infection.” CNN Health. Last modified September 27, 2012. Accessed December 22, 2014. http://www.cnn.com/2012/09/26/healthfecal-transplant/.

[13] Youngster, Ilan, George H. Russel, Christina Pindar, Tomer Ziv-Baran, Jenny Sauk, and Elizabeth L. Hohmann. “Oral, Capsulized, Frozen Fecal Microbiota Transplantation for Relapsing Clostridium Difficile Infection.” The Journal of the American Medical Association 312, no. 17 (November 5, 2014): 1772-78. Accessed December 22, 2014. DOI: 10.1001/jama.2014.13875.

[14] Microbiome Therapeutics. Last modified 2014. Accessed December 23, 2014. http://www.mbiome.com.

Image References:

[1] Retrieved December 20, 2014, from: http://bioweb.uwlax.edu/bio203/s2009/kumm_jakl/bucolic/colitis.jpg

[2] Retrieved December 20, 2014, from: http://i2.cdn.turner.com/cnn/dam/assets/120925125410-kaitlin-hunter-profile-shot-story-top.jpg

 

Kathryn Cavanna is a freshman at George Washington University. She is a Biochemistry major and hopes to one day pursue a career in Microbiology. Follow The Triple Helix Online on Twitter and join us on Facebook.

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