Faecal transplant, the future is self-production?

The thought of transplanting another person’s stool into their own colon can understandably seem unpleasant. Stool is a foul-smelling mixture of water, undigested food, live and dead bacteria, cells, and other substances. However, live bacteria present in feces have been shown to be useful for treating diseases and disorders of the digestive system. For this reason, for years, doctors have been transferring the feces of healthy donors to sick patientsusually via colonoscopy, enema, or pill, to restore gut health.

The concept is relatively simple: the “good” bacteria in transplanted stools will colonize a patient’s gut with an unbalanced microbiota, killing the bacteria that cause problems. Healthy fecal bacteria can for example be used to treat infection caused by the bacterium clostridioides difficile, which can infect the human colon and cause mild to life-threatening diarrhea. Clinical studies estimate that fecal microbiota transplants have aefficacy greater than ninety percent in eliminating infections from clostridioides difficile. Last month some Norwegian researchers they wrote in the magazine Gastroenterology that patients with irritable bowel syndrome who have undergone a fecal transplant suffer to a lesser extent from bloating, stomach cramps and constipation, even three years after surgery.

According to David Ong, a gastroenterologist at Mount Elizabeth Hospital in Singapore, these treatments have a even greater potential, since intestinal microbes are able to interact with our brain and other organs. Ong, who in 2014 was the first Singapore doctor to perform a fecal transplant on a patient with a clostridioides difficilereports how recent studies suggest the procedure could also help people with inflammatory bowel disease, obesity, or ailments of the autism spectrum with intestinal problems. They are currently underway more than 100 clinical studies examining the effect of fecal transplants on ranging pathologies from depression to epilepsy, passing through COVID-19 and tumors.

“Genes are something you are born with and cannot be changed – explains Ong -. But the intestinal microbiota can be manipulated. And if you can manipulate it to get a positive result for a disease, that’s great“.

The difficult search for donors

However, there is a small problem: finding the right donor. In addition to working as a gastroenterologist, the NGO co-founded the startup Amili, which hosts what is currently the only fecal transplant bank in Southeast Asia. Although in the last three years Amili has collected more than a thousand stool samples, most potential donors are excluded after filling out a questionnaire and an analysis of stool, blood and saliva.

Lifestyle, diet, medical history – which includes the use of antibiotics which can kill intestinal bacteria – and even the way you were born are all factors that can lead to the exclusion of candidates (vaginally delivered infants collect the first intestinal bacteria from the mother as they pass through the vaginal canal, reporting greater microbial diversity compared to babies born with a caesarean section). In the Norwegian study, stool samples used to treat 87 patients with irritable bowel syndrome came from a single donor: a 36-year-old vaginally born, breast-fed, non-smoker, who had used limited use of antibiotics. and exercised regularly, and on a diet rich in protein, fiber, minerals, and vitamins. Typically, once a donor is deemed healthy enough, lab technicians examine their stool sample for different microbiota and, in particular, bacteria that counteract the harmful ones.