FMT: An Ancient, Novel Solution to C. difficile

Many diseases that we battle on a daily basis have developed antibiotic or antiviral resistance mechanisms.

Tuberculosis, Streptococcus, and the influenza virus were all were once considered death sentences if contracted but became relatively harmless with the discovery of antibiotics and antivirals. However, as we continue to overuse and abuse these antimicrobials, these pathogens have become resistant to them and they now pose as big of a threat as ever.

Thanks to the development of these resistances and the lack of antimicrobials coming down the pipeline, doctors have recently begun reexamining treatments once thought alternative that have shown to have a profound positive impact.

Specifically, the concept of battling bacteria with bacteria through Fecal microbiota transplant (FMT) has taken off over the last 10 years.

Medical ecology is a young school of thought that proposes there is much more to learn about the human microbiome (the entire fauna of microbial non-human denizens of our bodies, 25,000 to 30, 000 species of which occupy our GI tract), and that we can use this information to more wisely treat our illnesses. When the microbiome functions correctly, it helps regulate our dental health, our respiratory and GI tract, our urinary tract, and perhaps even our insulin regulation.

When the microbiome is disrupted or unbalanced, however, trouble ensues.
Such is the case with Clostridium difficile (a particularly worrisome and deadly bacteria).

The problem with antibiotics is that they kill off a large portion of our microbiome and disrupt functions along the way. The idea is that by destroying everything, you also kill off the really bad stuff too.

The bad part is that after antibiotics kick in, sometimes only the the hardy little C.diff bugs are left, allowing them multiply rapidly and become the bullies on the sandlot.

Because of issues like the rise in C.diff and other bad stomach bacteria, in 1958, a handful of physicians heard of veterinary treatments for colic and similar diseases of cattle and horses involving a transfer of the balanced gut bacteria from a healthy animal to the suffering horse or cow. These physicians studied the same type of treatment for enterocolitis in humans and published their findings.

While friends sharing poop with sick friends may sound incredibly bizarre, a transplant of fecal matter from a healthy donor to a recipient ill with C.difficile, has shown a 90 to 100% cure rate in various studies. Imagine — 90% cure rate in a world where some 30% of patients who contract C.diff are likely to have a relapsed infection!

Sounds gross, I know. But donors are typically a friend or family member, each should be screened for diseases by the administering physician, and the transplant seems best given via enema.

Although feces is generally considered a level two biohazard, the process of giving it to your loved one is surprisingly safe. In fact, it’s so safe that when the FDA tried to halt the use of FMT until they could figure out the confusing regulatory category for it doctors everywhere fought heartily for the right to treat their sickest patients with FMT. The FDA relented, stating it would only issue a guidance for now since FMT is an “urgent issue affecting patients with life-threatening infections”. FMT will be regarded as an investigational new drug, meaning doctors must inform their patients of risks and obtain their informed consent, since there are no warning labels on our excrement.

As a microbiologist, I find progress like this to be fascinating and exciting. Sometimes it isn’t a radical, expensive, patented new drug that will help us battle back the enemy microbes. Sometimes, it’s an intuitive, old-school approach that reminds us our bodies have evolved to do wonderful things in partnership with microbes.

Xenex is a company on a mission to eradicate the harmful bacteria and viruses that cause the healthcare associated infections which take countless lives around the world every day. While we produce a robot that is used to disinfect hospital rooms, we also think it is critical to inform, support, and arm the general public with the tools and knowledge necessary to help them navigate the tough and often complicated worlds of infection control and health.

Rachael Sparks is the Technical Director  at Xenex Disinfection Services and was previously a transplant specialist working with hospitals throughout Texas. When she’s not looking for a way to reduce the burden of HAIs, she’s cooking up delicious dishes with fresh produce from her garden. 

Credit xenexadmin