Could A Fecal Microbiota Transplant Save Your Life?

Imagine your loved one suffering for weeks, their body ravaged by a persistent infection. Antibiotics, often a miracle cure, become the enemy, leaving them weaker and more miserable. C. Diff, a nasty gut bacterium, thrives in this antibiotic chaos. This isn’t just a story for hospital patients; C. Diff can strike anyone who’s taken antibiotics.

But there’s hope! A groundbreaking treatment, once relegated to the realm of “too weird to be true,” is saving lives. Fecal transplants are no longer a punchline; they’re a highly effective weapon against C. Diff.

This post will delve into the world of fecal transplants, explaining how they work, why they might be the answer to your gut woes, and the exciting future possibilities of this revolutionary treatment. We’ll cover what C. Diff is, how fecal transplants restore a healthy gut, the screening process for donors, and the ongoing debate about regulating this life-saving procedure.

What is C. diff?

C. diff, if you are unfamiliar with it, is a bacterium called Clostridium (recently renamed to Clostridioides) difficile that wreaks havoc on the gut, often after someone has been on antibiotics for a while. When you get a C. diff infection, you will have diarrhea, fever, nausea, and gastrointestinal pain. C. diff can become a significant issue when it survives antibiotic treatment. One in five patients will get treated, seem to get better, but then have their symptoms return. However for those recurrent infections, patients can seek out fecal transplants. Sounds gross, but just hold your judgment and keep reading.

What are fecal transplants?

I’ll never forget reading an article in Science about fecal transplants called “The Promise of Poop” by Jop de Vrieze and thinking, wow, this is insane but so cool.

A fecal transplant, or a fecal microbiota transplantation (FMT), is a procedure in which the stool from a healthy person is given to a sick person who has a recurrent C. diff infection. After antibiotic treatment, C. diff can sometimes survive and take over the gut. So, you go from having a large assortment of microbes in the gut to having one dominant pathogen, C. diff. A fecal transplant attempts to restore a healthy assortment of microbes by introducing a healthy person’s stool into a sick person’s gut.

First, you have to find a healthy donor. This may sound easy, but it’s not.

One way you can find a healthy donor is through OpenBiome, a company that provides healthy donor fecal matter. They have a rigorous screening process where they ask the potential donor about their health, activities, travel, if they’ve gotten a blood transfusion, and other questions. They want to make sure the donors are not carrying any infectious diseases.

Due to this screening process, they end up selecting only a small number of people. “The acceptance rate of being a healthy donor is lower than the acceptance rate of getting into MIT. So, very stringent,” says Kristina Campbell, M.Sc., a science writer who specializes in the area of microbiome research, writing on topics such as microbial therapies (including fecal transplants), fermented foods, probiotics, and microbes in human health. She interviewed the OpenBiome staff and toured their Cambridge, MA facility in 2016.

The donors are screened for pathogens, and if they pass, they can begin providing healthy samples periodically. “At OpenBiome, they keep the samples in freezers and ship them on ice to different centers around the US. Basically, you have a frozen sample—it’s really not altered very much, if at all,” says Campbell.

This fecal sample is then given by enema to the patient who is suffering from recurrent C. diff. “There are different modes of administration, like in Europe, they often do it through nasogastric tube from the top down, and then there’s also the option of putting it into a pill format,” says Campbell.

Do fecal transplants work?

The idea of a fecal transplant still probably sounds pretty strange, but people suffering from C. diff infections become desperate. So, does this treatment option work?

For recurrent C. diff infections, this treatment has saved lives—sometimes within hours people begin to feel better. “I had one doctor say that there was one case where he did this, and, and he was shocked. The next day, the patient was out gardening in her garden,” says Campbell.

Most importantly, fecal transplants have been highly effective in clinical trials, with 80% and 90% resolution. So, that’s pretty exciting. If you are interested in reading more about the current state of the fecal transplants clinical trials, here is a review with a table (Table 4) summarizing the results from clinical trials up to 2014.

Even though fecal transplants seem to work well, doctors can still be reluctant simply because of the risks involved. This is not as well-controlled as, say a probiotic pill where you know exactly which strains are being used for the treatment. It’s possible that the donor harbors an infectious microbe that the screening process missed. Or it’s even possible that the donor could carry an unknown microbe in their microbiota that could change the patient’s health in some way, good or bad.

What does the future hold?

Because fecal transplants work so well for recurrent C. diff, scientists have already begun to and will continue to explore using them for treatment of other diseases and disorders, like ulcerative colitis, obesity, and autism.

The use of fecal transplants in the clinic is still very new, and with new treatments, come regulations. A huge decision has to be made, and it won’t be an easy one: is fecal matter a tissue or drug? Tissues and drugs are regulated differently.

If it’s a drug, then it would need to become a product with each component highly controlled, and as a result, it would be heavily regulated. But it’s possible that these highly-controlled products will have to be derivatives of stool, and will not be as effective as plain old stool. One example of the concept of creating a natural product is human blood. “We’ve never been able to recreate fully-functioning human blood—there’s no synthetic blood, even to this day,” says Campbell.

So, this treatment option is as complex as it is exciting. It will be fascinating to watch as these issues unfold.