The icky but remarkably effective world of fecal transplants

University of Minnesota post doctorate fellow Matt Hamilton displays a sample of fecal bacteria at the St. Paul, Minn. campus Nov. 14, 2012. The fecal matter is donated and used to treat patients with Clostridium difficile, an intestinal disease that is caused when a person’s gut flora is eliminated by antibiotics.

One person’s poop is another person’s soup

After around 22 months stuck in the womb, you might forgive an infant elephant feeling a little peckish post-delivery.

Mmmm, a nice comforting slurp of mother’s milk perhaps?

Well, no, actually.

In fact an elephant calf’s welcome-to-the-world meal is more likely to consist of a great big scoop of mom’s poop.

You see elephants, along with hippos, koalas and pandas, are born with sterile intestines, and the only way for them to digest vegetation is by getting a bellyful of bacteria, which they do by being fed their mother’s feces, the polite term for which is coprophagia.

As ever, nature is way ahead of us.

Transplanting feces from one creature to another turns out to be an extraordinarily powerful way to restore microbial balance, and it’s precisely what is achieved through a process called fecal microbiota transplantation (FMT), when healthy bacteria from a donor are introduced into the colon of someone who is diseased.

Not to put too fine a point on it, it’s a poop transplant.

And although that probably sounds gross, FMT achieves astonishing results in the treatment of C. difficile, a gut disease affecting almost half a million Americans a year, killing around 15,000.

The usual treatment for C. difficile is with antibiotics, but about one in five patients don’t respond to them.

Remarkably, though, randomized controlled trials of FMT have proved 85% to 90% effective.

If that weren’t enough, it’s not only gut diseases which respond to FMT.

Ongoing research is investigating its use in conditions as varied as autoimmune disorders, obesity, diabetes, Crohn’s disease, multiple sclerosis, and Parkinson’s disease.

The first description of FMT was published in 1958 when a team of Colorado surgeons successfully used it to treat four critically ill patients.

But even these surgeons were beaten to the post by the 16th century Chinese physician Li Shizhen who treated abdominal diseases with brews of fresh, dried, or fermented stool he wisely labelled as “yellow soup” and “golden syrup”.

Clearly a marketing man ahead of his time.

These days there are three main ways to introduce donor fecal matter into a patient.

To put it bluntly, it can go down a tube inserted in the mouth, up the other end via a pipe popped into the colon, or (very new) swallowed in the form of a novel type of capsule, although you’d need to knock back thirty of these to get a single dose, along with a hefty price-tag of over $600.

If this seems steep, however, it’s worth knowing that donor stool needs to be rigorously and expensively screened before transplantation, since the risk of introducing new disease that could make things worse is actually pretty significant.

Clinicians (and the FDA) suggest that donor and patient should be known to one another, or at least to the treating physician. Even so, donors should be scrupulously blood- and stool-tested.

OpenBiome, a Massachusetts-based nonprofit, operates the USA’s first public stool bank. But they don’t take just any old poop.

No sir.

In fact only 3% of prospective donors make it through their screening.

OpenBiome supplies clinicians with frozen ready-to-administer stool samples, mainly for use in treating C. difficile.

Unfortunately, despite its effectiveness – especially for treating C. difficile – FMT is still seen by some clinicians as a controversial alternative, meaning that some patients find it hard to get referred.

So a few literally take matters into their own hands, performing DIY transplants at home.

Although we can’t possibly recommend it, comprehensive instructions are available online, but I do warn you that they’re not for the squeamish, involving kitchen blenders, enema kits, and copious volumes of personal lubricant.

By the way, I love that these directions recommend using a cheap blender, presumably on the grounds that you’re not going to want to use it to whip up a banana smoothie after it’s had number twos in it.

Someone else’s number twos at that.

Seriously, it probably really isn’t wise to consider the DIY route.

Mind you, if you share a bathroom with someone at home, sorry, but you’re probably already ingesting their feces.

The popular TV show Mythbusters proved that toothbrushes kept for a month in the vicinity of a toilet got regularly bathed in an aerosol of tiny contaminated water droplets whenever it was flushed, a microbiologist confirming that the brushes’ bristles did indeed harbor fecal matter.

Not enough for a transplant, perhaps, but still hard to swallow.

Have a great week!
Alexandra
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Alexandra Carmichael
Director of Product, Community, and Growth
uBiome

The icky but remarkably effective world of fecal transplants

One person’s poop is another person’s soup

Further reading