Fecal Microbiota Transplant

Disclaimer: I suggest you do not read this right now if you have just eaten, are eating, or are about to eat.

Microbiology—micro-what-now?

Did you know that your body does not consist of… just your body? ”What do you mean? Are you delusional?” you ask. No, not delusional. Your body is home to 100 trillion microbes—fungi, bacteria, protists—or even more. To put this in context, our body has only 40 trillion cells. That means that there are more than one microbe for every cell in your body!

Microbiology is the study of microorganisms, and a significant part of the field is the study of the human microbiome. While some of your microbes are commensal, others mutualistic, or pathogenic, scientists have been working hard to discover as much as they can about this excitingly hidden and wonderfully diverse ecosystem in order to manipulate it to treat some diseases or health conditions.

Fecal Microbiota Transplant

One example is the implementation of fecal microbiota transplant (FMT) or fecal transplant. The name says it all: FMT is the procedure of (typically by enema administration—injecting fluid into the anus and rectum) introducing microbes from the stool of a healthy donor into a patient’s gut microbiota. Gross as it may sound, a little reassuring piece of information is that only the bacteria taken from the stool of a healthy screened donor is transplanted.

Fecal transplant is used to treat bacterial infections such as Clostridium difficile infections. Why and how does this work?

Key concepts

When understanding the human microbiome, it is important to grasp the complex relationships that our microbes have formed with one another and with our body itself: some cause diseases, but majority are not harmful, and in fact are beneficial to us. Thus the key to a healthy human being is BALANCE—equilibrium in the various dynamics between bacteria and the your body. This is called symbiosis. An imbalance is called dysbiosis, which often results in an unhealthy body. For instance, Streptococcus salivarius is a strain of Streptococci bacteria found in the human mouth: it helps prevent gum disease and tooth decay, but if found outside the oral cavity it may cause disease.

Fecal Transplant and C. diff

Though having existed for over a millennium, due to its nature, it has not been very popular, and has never been regulated properly. Only in 2013 did the Federal Drug Agency (FDA) categorized fecal matter as a drug, as there rose a number of cases in which fecal transplant had successfully treated Clostridium difficile infections.

It all started in 1958, when physicians who had been trying to treat their patients dying of diarrhea caused by C. diff had no other option but fecal transplant. Clostridium difficile is a bacterium that attacks the large intestine. Symptoms include diarrhea and abdominal cramping at best; dehydration, fever, kidney failure, and intestinal inflammation leading to death at worst. Within 48 hours, the fecal transplant patients were free of symptoms.

Patients frequently contract C. diff upon taking a course of antibiotics which eliminate both good and bad bacteria, thus leading to dysbiosis. Whilst antibiotics is an effective treatment 65% of the time, however, the other 35% of the time, for each time it relapses, the chances of being cured with another course of antibiotics decrease. This is where fecal transplant comes in. Fecal transplant restores the normal gut microbiota, returning the patient’s gut microbiome to a state of symbiosis.

Conclusion

The human microbiome is as diverse as a rainforest, hiding many secrets yet to be uncovered as technology and knowledge of the microbiome advances. One of such advances is the official and clinical implementation of fecal microbiota transplant. In contrast to the success rate of antibiotics of 65%, fecal transplant has a whopping 90%. However, having only emerged recently, the field of study around the human gut ecosystem is still being highly questioned, with the characteristics of a healthy microbiome still a grey area. As for now, though, fecal microbiota transplant—as disgusting as it sounds—is a powerful therapeutic weapon in saving the lives of many.

References

TEDx Talks. (2015, November 3). Fecal transplants & why you should give a crap | Mark Davis | TEDxSalem [Video]. YouTube. https://www.youtube.com/watch?v=C9bYKd_Ffgc

Kim, K. O., & Gluck, M. (2019). Fecal microbiota transplantation: an update on clinical practice. Clinical Endoscopy, 52(2), 137–143. https://doi.org/10.5946/ce.2019.009

What is FMT? - The Fecal Transplant Foundation. (2022, August 2). The Fecal Transplant Foundation. https://thefecaltransplantfoundation.org/what-is-fecal-transplant/

Fecal transplant. (2022, April 4). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/fecal-transplant