Fecal Transplantation, the Sweet Smell of Success
by Jeffrey Dach MD
A recent medical meeting I attended covered the “microbiome”, the friendly bacteria in our gut. Apparently these little microbes are doing a lot more than we thought.
Dybiosis is disruption of our normal microbial flora. One example is the dreaded complication, Clostrida Difficile entero-colitis, resulting from over-use of antibiotics allowing the pathogenic Clostridia Difficile to dominate.
There are hundred of strains of Clostridia, and some produce toxins which disrupt neurotransmitter function in the brain. Hence the interest in probiotic therapy and fecal transplantation for neurological disease. Left Image: Air Contrast Barium Xray of Colon courtesy of How Fecal Transplants Work.
When Probiotics Are Not Enough
Restoring our normal gut flora with probiotics usually gets things back to normal. If the probiotic capsules from the health food store are not enough, then the next step is fecal transplantation. This more drastic measure “transplants” the microbial flora from a normal person into the colon of the recipient. The procedure is done with a large syringe filled with colon contents (fecal material) which is injected into the colon of the recipient. As disgusting as this might sound, it works remarkably well for Clostridia Difficile entero-colitis, used when antibiotics such as Flagyl and Vancomycin are ineffective and stop working. More than 100 US hospitals are offering fecal transplantation for Clostridia difficile. Here is a list of providers and trials. Above left image Electron Microscope view of Clostridia Difficile
Fecal Transplantation for Inflammatory Bowel Disease
Crohn’s Disease: Dr David Suskind at Seattle Children’s Hospital reported success using fecal transplant in ten children with Crohn’s Disease in the first FDA-approved study of its type. Seven of ten actually went into “remission” after the procedure. Left image: Typical apthous ulcers of crohn’s colitis on air contrast barium Xray of colon. Crohn’s usually involves the terminal ileum, yet can also involve the colon as well.
Ulcerative Colitis: Thomas Borody MD reported in 2003 his experience with fecal transplant for Ulcerative Colitis. He concluded the procedure is capable of reversing the ulcerative colitis in “selected patients” (7)
Left image: air contrast barium enema of colon typical findings of ulcerative colitis with granular mucosal pattern.
Fecal Transplant for Autism, Parkinson’s and other Neurological Disease
Lately, fecal transplantation has been proposed as a treatment for many other diseases. For example, there have been case reports with favorable outcomes in autism, “Parkinson’s disease, multiple sclerosis, myoclonus dystonia, chronic fatigue syndrome, and idiopathic thrombocytopenic purpura” (1)
The well known neurologist, Dr David Perlmutter was one of the keynote speakers at the meeting. He presented video clips of remarkable recoveries in two cases after fecal transplantation. The first case was Jason, a 10 year old autistic youngster with documented dysbiosis from frequent bouts of antibiotics. Jason and his mom, Melinda, traveled to Europe for a series of fecal transplants with remarkable recovery.
The second case was a Parkinson’s patient unable to walk because of his neurological disorder After a series of fecal transplants in Europe, his video showed him walking nonchalantly down the hall of his hotel.(2) This certainly got my attention.
One should be cautious and not too hasty in placing too many expectations on a new therapy. Perhaps the field of “targeted” probiotcs and fecal transplantation will prove to be the next great discovery of modern medicine. On the other hand it may not pan out as advertised, in which case, we would be “sh_t out of luck.”
Jeffrey Dach MD
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Links and References
1) Xu, Meng-Que et al. “Fecal Microbiota Transplantation Broadening Its Application beyond Intestinal Disorders.” World Journal of Gastroenterology : WJG 21.1 (2015): 102–111. PMC. Web. 22 May 2015.
Intestinal dysbiosis is now known to be a complication in a myriad of diseases. Fecal microbiota transplantation (FMT), as a microbiota-target therapy, is arguably very effective for curing Clostridium difficile infection and has good outcomes in other intestinal diseases. New insights have raised an interest in FMT for the management of extra-intestinal disorders associated with gut microbiota. This review shows that it is an exciting time in the burgeoning science of FMT application in previously unexpected areas, including metabolic diseases, neuropsychiatric disorders, autoimmune diseases, allergic disorders, and tumors. A randomized controlled trial was conducted on FMT in metabolic syndrome by infusing microbiota from lean donors or from self-collected feces, with the resultant findings showing that the lean donor feces group displayed increased insulin sensitivity, along with increased levels of butyrate-producing intestinal microbiota. Case reports of FMT have also shown favorable outcomes in Parkinson’s disease, multiple sclerosis, myoclonus dystonia, chronic fatigue syndrome, and idiopathic thrombocytopenic purpura. FMT is a promising approach in the manipulation of the intestinal microbiota and has potential applications in a variety of extra-intestinal conditions associated with intestinal dysbiosis.
2) Ananthaswamy, Anil. “Faecal transplant eases symptoms of Parkinson’s disease.” New Scientist 209.2796 (2011): 8-9.
3) Fecal Flora Transplantation February 20, 2011 Jacob Schor ND, FABNO
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