Introducing the first bank of feces

BY Erika Engelhaupt

A new nonprofit called OpenBiome is hoping to do for fecal transplants what blood banks have done for transfusions. It’s a kind of Brown Cross.

And it’s an idea whose time has come. Recent trials testing transplants of fecal microbes from the healthy to the sick have been so promising that people are attempting dangerous do-it-yourself fecal transplants by enema, for lack of access to authorized medical procedures.

Graduate students Carolyn Edelstein and Mark B. Smith got the idea for OpenBiome after a friend had trouble getting a fecal transplant to treat an infection with Clostridium difficile. The bacterium causes dangerous, even fatal, diarrhea and in an increasing number of cases is resistant to antibiotics.

People tend to get C. difficile infections after antibiotics or chemotherapy has knocked out helpful bacteria, allowing what is normally a background player to take over. Transplants of fecal bacteria from healthy donors can help reset the microbiome, the mix of bacteria in the body, and crowd out C. difficile. A 2011 review of 317 patients treated for C. difficile found that fecal transplants cleared up infections in 92 percent of patients. And more recent research showed that taking a round of pills containing bacteria isolated from fecal matter (without the feces itself) resolved C. difficile infections in all of 32 patients treated.

There’s also interest in transplanting healthy fecal microbiomes into people with inflammatory bowel disease or even obesity. In one recent test, mice implanted with fecal microbes from thin humans stayed thin, while mice given bacteria from obese people gained weight.

But the transplants are hard to get. As Edelstein and Smith’s friend learned, the U.S. Food and Drug Administration requires lots of paperwork for the experimental therapy, and donor feces has to be screened for a host of potential pathogens.

That’s where OpenBiome steps in. The nonprofit offers hospitals fecal samples for $250 that have been prescreened to ensure they are free of pathogens and parasites. Since October, they’ve sent more than 100 samples to a dozen hospitals and clinics, according to an interview with Smith in the Chronicle of Higher Education. Edelstein, who’s studying public affairs at Princeton, and Smith, who’s studying microbiology at MIT, recruited friends and donors and negotiated permissions with the FDA to set up the organization, which houses its samples at MIT. OpenBiome is also offering to collaborate with researchers for long-term follow-up on patients’ microbiomes.

Because FDA considers feces to be a drug in the context of transplants, OpenBiome is providing stool only for treatment of C. difficile. People hoping to shift their microbiomes for other purposes are still out of luck. Until more testing and approval comes through, that leaves open the risk that some people may resort to home transplants.

Let me be very clear about this: Whipping up an enema of your friend’s stool is a terrible idea.There are excellent reasons why people normally avoid poop: It can carry pathogens and parasites that cause serious disease. Even a donor who appears perfectly healthy might be carrying around bacteria or viruses that his or her immune system or particular microbiome mix is able to deal with. Your mileage may vary.

Your genetics, your immune system, your diet and environment — all these things create the ecology of your insides, making it hard to predict what your outcome might be. What’s more, you may need to make other medically supervised changes along with the transplant. Research on microbiome links to obesity, for instance, suggests that a new “skinny” microbiome has to be accompanied by a switch to a diet lower in fat and calories, or else the new microbes will just be outcompeted.

These dangers and complicating factors are why a supply of prescreened stool is so important. The procedures need to be done under medical supervision, and when done right the results look really promising. The recently tested pill approach avoids some of the yuck factor of fecal transplants, but most transplants are done via an enema, colonoscopy or nose tube to the gut.

If you get transplant material from OpenBiome, you’ll have to submit to one of the usual transplant methods rather than a pill, but you can rest assured you’re getting high-quality stuff. Not only are the samples screened, the donors are among the best and brightest: a few young researchers and scientists from Harvard and MIT.

Introducing the first bank of feces

Thanks to Jody Troupe for bringing this to the attention of the It’s Interesting community.

Fecal transplant cures woman’s bacterial infection

After surviving a near-fatal car accident, Kaitlin Hunter found herself battling a devastating bacterial infection in her colon that also threatened her life.

The persistent infection was beaten through a little-known technique involving the transplant of fecal matter from Hunter’s mother, which put healthy bacteria back into her colon.

Following the July procedure, “I’ve been so happy,” said Hunter, 20, of Marietta, Georgia. “I’m cured.”

Her struggle began more than a year earlier when she was released from a hospital in Sacramento, California.

A June 2011 car accident fractured her lower spine, lacerated her liver and colon, and broke all 10 toes. Emergency crews used the Jaws of Life to cut Hunter from her dad’s car, and then she was flown to the hospital, where she spent the next month.

Upon her release, Hunter flew home to Georgia. It hadn’t been the summer vacation she imagined, but she thought she was getting better.

But “right when I got off the plane, I went to the hospital. I was having extremely bad stomach pain. A month later, we found out it was C. diff,” Hunter said, using the abbreviation for the bacteria clostridium difficile.

How it began

In the hospital after her accident, doctors followed standard care and put Hunter on antibiotics to prevent an infection.

In spite of the antibiotics — or possibly because of them — C. diff infected her colon, causing severe stomach pain, diarrhea and vomiting.

Hunter, who stands 5 feet 7 inches tall, lost 40 pounds during her struggle. Her weight plummeted to 85 pounds.

It’s believed that antibiotics, which kill harmful infection-causing bacteria, also weaken the beneficial, healthy bacteria percolating in the colon. With the colon’s defenses down, C. diff grows rampant, releasing a toxin and inflaming the colon.

C. diff infections kill about 14,000 people in the United States every year, according to the Centers for Disease Control and Prevention, and the number and severity of total cases have increased dramatically over the past decade.

Experts: Alcohol enemas ‘extremely dangerous’

Even though antibiotics put someone at risk of developing a C. diff infection, standard treatment still calls for prescribing more and different antibiotics to kill the C. diff and allow healthy bacteria to recolonize.

But for many people such as Hunter — who went through nine rounds of antibiotic treatments — the healthy bacteria never get the upper hand, and the C. diff just keeps coming back.

‘Brand-new’ treatment

Increasingly, doctors are taking a different approach. Instead of continued assaults on bacteria, “fecal matter transplants” recolonize the colon with new bacteria from a healthy donor.

“This is brand-new for most gastroenterologists,” said Dr. Suku George, Hunter’s treating physician. “We are very excited about this.”

George had never deposited fecal matter by colonoscopy into a patient until Hunter wanted to try it.

Hunter’s mother “donated” one of her stools for the procedure. Next, the hospital lab carefully diluted it, and George pumped the foreign fecal matter right into Hunter’s colon.

The result ended Hunter’s struggle with C. diff.

A study published in March reported a 91% cure rate after just one fecal matter transplant, and a 98% cure rate when combined with an additional round of antibiotics.

Remarkably, that study only included the sickest of patients. All 77 of the study participants already had a recurring C. diff infection, having tried and failed five rounds of antibiotic-only treatments over 11 months, on average.

The study used the colonoscopy method, which many believe is the most effective, because relatively large amounts of fecal matter can be placed deep inside the colon.

Other methods use either an enema or a nasogastric tube, which sends fecal matter through the nasal passage, down the throat and into the stomach.

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George tried the nasogastric tube on Hunter, using fecal material from her father, but the C. diff infection returned. He then asked for and received permission to perform the hospital’s first colonoscopic fecal transplant.

Looking ahead

Gastroenterologists pioneering the practice unanimously seem to agree that eventually a cleaner, commercially developed suppository will replace the crude feces and water mixtures currently in use.

“It’ll become a little more acceptable to hospitals and patients and more widely performed,” said Dr. Lawrence Brandt, a professor of medicine and surgery at New York’s Albert Einstein College of Medicine who was the lead author on the March study.”But for people that have recurring C. diff, it doesn’t really much matter, because these patients are so ill and so much want to get better. The fact that it’s stool, it doesn’t matter to them.”

To enroll in a fecal transplant study, visit clinicaltrials.gov.

Thanks to the future Dr. Goldman for bringing this to the attention of the It’s Interesting community.