Fecal transplants as standard operating procedure?

I tell my students that humans are essentially a donut.  Around the outside of the donut, we have our wall (skin/epidermis)  which separates the outside and inside. We humans know and expect to find bacteria there. But what people don’t think about  is that the donut hole, or the  tube down the middle of you that connects your mouth to your anus, is essentially outside, meaning it is full of stuff that simply passes through your body as well as a huge number of bacteria. The overall ratio of  bacteria cells  to human cells is about 10 to 1.

These bacteria that are found on our surfaces and in our tube have historically been called  commensal organisms: they benefited from us but did not help their human hosts. But not even Wikipedia calls them that anymore. This is because we now know that these microbes that colonize our skin and donut tube may be essential for human health. We now call them our  “human microbiome“. We are just beginning to understand that an intact microbiome can be as important as your immune system in keeping you healthy.  You can think of our microbiome as the organisms that we are just beginning to understant protect us  in a myriad of ways. One is simple one is to keep bad bacteria from getting established and running amok.

We now are aware that in fighting some deadly bacterial infections, we cause calamities in our microbiome. The antibiotics that are targeting pathogenic bacteria will also act on our essential gut bacteria.  When our microbiome is decimated this opens space for deadly invaders (such as Clostridium difficilealso known as C. diff) to gain a foothold. The problem with C. diff specifically is also that it is also very resistant to antibiotics.

Historically we have treated life threatening C. diff infections with higher and more dangerous levels of antibiotics.  A wonderful new article in the New York Times details the trials and tribulations of a C. diff infection as well as a new and exciting cure for this deadly infection.

Fecal transplants. Wait a minute. This is nothing any different than using a healthy microbiome as therapy/treatment.  Yes, this therapy sounds disgusting, but we now understand that  these bacteria, our microbiome, are fundamentally a PART OF US, an essential component to human health. Transplanting a microbiome is no different than any other form of transplantation where you take healthy tissue from one individual and give it to another. Physicians should stop using fecal and start using a microbiome transplant.

Research detailed in the New England Journal of Medicine describe the amazing results using fecal microbiome transplants. From the NYT article:

(fecal) transplants cured 15 of 16 people who had recurring infections with Clostridium difficile bacteria, whereas antibiotics cured only 3 of 13 and 4 of 13 patients in two comparison groups.

Amazing. 15 of 16. In another part of the NYT article they describe the symptoms of one patient in the study:

Melissa Cabral, 34, of Dighton, Mass., was healthy until she contracted C. difficile in July after taking an antibiotic for dental work. She had profuse diarrhea, uncontrollable vomiting and high fevers that landed her in the hospital. She suffered repeated bouts, lost 12 pounds and missed months of work. Her young children would find her lying on the bathroom floor.

They treated her without success with antibiotics. Within ONE DAY of a fecal microbiome transplant she was cured. ONE DAY.

The article from the New York Times is wonderful. It describes C. difficile, exactly what a fecal microbiome transplant consists of, as well as lots of fabulous reporting.

We are now essentially entering a new golden age of microbiology. This will show not just how bacteria can cause disease, but how bacteria can make us healthy.  Stay tuned.  This is going to be a wonderful ride.

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