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.

Outlines

00:00

🌿 The Ancient Secret of Ge Hong's Feces-Based Remedy and Modern Fecal Transplants

This paragraph delves into the historical use of feces in medicine by Chinese alchemist Ge Hong, who used a secret ingredient in his healing soup. It transitions to the modern application of fecal matter in fecal microbial transplantation (FMT), a treatment that introduces healthy gut bacteria to patients to restore balance in the gut microbiome. The paragraph explains the importance of the gut microbiome, its role in human health, and how disruptions can lead to various health issues. It also discusses the current experimental status of FMT, primarily used for treating Clostridiodes difficile infections, and touches on the rigorous donor screening process. The effectiveness of FMT is highlighted, with an 80% success rate in curing patients after a single treatment.

05:03

🔬 The Promising Future of Fecal Microbiota in Medicine

The second paragraph looks forward to the potential future uses of fecal microbiota in medicine. It suggests that beyond its current application in treating gut infections, fecal transplants might be used to address a broader range of health conditions, including type 2 diabetes, anxiety, depression, and possibly other disorders linked to the gut microbiome. The paragraph concludes by acknowledging the ongoing research and the need to further understand the 'best' gut microbiome composition for optimal health benefits.

Keywords

💡Alchemist

An alchemist is a person who practices alchemy, an ancient branch of chemistry that sought to transform base metals into gold and discover the elixir of life. In the context of the video, Ge Hong is described as an alchemist known for his special soup, which is a historical reference that sets the stage for the discussion of fecal matter's surprising medical applications.

💡Gut Microbiome

The gut microbiome refers to the complex community of trillions of microorganisms, including bacteria, viruses, fungi, and archaea, that live in the human gastrointestinal tract. The video emphasizes the importance of the gut microbiome for human health, as these microbes are essential for processes like breaking down food, producing vitamins, and training the immune system.

💡Fecal Microbial Transplantation (FMT)

Fecal Microbial Transplantation is a medical procedure that involves transferring fecal matter from a healthy individual to a recipient to restore a healthy balance of gut bacteria. The video discusses FMT as a novel treatment that can help reset the gut microbiome and treat conditions like Clostridiodes difficile infections.

💡Clostridiodes difficile

Clostridiodes difficile, also known as C. diff, is a bacterium that can cause severe diarrhea and more serious intestinal conditions, especially in people who have taken antibiotics. The video mentions it as a target for fecal transplants, highlighting its antibiotic resistance and the effectiveness of FMT in treating related infections.

💡Gastroenterologist

A gastroenterologist is a medical specialist who deals with disorders of the gastrointestinal tract. In the video, a gastroenterologist is responsible for performing fecal microbial transplants, retrieving fecal samples from a stool bank, and administering them to patients via pills or tubes.

💡Stool Bank

A stool bank is a repository for screened and tested fecal matter used for fecal microbial transplantation. The video describes the rigorous selection process for donors, emphasizing the importance of ensuring the samples are free from infections and other contaminants.

💡Infectious Diarrhea

Infectious diarrhea is a condition characterized by frequent loose bowel movements caused by an infection, often bacterial or viral. The video discusses how a disturbed gut microbiome can lead to such infections and how fecal transplants can be used as a treatment to restore balance and health.

💡Insulin Resistance

Insulin resistance is a condition in which the body's cells do not respond properly to the hormone insulin, leading to high blood sugar levels and potentially type 2 diabetes. The video suggests that fecal transplants from non-diabetic mice have been shown to improve insulin resistance in mice with type 2 diabetes, indicating potential therapeutic applications for FMT.

💡Psychiatric Disorders

Psychiatric disorders are a broad range of mental health conditions that affect a person's mood, thinking, and behavior. The video mentions that scientists are finding different microbial patterns associated with psychiatric disorders, suggesting that the gut microbiome may play a role in mental health and that fecal transplants could potentially be used as a treatment.

💡Autoimmune Disorders

Autoimmune disorders occur when the immune system mistakenly attacks the body's own cells. The video implies a connection between the gut microbiome and autoimmune conditions, hinting at the possibility that fecal microbial transplantation might offer new avenues for treating such disorders by altering the microbiome.

💡Oncologic

Oncologic refers to the study and treatment of tumors and cancer. The video suggests that there are different microbial patterns associated with oncologic conditions, indicating that the gut microbiome may have implications for cancer research and treatment, and that fecal transplants could potentially play a role in this area.

Highlights

Ge Hong, a Chinese alchemist 1,700 years ago, was known for a special soup that could cure diarrhea.

The secret ingredient of Ge Hong's soup was derived from feces.

Modern research suggests that introducing feces into the body might have health benefits.

Fecal microbial transplantation is a treatment that leverages gut microbiome.

The gut microbiome is composed of trillions of bacteria, viruses, fungi, and archaea.

Microbes in the gut microbiome are essential for human life, aiding in digestion, vitamin production, immune system training, and protection from infections.

Microbiomes may begin forming in the womb or during birth, influenced by the mother's fecal matter.

A diverse microbiome is crucial for gut health and can be affected by nutrition, chronic disease, and antibiotics.

Fecal microbial transplants can help reset the gut microbiome by introducing new microorganisms.

The FDA currently allows fecal transplants experimentally for treating Clostridiodes difficile infections.

Clostridiodes difficile is an antibiotic-resistant bacterium that forms spores in the colon.

Fecal microbial transplants have an over 80% success rate in curing patients with Clostridiodes difficile in a single treatment.

The FDA classifies fecal transplants as experimental due to the uniqueness of each stool sample.

Rodent research suggests fecal transplants could be used to treat conditions like type 2 diabetes and mental health disorders.

Human studies are finding microbial patterns associated with various disorders, indicating potential for fecal bacteriotherapy.

The 'best' gut microbiome and most beneficial fecal transplants are still subjects of ongoing research.

Feces have a promising future in medicine, particularly in fecal microbial transplantation.

Transcripts

1,700 years ago, a Chinese alchemist named Ge Hong

was renowned for his special soup that could cure diarrhea-stricken patients.

The stew was deep yellow, and had an intense aroma.

And, like many family recipes, it had a secret ingredient.

But in this case, that ingredient didn’t come from the kitchen—

it came from the bathroom.

It might seem unwise to consume feces,

and today, there aren’t many doctors who would prescribe Ge Hong’s recipe.

However, exciting new research suggests that taking poop into the body

in other ways might benefit our health.

One such treatment is fecal microbial transplantation,

and the secret to how it works lives in your gut.

Trillions and trillions of bacteria, viruses, fungi, and archaea

consider your bowels their home.

Collectively, these microbes make up what’s known as your gut microbiome,

and each of these organisms possesses dynamic, specialized abilities

that seem to be essential for human life.

They break down our food, make vitamins,

train our immune system and circadian rhythm,

and even protect us from infections.

In return, they receive a nice warm place to live,

complete with an all-you-can-eat buffet.

Some research suggests our microbiomes might start forming in the womb,

but if not, they certainly get started when we're born.

During a vaginal birth, infants take in some of their mother’s fecal matter

and microbe-filled fluids.

From then on, our microbiomes are constantly diversifying

with exposure to various foods and environments.

This is essential for maintaining gut health.

If poor nutrition, chronic disease or antibiotics disturb this delicate balance,

the body can become vulnerable to problems

like bacteria and fungal overgrowth or infectious diarrhea.

But infusing a new batch of microorganisms into the intestine

seems to help reset the gut microbiome—

this is where fecal microbial transplants come into play.

This line of treatment is still very new,

and there are tons of unanswered questions about how it works.

So currently, the US Food and Drug Administration only allows doctors

to use fecal transplants experimentally

for battling one of the toughest gut infections—

antibiotic-resistant Clostridiodes difficile.

This infectious bacterium forms spores in the colon that are immune to antibiotics

and very difficult to destroy.

Patients dealing with this infection can experience months of intermittent fevers

alongside bouts of abdominal cramping and extreme diarrhea

despite antibiotic treatment.

So when symptoms get this bad, it’s time for a fecal microbial transplant.

To start the process,

a gastroenterologist first retrieves some feces,

typically from a stool bank.

These frozen samples are particularly impressive number twos—

the selected donors go through a strict process

to ensure their samples are infection-free.

In fact, these protective protocols are so stringent,

one prominent stool bank’s acceptance rate is less than 3%.

Next, the gastroenterologist gets that sample inside the patient via a pill,

or, more commonly, a tube into the stomach or colon.

Finally, the transplanted microbes migrate through the tract

until they find the colon,

where they quickly multiply and displace the infectious invader.

This process is so effective that it cures over 80% of patients

in just one treatment.

Because each stool sample is unique,

the FDA still classifies fecal transplants as an experimental treatment

rather than a formal medication.

But promising research in rodents suggests new ways

we might use fecal bacteriotherapy in the future.

For example, fecal transplants from non-diabetic mice

improved insulin resistance in mice with type 2 diabetes.

Similarly, some studies have shown mice exhibiting anxiety and depression

become calmer after transplants from their less anxious peers.

Scientists studying humans have even started finding

different microbial patterns

associated with various intestinal, autoimmune, oncologic,

and even psychiatric disorders.

So, it seems entirely possible that altering a patient’s microbiome

could allow for multiple new modes of treatment.

We still have a lot to learn about what makes the “best” gut microbiome,

or the most beneficial fecal transplants.

But for now, at least we can say that our feces have a bright future.