Fecal therapy is a strange but promising therapeutic approach
Transplantation of donor feces looks the strangest of all currently existing methods of therapy, almost finally recognized by official medicine. However, this approach may prove to be not only an effective method of treating severe intestinal infections and, possibly, many non-communicable diseases, but also a solution to the rapidly worsening global problem of antibiotic resistance of pathogenic bacteria.
Fecal microbiota transplantation (TFM) is a variant of bacteriotherapy – the use of bacteria that are not dangerous to humans to displace pathogenic microorganisms. In addition to treating infections, bacteriotherapy, unlike traditional antibacterial drugs, should not disrupt the body's natural microflora.
Recently, the media actively discussed the case of a woman who, after transplantation of the feces of an overweight donor, developed obesity. From this story, many people first learned about the existence of such an unusual medical approach.
Where did fecal microbiota transplantation come fromThe first mention of the procedure was recorded in China in the 4th century AD.
The records of that time indicate that fecal transplantation was used to treat food poisoning and diarrhea.
Later, in the 16th century, a well-known Chinese doctor named Li Shizhen used drugs called "yellow soup" or "golden syrup" for the treatment of abdominal diseases and containing fresh, dried or fermented feces.
In veterinary medicine of the 16th century, the method of transfaunation, which has been preserved so far, was actively practiced, consisting in the transfer of microorganisms from healthy ruminants into the digestive tract of diseased individuals.
During the Second World War, German soldiers confirmed the effectiveness of the Bedouin method of treating dysentery – the use of camel feces.
Thus, the use of feces as a medicinal product has its roots deep in history and over the period from the 4th century to the present day, the effectiveness of this method has received many confirmations. However, recently medical practice has made significant progress, and the process of therapeutic use of feces has also undergone significant changes.
Mechanism of action of fecal microbiota transplantationCurrently, the TFM procedure is carried out with almost no intermediate stages.
It begins with the selection of a healthy donor who provides a sample of his feces. The resulting material is mixed with a solution and filtered to remove solid particles.
There are several methods of introducing a prepared graft into the recipient's body. Doctors can use conventional douches for this or apply more complex approaches such as endoscopy, colonoscopy and sigmoidoscopy. To date, there is no evidence of the advantage of any approach over others and in each case its choice is based on the needs of the patient.
It is believed that microorganisms inhabiting the intestine play an important role in maintaining a good state of human health, including through "training" the immune system and suppressing the activity of pathogenic microorganisms. Therefore, the purpose of TFM is to create a variety of microorganisms in the patient's intestine to eliminate infection and prevent more relapses.
The Clostridium difficile problemAt the present stage, TFM is used mainly for the treatment of patients with infections caused by C.difficile, whose population is rapidly increasing with a decrease in the number of normal intestinal microorganisms and affects the intestinal mucosa, causing so-called pseudomembranous colitis.
Infection can manifest itself in the entire range of intestinal disorders, from relatively safe diarrhea to intestinal perforation.
As a rule, the disease develops against the background of taking antibiotics, which can be effective against bacterial infections, but cause significant damage to the intestinal microflora. Traditionally, antibiotics are also used to treat intestinal infections caused by clostridium, which in many cases led to the rapid development of relapses, exceeding the severity of the primary episode of the disease. The reason for this is that antibiotic therapy, which destroys part of clostridium, not only does not restore the normal intestinal microflora, but also further aggravates its condition.
However, the destruction of beneficial microorganisms is not the only problem associated with the use of antibacterial drugs. Bacteria that survive after such therapy acquire resistance to antibiotics, which makes emerging new strains immune to previously effective drugs.
TFM offers an effective solution to these problems and, according to published data, the process of carrying out this procedure is safe and does not require large financial costs. At the same time, its efficiency exceeds 90%. Mayo Clinic specialists even described a randomized controlled clinical trial, the decision to terminate it early was made on the basis of the undeniably positive results obtained.
Legislative regulation of the procedure in the USAThere are a number of problems preventing the widespread introduction of the procedure into clinical practice.
One of them is the peculiarities of the official status of the procedure in the USA.
There are many websites on the Internet that contain recommendations about fecal microbiota transplantation at home using available household devices.
TFM has not yet received final approval from the US Food and Drug Administration (FDA). To date, doctors have the right to carry out the procedure at their discretion to patients who do not respond to standard methods of treatment, provided they receive written informed consent from them, which indicates that the procedure is considered experimental.
According to the FDA documentation, fecal transplants are classified as a medicinal product. Experts believe that this approach can be a source of problems, since it implies the possibility of monopolizing the official conduct of the procedure and, accordingly, the emergence of many illegal underground options for its conduct.
In 2012, Mark Smith and his colleagues opened the first OpenBiome human fecal bank. The purpose of this was to increase the safety of TFM, as well as to reduce the cost of the procedure and increase its accessibility for doctors and patients. The Bank provides clinics with frozen fecal samples ready for use.
Uncertainty and future prospectsTo date, there are still factors that need to be studied and understood.
Experts do not know how donor bacteria change the microflora of the patient. Moreover, it is unclear which of the billions of bacteria contained in faeces are beneficial, which are dangerous, and which have no effect.
Researchers have yet to explore the possibility of using TFM for the treatment of other diseases affecting the intestinal microflora. Potential targets of future research programs are inflammatory bowel diseases, irritable bowel syndrome, as well as obesity and type 2 diabetes mellitus.
Clinicians will have to develop a system that guarantees the safety of TFM. Despite the fact that no serious side effects of the procedure have been recorded since the 4th century to the present day, the recently described case of obesity in a patient indicates an element of uncertainty associated with it.
There is also a need to determine the optimal approaches to the selection of donors and the preparation of biological material, which is necessary for the standardization of methods of transplantation of fecal material.
There is also an opinion that the problem of variability of biological material can be solved by developing artificial samples capable of replacing human feces. Researchers are already working on the creation of drugs that will be convenient for oral use gel capsules filled with a mixture of specially selected bacterial cultures.
Despite the fact that at first glance the situation looks rather vague, TFM combines the past and the future of medicine. And given the growing problem of antibiotic resistance of pathogenic microorganisms on a global scale, in the coming years, the improvement of this procedure will be an important area of medical research.
Evgeniya Ryabtseva
Portal "Eternal youth" http://vechnayamolodost.ru according to Medical News Today:
Fecal matters: treating infection with stool transplants.
24.02.2015