ADVENTURES IN FOOD AND FITNESS: Fecal transplants help Fort Wayne patients suffering from deadly diarrhea
When Professor Rachel Polando tells her microbiology students at Manchester University about her brother the poop donor, it invariably generates a wisecrack or two.
Who knew you could actually get paid for a foul-smelling waste product most humans produce every single day?
But qualifying as a stool donor is tough. You must be exceptionally fit — inside and out – to provide material for the process known as fecal microbial transplant (FMT), in which stool containing desirable gut bacteria is inserted into someone else’s troubled colon.
“The amount of health information he had to give them was incredible,” Polando said.
You must also live near a stool bank, which means that for now, at least, Midwesterners are out of luck. (Polando’s brother lives in Boston, near OpenBiome, the nation’s largest poop provider.)
The deadly pathogen that led the FDA to approve FMT as an “investigational new drug,” however, has made its way to Fort Wayne. Luckily, so has the procedure that may have the best shot at stopping it.
A deadly disease
You might think that the prospect of another person’s poop entering your body would be too gross to contemplate.
But patients infected with the bacterium Clostridium difficile are often so desperate for relief from the resulting diarrhea that some now ask for FMT, says Dr. Andrew Katz, the gastroenterologist who initiated the fecal transfer program at Lutheran Hospital in 2015.
C. diff, which sickens half a million Americans a year and kills up to 30,000 annually, invades the colons of patients whose gut bacteria has been wiped out by antibiotics. According to one study, C. diff now infects more people in long-term care facilities than the drug-resistant staph infection known as MRSA.
Because the FDA closely monitors the use of human stool as a “biological agent,” and because doctors are sworn to uphold the principle of “first do no harm,” protocol dictates that a more conventional treatment such as the oral antibiotic vancomycin be tried first.
In a sign that FMT is becoming more mainstream, however, in February the Infectious Diseases Society of America issued new guidelines recommending the procedure for C. diff patients who have repeatedly failed standard treatment.
At Parkview Health, Dr. Scott Stienecker, director of epidemiology and infection prevention, has performed FMT since 2012 for C. diff patients who have failed “at least one reasonable course of therapy,” said spokeswoman Jessica Miller.
How FMT works
With C. diff, “every patient is different,” Katz says, and so is the procedure. Generally, he delivers the fecal transplant via colonoscopy, but sometimes he “goes in from above,” inserting an endoscopic tube into the esophagus for delivery into the small intestine.
In some cases, he uses both methods in the same patient to increase the chance of reculturing the colon.
The fecal material used by Lutheran Health Physicians is purchased in liquified, flash-frozen form from a company in Pennsylvania that tags and traces both the source and the result of each “transfer.”
“The FDA watches them very closely,” Katz said. “They have very explicit parameters. This isn’t something that’s available on the open market.”
Katz says he and his partners perform about four or five FMT procedures a month. He estimates that around 70 percent are successful.
“If you’ll excuse the expression, they come in spurts,” he said. “I can go several months without doing one, but now I’ll probably do four this month.”
One patient, he said, “came in with such a horrible looking colon,” he thought it might need removed. She’d already failed three or four rounds of antibiotic treatments; he wasn’t hoping for a cure so much as to gain enough improvement that a second procedure could be attempted later.
Instead, he said, “we pulled her back from the brink.”
Looking to the future
Despite the apparent success of FMT, Katz describes the procedure as “a compassionately delivered experimental therapy.”
“We really don’t know what we’re doing,” he says. “But it seems to help.”
When it comes to understanding the human microbiome, Katz firmly believes that “we’re still in the Stone Age.”
He compares studying microorganisms in the human colon to the difficulties involved in observing creatures that live in the deepest parts of the ocean:
“You’ve got this long, dark tube about 25 feet long,” with a very low oxygen environment, and “it’s very hard to study what lives in there without changing the environment” in a way that alters what you are trying to study.
Katz is skeptical of studies exploring whether FMT might cure everything from obesity to irritable bowel syndrome.
But maybe someday Polando’s microbiology students will help further our understanding of how FMT works – and what else, if anything, it might be used for.
“It’s a very fascinating topic,” she said, “and one that my students want to discuss more as they learn more about the microbiome.”
Contact Tanya Isch Caylor at firstname.lastname@example.org. This column is the personal view of the writer and does not necessarily reflect the views or opinion of The News-Sentinel.