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reference
Grehan MJ, Borody TJ, Leis SM, Campbell J, Mitchell H, Wettstein A. Permanent alteration of gut microbiota by administration of donor stool flora.J Clin Gastroenterol.2010;44(8):551-561.
Participant
Ten patients undergoing “fecal bacteriotherapy,” often referred to as “fecal transplantation” in the United States. The intestines are cleaned with antibiotics and then stool suspensions from healthy donors are administered daily. In this study, the first infusion was administered via colonoscopy and subsequent doses were administered over a 60-minute period via a nasal jejunal tube or via enemas. Intestinal flora was analyzed 4, 8, and 24 weeks after the first infusion and compared to the donor's originally infused stool suspension to determine whether the donor flora had developed into a stable stool microbiota.
Key findings
At each post-infusion interval at which the samples were evaluated, "the bacterial populations in the patients' stool samples consisted predominantly of bacteria derived from samples from healthy donors." “This is a groundbreaking study and suggests that manipulating the colon microbiota is effective and holds promise for new therapies in the treatment of colon or metabolic diseases.”1
A fecal transplant is nothing new. Case reports describing this technique date back to at least the late 1950s. A report published in 1958 by Eiseman et al. is considered the first to describe the use of fecal enemas, in this case for the treatment of pseudomembranous enterocolitis.2
This is a groundbreaking study and suggests that manipulating the colon microbiota is effective and holds promise for new therapies in the treatment of colon or metabolic diseases.
Since then, there have been a number of reports of the use of donor stool administered both rectally and through a nasogastric tube.3,4,5,6,7,8Most of these reports focus on the treatment of recalcitrant patientsClostridium difficileInfection.
Two other reports on fecal transplants were published in the same September issue of theJournal of Clinical Gastroenterologylike the study by Grehan et al. They are of almost equal importance to Grehan's study and deserve special mention.
In a report, Yoon et al. from Montefiore Medical Center in the Bronx reported 12 cases ofC. difficilesuccessfully treated with donor feces transplanted into the colon through colonoscopy.9The second work by Rohlke et al. again reports on 19 patientsC. difficiletreated with a fecal transplant performed via colonoscopes. Treatment was successful in all 19 treated patients and patients remained disease-free after a follow-up period of 6 months to 4 years.10
This therapy may be useful in treating other types of diseases other than gastroenteritis.
Borody et al. reported remarkable results in a small trial of ulcerative colitis (UC) treatment with fecal transplant therapy in 2003. They treated 6 patients with “severe, recurrent symptoms in whom UC was confirmed by colonoscopy and histology.” Using “retention enemas…repeated daily for 5 days, complete reversal of symptoms was achieved in all patients by 4 months…at which point all other UC medications had been discontinued.” From 1 to 13 years of age…there was no clinical, colonoscopic, or histologic evidence of UC in any patient.”11
Borody is currently recruiting participants for a study using fecal transplants to treat Parkinson's patients.12
At a conference in September 2010, Anne Vrieze and colleagues described results after transplanting stool flora from lean donors into patients with metabolic syndrome. Their study was a double-blind, randomized, controlled trial. Starting with 18 male subjects with newly diagnosed metabolic syndrome, half received stool material from lean male donors and the other half had their own stool implanted as a control. At the end of the study, fasting triglyceride levels were significantly reduced in the subjects who received donor feces. No effect was observed in the control group, which was again given their own feces. Peripheral and hepatic insulin sensitivity improved significantly after 6 weeks in the experimental group, but not in the control group.13
Current evidence suggests that the intestinal community of bacterial flora contains at least 1 x 1014Bacteria, which consists of 500 to 1,000 different species of anaerobic bacteria.14Obviously, our current methodology of testing these using agar culture media to identify only a handful of species and treating with multiple limited strains of “probiotics” may be too simple an approach to provide lasting benefit. Although fecal transplantation sounds primitive, it may actually be a more sophisticated option and offer the ability to recreate a healthy intestinal ecosystem in diseased patients. As unappealing as it may sound, it could prove to be a useful therapy in the years to come.