02 July 2014

"Fecal transplants" explained

Most people by now have heard of fecal transplants, but a BBC article provides some additional detail:
A classic study of nine healthy British volunteers found that bacteria accounted for more than half of the mass of their faecal solids... Scientists have linked disruptions to this organ, a condition known as dysbiosis, to everything from inflammatory bowel disease and high blood pressure to diabetes and obesity.

Viewed in this light, a faecal microbiota transplant is nothing more than an attempt to reseed an intestinal tract, often after antibiotics have killed off the native flora that might have kept invasive species at bay. No other medical therapy can claim such a high cure rate for the infection widely known as C. diff...

After the Mayo Clinic in Scottsdale, Arizona, performed its first faecal microbiota transplant in 2011, a patient who had been bed-ridden for weeks left the hospital 24 hours later. And in 2013, researchers in the Netherlands halted a landmark C. diff. clinical trial early for ethical reasons when they saw that the overall cure rate of 94% with donor faeces had far outpaced the 31% cured with the antibiotic vancomycin. ..

The first known record of faecal transplants dates back to fourth-century China, when a doctor named Ge Hong included several mentions in his ambitious collection of therapeutic formulas called Handy Therapy for Emergencies. Ge dutifully described how to treat patients with food poisoning or severe diarrhoea by feeding them a faecal suspension bluntly named “solution of stool”...

Canadian veterinarian and epidemiologist David Waltner-Toews suggests in his own book, The Origin of Feces, that our response to poo may instead reflect a complicated and contradictory cultural history based more on geography. Whereas faeces was traditionally associated with fertiliser in rural agricultural areas, he says, it took on a more sinister role in urban centres as public health officials emphasised the very real danger of diarrhoeal diseases. ..

Scientists have already raised the idea that a rise in allergies and autoimmunity in industrialised nations may derive from a kind of collective defect of reduced microbial diversity.

We cannot find people who’ve never been on antibiotics,” Khoruts says of his donors. For complex autoimmune diseases such as ulcerative colitis, faecal transplants may offer only a partial solution. And with some data suggesting that susceptibility may be linked in part to past antibiotic exposure, perhaps no Western donor can provide the microbes needed to fully reseed the gut.
More at the link.

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