The very thought of receiving a transfusion of someone else’s poop into your body can make you shudder, but stool transplantation has not only helped patients with gastrointestinal tract problems, it has also saved those who have had transplants. of bone marrow.
At the Infectious Diseases Center of Excellence and Department of Hematology, Deenanath Mangeshkar Hospital, Pune, seven out of 11 bone marrow transplant patients developed Clostridium difficile infection. They were treated with fecal microbial transplantation (FMT), also known as stool transplantation, within the past year.
Research around the world has shown that a fecal transplant can restore healthy bacteria in the small intestine that can help control Clostridium difficile, or C. diff. According to the Johns Hopkins University School of Medicine, FMT may be more effective than antibiotics in controlling C. diff in some cases.
“Because C. diff infection can come back and cause colitis (inflammation in the colon), FMT restores good, healthy bacteria,” said Dr. Parikshit Prayag, infectious disease consultant and head of the Center of Excellence for Infectious Diseases at the Deenanath Mangeshkar hospital. .
Dr. Sameer Melinkeri, head of the hospital’s hematology department, said diarrhea related to C. diff infection can occur in a normal setting where antibiotics can be used for treatment. However, antibiotic treatment for recurrent infections may involve one or more courses of medication, and its effectiveness decreases with each subsequent episode. FMT can stop these types of infections after bone marrow transplantation, as it can be life-threatening, he added.
FMT is also done for certain diseases such as graft versus host disease (GVHD). Most people who have a bone marrow transplant have blood cancers. “Graft-versus-host disease can occur at any time after an allogeneic transplant in which the donated bone marrow or peripheral stem cells can attack the recipient’s body. It can develop in the GI tract, the skin, or the liver,” said Dr. Prayag.
Recent research published in the Journal of International Medical Research and others has shown how FMT is a promising treatment for patients with steroid-resistant GvHD. “We have seen clinically relevant results in six of our patients,” said Dr. Prayag.
So who can be donors? They are selected based on certain parameters. They should not be immunocompromised or have taken antibiotics in the past six months, says Dr. Sampada Patwardhan, head of the hospital’s microbiology department. “The selection of donors must be done with care. We need to rule out infections,” he said.
Procedures on transplant delivery methods may vary, such as colonoscopy and use of a nasojejunal tube. Recovery can take a week or more and in most cases there are at least two weekly installs of the stool (in liquid form).
Very few centers perform FMT, and among them, the Deenanath Hospital center actively treats cases related to bone marrow transplants. At a recent virtual meeting of the International Society of Blood Transfusion, Dr. Prayag made a strong case for encouraging stool transplants. “The C. diff condition is also underdiagnosed in the country, as there is no adequate infrastructure to correctly detect the problem,” he noted.
In fact, FMT is promoted as a treatment option for many intestinal health problems. In an opinion piece published June 30 in the journal Trends in Molecular Medicine, a team from Harvard Medical School and Brigham and Women’s Hospital (BWH) propose that people store samples of their own gut microbiota when they’re young and healthy for potential use later. in life in an autologous FMT.
A report in Science Daily quotes corresponding author Yang-Yu Liu, an associate professor of medicine at Harvard and an associate scientist in the Channing Division of Network Medicine at BWH, as saying, “The idea of ’rebuilding’ the human microbiome has taken off in recent years and has been the subject of heated debate from medical, ethical, and evolutionary perspectives. It is still unknown whether people in industrialized societies can derive any health benefit from restoring their microbiome to an ancestral state. In this article, we proposed a way to rejuvenate the human gut microbiome.”
The report also listed OpenBiome, a nonprofit stool bank based in Somerville, Massachusetts, as the first stool bank to offer an option for people to store their own stool for future treatment of C. diff. Yang and his colleagues are now looking at whether this treatment can be used for other diseases.
“Conceptually, the idea of storing feces for autologous FMT is similar to when parents store their baby’s umbilical cord blood for possible future use. However, there is greater potential for stool storage, and we anticipate that the possibility of using stool samples is much greater than for umbilical cord blood. But there are many practical problems in implementing this idea,” Yang is quoted as hinting at optimal storage and cryopreservation issues.