What is a fecal microbial transplant? - Kathryn M. Stephenson and David L. Suskind

Summary

The script narrates the historical and modern significance of fecal matter in medicine, highlighting the ancient Chinese alchemist Ge Hong's use of it in a healing soup. It delves into the role of the gut microbiome in human health, emphasizing its impact on digestion, immunity, and disease resistance. The script particularly focuses on fecal microbial transplantation (FMT) as a cutting-edge treatment for antibiotic-resistant C. difficile infections, detailing the process from donor selection to treatment efficacy. It also speculates on future applications of FMT in treating conditions like type 2 diabetes and mental health disorders, underscoring the potential of fecal matter in revolutionizing healthcare.

Takeaways

• 🧪 Ge Hong, a Chinese alchemist 1,700 years ago, was known for a special soup with a secret ingredient derived from feces, which was used to cure diarrhea.
• 🌐 Modern research indicates that introducing feces into the body, through methods like fecal microbial transplantation (FMT), can have health benefits.
• 🌟 The human gut is home to trillions of microbes, including bacteria, viruses, fungi, and archaea, which form the gut microbiome and are essential for human health.
• 🍽️ Gut microbiomes play a crucial role in breaking down food, producing vitamins, training the immune system, and protecting against infections.
• 👶 Microbiomes begin to form during birth, especially through exposure to the mother's fecal matter during vaginal delivery, and continue to diversify with diet and environment.
• 🚫 Disruptions to the gut microbiome due to poor nutrition, chronic disease, or antibiotics can lead to health issues like bacterial overgrowth or infectious diarrhea.
• 💉 Fecal microbial transplants are a treatment method that introduces new microorganisms to reset the gut microbiome, currently used experimentally for treating Clostridiodes difficile infections.
• 🏥 The FDA classifies fecal transplants as experimental and only allows their use for treating antibiotic-resistant C. difficile under strict protocols.
• 🐁 Animal studies suggest potential future uses of fecal transplants, such as improving insulin resistance in type 2 diabetes and reducing anxiety and depression.
• 🔬 Scientists are discovering different microbial patterns associated with a variety of disorders, indicating that altering the microbiome could lead to new treatment methods.

Q & A

Who was Ge Hong and what was his contribution to medicine?

Ge Hong was a Chinese alchemist from 1,700 years ago, renowned for his special soup that could cure diarrhea-stricken patients. His recipe included a secret ingredient derived from feces, which was unconventional but showed early insight into the potential health benefits of certain fecal matter.

What is a gut microbiome and why is it important?

The gut microbiome is a collection of trillions of bacteria, viruses, fungi, and archaea that reside in the human bowels. It plays a crucial role in human health by breaking down food, producing vitamins, training the immune system, regulating circadian rhythms, and protecting against infections.

How do infants initially acquire their microbiomes?

Infants typically acquire their initial microbiomes during vaginal birth by taking in some of their mother's fecal matter and microbe-filled fluids. This exposure begins the formation of their gut microbiome.

What can disrupt the balance of the gut microbiome?

The balance of the gut microbiome can be disrupted by poor nutrition, chronic disease, or the use of antibiotics, which can lead to issues such as bacterial and fungal overgrowth or infectious diarrhea.

What is fecal microbial transplantation and how does it work?

Fecal microbial transplantation is a treatment that involves infusing a new batch of microorganisms into the intestine to help reset the gut microbiome. It is done by transplanting fecal matter from a healthy donor into a patient's colon, where the new microbes multiply and displace harmful bacteria.

Why is fecal microbial transplantation currently used experimentally by the FDA?

The FDA currently allows fecal microbial transplantation to be used experimentally because it is a relatively new treatment with many unanswered questions about its mechanisms. It is primarily used to treat antibiotic-resistant Clostridiodes difficile infections.

What is the process of performing a fecal microbial transplant?

The process involves a gastroenterologist retrieving fecal matter from a stool bank, ensuring the sample is infection-free. The sample is then administered to the patient, typically via a pill or a tube into the stomach or colon, allowing the microbes to migrate to the colon and multiply.

What is the success rate of fecal microbial transplants in treating Clostridiodes difficile infections?

Fecal microbial transplants have a high success rate, curing over 80% of patients with Clostridiodes difficile infections in just one treatment.

How are stool donors selected for fecal microbial transplantation?

Stool donors are selected through a strict process to ensure their samples are infection-free. The protocols are so stringent that some stool banks have an acceptance rate of less than 3%.

What are some potential future applications of fecal bacteriotherapy based on current research?

Promising research suggests that fecal bacteriotherapy might be used in the future to treat conditions such as type 2 diabetes, anxiety, depression, and various intestinal, autoimmune, oncologic, and psychiatric disorders by altering a patient's microbiome.

What is the current understanding of the 'best' gut microbiome for health?

The understanding of the 'best' gut microbiome is still evolving. While research is ongoing, it is known that a diverse and balanced microbiome is essential for maintaining gut health, and fecal transplants are being studied for their potential to provide such balance.