Fecal Transplantation

[TooManyHats]

I've been reading the debate going on concerning the existence vs nonexistence of autoimmune disease and the over vs under active immune response causing MC with interest. I wonder what you all think about the concept of fecal transplantation? I'm aware that the recent coverage has been surrounding fecal transplantation for treatment of C-diff, but consider this:

Further development of clinical microbial transplantation programs can create new opportunities to address important questions central to mucosal immunology and clinical medicine. We can see some of these opportunities potentially arising from our current work with recurrent CDI. Patients with inflammatory bowel disease are at increased risk for contracting CDI.25 So far, among our refractory CDI patients, there seems to be an increased prevalence of patients with Crohn's disease and microscopic colitis. This opens the door to numerous questions, including: Could fecal transplantation have an impact on its underlying inflammatory bowel disease? What will be the fate of the new microbiota over the long term? How do the new microbiota affect overall health and weight gain? Will the composition evolve differently from that seen in patients without discernible underlying intestinal inflammation? Investigating complex patients such as these could provide some interesting pilot data.

A more direct approach to test the therapeutic potential of fecal transplantation for some diseases may also be justifiable, and accompanied by basic investigations. In 1989, Bennet and Brinkman26 described a case report of the successful treatment of refractory ulcerative colitis by fecal bacteriotherapy following antibiotic “sterilization.” Borody et al. published a case series of six patients with refractory ulcerative colitis who have apparently achieved complete (clinical and histological), medication-free, remission using a similar procedure. No disease recurrence was noted in 1–13 years of follow-up.27 However, no follow-up controlled trials have yet emerged, and similar to fulminant CDI, the standard care for refractory ulcerative colitis remains surgical removal of the colon. Nevertheless, replacement of the host's intestinal microbiota by fecal transplantation following deliberate antibiotic treatment and durable persistence of donor bacteria for up to 24 weeks has recently been documented.28 This provides evidence for the plausibility of using this therapeutic approach for conditions that may be caused by the pathogenic microbiota.

Here is the link for the full text:

http://www.nature.com/mi/journal/v4/n1/ ... 1079a.html

[tex]

Personally, I think it's nasty, , but it's probably the future of IBD treatment. I would certainly endorse trying it before considering any of the "Big Gun" immune system suppressants, and definitely before considering surgical intervention.

Thanks for the link. I hadn't seen that one yet.

Tex

[TooManyHats]

Nasty? For sure, but so was/is the result of a MC flare. LOL!

But this does support your theory that MC may be caused by an undetected/undiscovered infection. No? Or did I get that wrong in my reading? Anything's possible with all that I've read over the last few days.

I'd definitely go for this, and WAY before any bowel resection. I spent a year on prednisone as a child and will do anything else before doing that again. The trick would be to get some pioneer GI to try it. I do wonder how long it will take for this to become more mainstream. It does satisfy the doc's desire to DO something.

[Polly]

Arlene,

Thank you for bringing up this topic. I believe that this is an exploding area of research and critical to unlocking the mysteries of MC and other IBDs. Just for fun, check out "gut flora" in wikipedia. It has an extensive discussion of all of the lastest findings.

Gut flora, from birth on, have a HUGE role in regulating the immune system. And when they are disturbed, which is the hallmark of MC, serious consequences occur. It appears that once enough of our originally programmed gut flora are killed off (by antibiotics, for example), it is impossible to ever recover that balance. Probiotics work, but only for a short time - you have to keep taking them forever. But human-to-human fecal transplantation apprears to restore that all-important "branded" bacteria that we get at birth from our moms, that is able to perform indefinitely in the gut without constant replacement like probiotics.

I would definitely consider this treatment personally. I have long believed that gut bacterial imbalance and damage are major features of my MC.

Hugs,

Polly

[tex]

But this does support your theory that MC may be caused by an undetected/undiscovered infection. No? Or did I get that wrong in my reading?

Yes, I agree with you that this concept supports my position that an overactive immune system is not the reason why IBDs, (and other autoimmune diseases), occur. It provides a legitimate explanation for the reason behind the adverse reactions that are involved. IOW, if the intestinal microbial profile/balance is altered to a sufficient degree, from it's original state, then it can be said that it no longer constitutes "self", so it no longer retains immunity from immune system attacks.

Of course, proponents of the overactive immune system theory might argue that the body should accept/tolerate/recognize any form of non-hostile microbiota as "self", but obviously, there's no logical reason why that should be true. The bottom line is, antibiotics are a very dangerous tool for intestinal homeostasis, and I suggest that medical science needs to develop a process whereby, very early in life, say, before the age of 3, (but maybe it needs to be done earlier than that ), a representative sample of one's microbiota should be preserved, in anticipation of the date when an antibiotic might be needed, because of some life-threatening health issue. It would constitute the perfect, customized probiotic, (which is the only type of probiotic with any real value).

Tex

[Polly]

Tex,

Great idea about saving infant gut flora! We already save (umbilical) cord blood on many infants, which can be lifesaving later if the child develops certain blood diseases. I would guess that it would have to be obtained long before age 3, though, since infants are routinely given antibiotics for infections, especially ear infections. And antibiotics could alter the flora, of course. Did you the see the recent study showing that infants given antibiotics before 6 mo. of age had a much greater chance of developing later allergies, even as early as age 1? I'll bet this applies to the eventual development of IBDs, too.

Love,

Polly

P.S. Maybe you should start this business? We could have fun coming up with names and logos for you!

[tex]

Polly,

Timing is the big question in my mind. What is an optimum time? Immediately after birth, the bacteria profile will be much more limited than it will be after enough time has passed to allow the introduction of solid foods, and exposure to additional bacteria, which will "individualize" the microbiota mix, (or at least, that's what I would expect). Or do we have a sufficiently broad mix of bacteria at birth?

Yes, I believe I saw a report on that study, and I certainly agree that once an antibiotic is used, all bets are off.

I think it's a viable idea, but it's a little out of my area of expertise, (to say the least). You, on the other hand, are as eminently qualified to do this as anyone in the world. Go for it.

Love,
Tex

[Polly]

How about Coprophagia, Inc. for a company name?? LOL!

[tex]

Catchy, (and certainly descriptive), but will it appeal to clients?

[TooManyHats]

Thinking about how long it might take for this to become a mainstream treatment, C-diff is considered a hospital-acquired infection (HAI). I know that the hospital I work for is no longer reimbursed by Medicare or Medicaid for treatment of a HAI. We are struggling financially because of this. This issue alone may force institutions to perform this treatment since it's positive outcome far outweighs the current treatment for C-diff. This alone will make it more common place and give the opportunity to GIs to think about patients with other inflammatory bowel diseases. Especially with the fact that there is such a huge overlap between C-diff and MC.

3) Changing Reimbursements for Healthcare Institutions
a) Medicare/Medicaid along with most healthcare providers will no longer reimburse
hospitals for many secondary diagnoses (ie. no reimbursement for condition not
present on admission). This will include many hospital acquired infections.
b) Final rule will expose hospitals to substantially higher costs associated with HAIs
without the possibility of reimbursement

This was quoted from a paper dated 2009, and is already in practice. http://www.trcsolutions.com/Documents/W ... _Paper.pdf

Just my thoughts. This is very promising for IBD and I look forward to a day when a better solution than diet/medication alone is available, especially for refractory cases. Perhaps it won't take a year or more to heal the colon, another very positive outcome.

[Rosie]

I just noticed an excellent article on fecal transplants at the on-line magazine Slate. I follow Slate regularly, but I don't know how popular it is, or if anyone else here reads it. At any rate, it provides a nice overview of the research to date, mentions that it's hard to get funding because it won't make the drug companies any money, and talks about a (hopefully) upcoming study. It also describes a "do-it-yourself" method for anyone brave enough to try. It has the cutesy name "The Enema of your Enemy is Your Friend".

http://www.slate.com/id/2282768/

Rosalyn

[TooManyHats]

While drug companies may not profit from it, hospitals are loosing their shirts because of the obligation to provide care for HAIs without reimbursement. As it was explained to me by my boss, the hospital is OBLIGATED to provide care and at the same time they will NOT be reimbursed for that care by Medicare or Medicaid. And once Medicare or Medicaid put a policy into place, other insurance companies are usually not far behind them. There may be some push and pull over this, but in the end it will become an accepted practice out of sheer necessity of the hospitals to plug the drain on the costs associated with c-diff.

[Mags]

So[i] that's [/i]why they said my c. diff was caused by me taking antibiotics for sinus infections.....

BTW, I think Coprophagia is brilliant!!!!

Mags

[Gayle]

Coprophagia, Inc. – VERY apt name for such an operation... GOOD ONE Polly!

Actually, I have known a few folks with dogs that are coropohagic, an ‘icky’ little behavior that is anathema to humans.

Why some animals do this is not understood -- although there are several possible explanations -- depending on the species. And for example, a mama dog always cleans her puppies and also cleans their den by eating the pups excrement. That is a normal behavior. There is undoubtedly some kind of feed-back loop effect going on with this behavior, as once pups are weaned off the mama’s lactation, cleaning up after puppies becomes someone else’s job.

If one has a dog that engages in this kind of behavior by either reingesting their own feces, or eating the feces of other animals, the best way to deal with it generally is simply to accompany the animal and pick up deposits immediately -- before their head turns around -- so to speak.

Certainly there have been cases reported where fecal transplant (nice scientific terminology) has been used successfully as something of a last ditch approach in treating persistent and life threatening C-diff infections. Of course, this human treatment would not exactly be conducted by one human eating the stool of another. (IOW -- I would believe that they have developed other and more palatable methods of transfer.)

C-diff has indeed become known as something of a hospital acquired situation. IMHO however, this is something of a mis-directed and/or mis-informed definition, which has come to be accepted (by insurers). BUT due to the fact that almost all patients in hospital today are given antibiotics of some kind -- and due to increased stress of their situation, -- their ability to fight infection in that situation is also dimishied. So YES, that combo of circumstances does lead frequently to acquired C-diff infection. BUT – anyone taking antibiotics, in patient or out patient, or whatever kind of patient, is vulnerable to having the Clostridian difficile organism taking over in their colon and raising a significant ruckus!!!

There has been a new antibiotic in development which is aimed specifically at the C-diff organism. I believe it is in trials now, which of course is the process of trying to gauge it’s effectiveness – in this case as compared to the current, only effective drug against the c-diff organism, which is Vancomycin. And of course also where -- hopefully -- the DEVIL...which IS IN THE DETAILS will be discovered.

What mankind (WE) really need however, is a new paradigm of infection control to replace antibiotic technology. As the newer generation antibiotics become ever stronger, they do carry with them, more and more unwanted consequences. Antibiotic technology is approaching the limits of how many effective and safe alterations can be made by the constant rearranging and rejiggering those molecules -- which is the technique that effects the necessary changes in product when attempting keep up with (or stay ahead of) the ability of bacteria to develop resistance to current drugs.


Cheers,
Gayle

[Mags]

Gayle--

You are so right. Everyone is now at risk of something called CACD, or Community Acquired C. Diff. They don't know if it is a new form, or just a result of so many people with c. diff. infections walking around before being diagnosed. The problem with the little buggers is that they form hard cysts around themselves and can stay dormant for ages, like nasty little time bombs.

Mags