Friday, September 28, 2012

Can A Fecal Transplant Cure IBD, Colitis, Crohn's, C. difficile, Multiple Sclerosis..?

Some call it a fecal transplantation. Others, fecal bacteriotherapy. Call it what you want, but there is regenerative power in poop for severe, bowel problems. Seriously? Yes. Cure rates are generally above 90% for Clostridium difficile; treatments for Crohn's Disease and Multiple Sclerosis are not as well studied, but appear promising. Everyone should know about fecal transplants as C. difficile infections have risen 400% since 2000 (largely due to hospitals spreading them). Just in the past year, I have had one family member and one friend come down with C. diff infection. Doctors are recalcitrant to prescribe fecal transplants, but that appears to be due to lack of knowledge rather than success.
  1. CNN raised the profile of fecal transplants a trillion fold when it posted this article on the front page of its website a couple of days ago: Little known fecal transplant cures woman's bacterial infection. If anyone was previously skeptical, this article basically legitimizes fecal transplantation.
  2. The Henry Ford Hospital in Detroit, MI recently found that 43/49 patients with C. difficile infections were cured after fecal transplants; they had no problems up to three months later. Fecal transplant from mom cures ailing toddler.
  3. A 2011 literature review found that 92% of 317 patients with recurrent C. difficile infection or pseudomembranous colitis had disease resolution upon fecal transplant. 
  4. Clinics and retreats are offered! For instance in the US, the Bright Medicine Clinic in Portland, Oregon performs Fecal Transplants for many conditions discussed below.
  5. There's a blog called Fecal Microbiota Transplant that reports seemingly unpublished data on transplants improving Multiple Sclerosis in patients with bowel syndromes. At a minimum, patients were able to walk again!
  6. Two papers on inflammatory bowel disease indicate that of nine patients who were non-responsive to standard treatment, all nine of them responded dramatically well to fecal transplant therapy.  Bacteriotherapy Using Fecal Flora (2004) and Treatment of Ulcerative Colitis Using Fecal Bacteriotherapy (2003)
  7. We NEED a site that provides location information on fecal transplants. I can not seem to find one and people will clearly be asking for more information. Googling around appears to come up with specific instances, so if you search hard enough, you may find something in your neck of the woods. (There is a partial list of USA fecal transplant places here); if you're in TN, Vanderbilt's clinical chief, Dr. Michael Vaezi of Gastroenterology is doing fecal transplants in response to refractory Clostridium difficultIn Virginia at the Virginia Commonwealth University, Dr. Michael Edmond is doing fecal transplants for C. diff [news link]; In Nevada, Gastroenterology Consultants in Carson City offers fecal transplantation for C. diff
  8. There's a Facebook Page that appears to be a good social media resource, aptly named Fecal Bacteriotherapy is "The Bomb"
  9. There are reports on the internet of do-it-yourself fecal transplants. Clinics can be hard to find and the treatment is not typically covered under insurance, especially for IBD. Understandably, these barriers to a treatment have led some to pursue self-treatment with enema kits. Probiotic Therapy Home Infusion Protocol and Success of Self-Administered Home Fecal Transplantation for C. difficile Infection
  10. A University of Guelph lab in Canada has developed a Robogut machine to simulate the human gut conditions in vitro. They have successfully used it to grow a cocktail of bacteria that cured C. diff infections from two elderly patients. What a breakthrough! Symbionticism Blog Post Link
Background: Despite the conventional lexicon that poop is dirty, an agent of infection, and should be left for one place and one place only - the toilet, poop may be as powerful in its regenerative capacity as stem cells. Perhaps better. Roughly 40% of your feces is made up of bacteria living inside and shed from your gut. These species help us digest food, develop intestinal tissue, and fight off infections among many other things.

Disease: The bacteria in your gut are as much a part of you as your genes. The fact that some fraction of them come out in your waste is fortunate because these symbiotic bacteria can be used in the purest form of recycling that humans may ever know. Friends or family that are suffering month-to-month, or year-to-year, with debilitating or deadly diseases such as Crohn's disease, ulcerative colitis (these first two are often referred to as IBD or inflammatory bowel disease), Clostridium difficile, etc know all too well the long and painful aspects of these diseases. In many cases, antibiotics are prescribed over and over, with each one that fails leading to more expensive ones that are also more difficult to get. The irony of the antibiotic ferris wheel is that antibiotics may be buying a little more time or even exacerbating the problem, while the solution happens to be right in front of us, or behind us to be technically accurate. The healthy bacteria in poop from a friend or family member can be "transplanted" into the gut of a sick patient and fully cure them in many cases.

Professor Thomas Borody (MD, PhD) is one of the leading physician scientists in this area and this video is definitely worth watching and sharing to classrooms, friends, and family.

Further Reading: Fecal Microbiota Transplantation and Emerging Applications. Borody and Khoruts 2012. Nature Reviews Gastroenterology and Hepatology 9: 88-96.

Thursday, September 6, 2012

Update from O'Neill Lab on Wolbachia / Eliminate Dengue Project

This news just in from the Eliminate Dengue project in Australia (NPR story and audio). As Ive tweeted and blogged about many times, Scott O'Neill's lab has been leading a Gates Foundation funded effort to introduce Wolbachia-infected mosquitoes into Australian suburbs in the fight to replace uninfected mosquitoes that are competent to transmit dengue virus with Wolbachia-infected ones that are incompetent to harbor and transmit dengue virus. The science has been remarkably fruitful and the project's success appears to be positioning the program to do releases in other countries, such as Thailand and Brazil. Here we get an update letter from the Team. The key updates are:

  • Wolbachia inhibits growth of Dengue virus in mosquitoes.
  • Release 1: Of the massive releases of wMel Wolbachia-infected mosquitoes performed 16 months ago, a whopping 97% of mosquitoes harbor Wolbachia. That's staying power!
  • Release 2: A second trial is ongoing to test if wMelPop Wolbachia can do the same as wMel. The difference between the two strains is that while wMelPop has stronger inhibition of Dengue virus growth in mosquitoes, it can not invade mosquito populations as efficiently as wMel.
  • Release 3: Mysterious - they are currently working with a 3rd strain that combines the best of wMel and wMelPop. I have not heard about this yet in the literature but it is tantalizing.
  • If you live in Australia, the Project needs you. Home owners in Edge Hill, Cairns North, Whitfield, Parramatta Park, Manunda, Westcourt, and Stratford, Australia should contact 1-800-811-054.