Warning – may contain offensive ideas
Poo Transplants – or Faecal Microbial Transplants (FMT) as they are more politely known
The revival of an ancient therapy:
As is often the case, the Chinese got there first; the earliest documented evidence of using human faecal therapy comes from a 4th Century Chinese handbook of emergency medicine. According to this book a ‘yellow soup’ was used to treat patients with food poisoning or severe diarrhoea. The ‘yellow soup’ was in fact a human faecal suspension, which apparently produced miraculous results by bringing patients back from the brink of death, (the term ‘yellow soup’ was used to conceal the origins of the treatment).
A thousand years later, in the 16th century ‘Compendium of Materia Medica’ a certain Li Shizhen describes the use of an assortment of faecal concoctions: fermented faecal solution, fresh faecal suspension, dry faeces or infant faeces for the treatment of abdominal diseases with severe diarrhoea, fever, pain, vomiting and constipation; these treatments also turned out to be very effective.
And then in 17th century Italy, an anatomist by the name of Fabricius Aquapendente, used FMT in veterinary medicine.
Fast-forward to the 20th century
The big re-discovery of FMT for c.difficile infections (CDI)
The first published Western use of FMT was by Eiseman in 1958 when it was successfully used for the treatment of pseudomembranous colitis. This success prompted clinicians in the 1980’s to try FMT on patients with chronic relapsing c.difficile diarrhoea; these small trials achieved dramatic 90% cure rates with the first treatment, and 98% after a second treatment.
It may not be long before FMT are a standard form of treatment for recurrent CDI.
(Recent studies on mice have shown that antibiotic damage to the gut microbiota permits invasion via lowered colonisation resistance).
And because of the high cure rate of FMT in recurrent CDI, there has been considerable interest in the use of FMT in other dysbiosis-associated conditions such as inflammatory bowel disease, irritable bowel syndrome, obesity and diabetes, as well as in extra-intestinal dysbiotic conditions such as chronic fatigue syndrome, idiopathic thrombocytopenic purpura, and MS.
Although, if FMT do become a standard form of treatment, it will be tough to convince patients to get past the ‘yuck factor’!
A bit more on the power of poo
The possibility of extricating particular bacterial strains that can be used in the treatment of dysbiosis related diseases is on the horizon.
Treatments could ultimately shape the microbiota to be more in keeping with that of lean and healthy individuals – ‘poo-pills’ from a Boston Biotechnology company have entered clinical trials; they aim to treat disease with live faecal microbes – enter ecobiotics!
Glossary
Dysbiosis = Imbalance of microbes (usually within the gut)