Tuesday, 25 October 2011

Bacterial transplantation: undesirable but effective

We have a term common to certain parts of the UK: 'where there's muck, there's brass'. The more usual interpretation of this phrase is that where there is a dirty job to be done, so there is money to be made. In the case of this post on probably the most undesirable therapy ever, bacterial transplantation, money might be replaced with health.

The paper in question is this review by Ethan Gough and colleagues* (available full-text not anymore). I'm not going to go through the whole paper because it is was free to view to everyone. The bottom line is that following the identification of various literature on other-person derived stool infusions, 27 reports fulfilled author criteria for review, of which over 90% of patients reported on showed 'resolution' of their problems of Clostridia difficile infection or pseudomembranous colitis following a bacterial transplant. Perhaps more importantly, the reported rate of side-effects including the ultimate side-effect of death, whilst present, could not be directly attributed to the transplant but rather the disease transplant was attempting to treat.

I note the authors also discuss the likelihood that bacterial transplantation might also be useful for other bowel-related conditions including inflammatory bowel disease and irritable bowel syndrome (although I offer no endorsement for anything on this blog).

Despite the subject matter, I have to say that I am interested in the combined results of bacterial therapy. There are lots of questions to answer about the hows and whys of this method and importantly, what are we transplanting aside from bacteria, the gut virome for example? Assuming that gut bacteria or pathogens affecting gut health are non-responsive to more traditional anti-microbial forms of treatment, and looking at the success rates included in this review, I wonder also how many GI-related conditions might benefit from such an intervention. Extending GI disease to cover other conditions as a comorbidity also, such as autism and the bacterial work being done there or even Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), does this mean we should be looking at this measure a little more closely rather than just squinting our eyes in disgust?

* Gough E. et al. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infect Dis. August 2011.
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5 comments:

  1. Matt25 October 2011 at 18:46

    Paul,
    I have had Ulcerative colitis since 2001. I have used Bacteriotherapy to treat my colitis, with good success. I also know that Dr. Borody in Sydney has been doing these for almost 10 years to treat colitis. The results are promising. While I cannot say that i'm cured, the therapy certainly helped tremendously. No I only go 1x/day.

    Best,
    Matt

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  2. Paul Whiteley25 October 2011 at 21:37

    Thanks for sharing your experiences Matt. I am really looking forward to research in this area taking off for lots of different reasons. I have heard of Dr Borody and his work in this area and look forward to seeing more for him and other like-minded gastroenterologists (and bacteriologists).

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  3. Mrs. Ed26 October 2011 at 15:43

    I have been following this somewhat. For those of us very affected by gut issues due to poor gut flora, it's easy to NOT be grossed out (years ago I would have never guessed I would say something like that). It will be interesting to see if this type of work continues. Should it become much more common, safe, and effective, I think many of us will get in line for it. I can't help but wonder if it might be helpful in autism.

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  4. Paul Whiteley26 October 2011 at 17:08

    Thanks Mrs. Ed. I share your sentiments. Certainly in autism where gastrointestinal problems seem to be prevalent (and not just the functional bowel issues but rather the chronic inflammatory ones which people don't generally like to talk about), this should be considered for further investigation. I do wonder which gastroenterologist will be brave enough to make the first bid for funding such a study?
    Thanks also for the comment on the 'emergency exit' post. The autism and GI bacteria studies are starting to stack up now, pretty consistently suggesting that there are some differences present in some cases of autism particularly those Clostridial fellows. I perhaps need to root around a bit to have a look at the c-section story, and whether the bacterial findings in autism are universal, or perhaps more or less likely in cases of an aided invitation into the world.

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  5. Matt26 October 2011 at 18:43

    Mrs. Ed,
    It's absolutely safe now, and has been going on to some degree since the 1940's. Vets have been doing it with cattle for 50 years with great success.

    Just a thought

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