Should We Bank Our Own Stool?
Should We Bank Our Own Stool?
Just recently my little 6 year old granddaughter developed an infection that led to a mild case of pneumonia. Of course she had to take antibiotics to clear the infection. Did you know that by age 10, the average Canadian child has had at least ten courses of antibiotics, and some microbiologists argue that even one course a year is too much. They feel that it may damage our native microbial ecosystem, with far reaching, possibly serious consequences.
Although physicians are becoming more enlightened about probiotics, it still amazes me why they don’t start “microbial restoration” immediately in order to restore the normal flora bacteria and prevent the infection from reoccurring. The newest technology involves reinfusing patients with their own microbes after antibiotics.
The scientific term for this is “autologous fetal transplant”. In theory it could work like a system reboot disk works for your computer. You would freeze your feces, which are roughly half microbes, and when your microbiome became corrupted or was depleted with antimicrobials, you could “reinstall” it from a backup copy.
The damage from antibiotics may not be trivial. Studies have linked antibiotic use early in life with a modestly increased risk of asthma, inflammatory bowel disease, obesity and rheumatoid arthritis. These are simply associations and do not prove that antibiotics actually cause these diseases. They just might make you more susceptible.
Many microbiologists feel more strongly that antibiotics contribute to disease because in animal studies, depleting certain microbes early in life—microbes that may promote gut health and soothe the immune system—makes rodents more susceptible to inflammatory disease later.
The “self-transplant” isn’t a new idea. In the late 1950’s, a medical technologist named Stanley Falkow practiced what he called “fecal reconstitution.” Gut problems often plagued surgery patients during recovery. They had received antibiotics prophylactically, depleting their native gut microbes. So Mr. Falkow, working with an internist, began giving these patients capsules containing their own feces, which was collected and frozen before treatment. It helped tremendously. But when the hospital administrator found out—patients didn’t know what they were swallowing—he fired Dr.Falkow. He later was hired back as an emeritus microbiology professor at Stanford, but had to abandon his project.
Almost 60 years later, the “fecal transplant” is a cutting edge treatment for the pathogen Clostridium difficile, a bug that kills 3000 people yearly and infects nearly half a million people. “C.diff” tends to strike after antibiotics deplete the microbes that naturally inhabit the gut, leaving us vulnerable to invasion. So far, fecal transplants have shown to be more than 90 per cent effective at curing these infections.
As currently practiced, the transplant material usually comes from someone else. Even with careful screening, that presents some risk. It’s theoretically safer to receive one’s own microbes. North York General Hospital in Toronto recently completed a pilot study banking incoming patients own stools. Should any of those patients develop infections after antibiotics, their own microbes were on hand for reconstitution.
In their study, not one patient became ill so the transplants were not needed. But the project proved feasibility, and achieved a processing time—gathering, blending and freezing—of less than one hour.
Memorial Sloan Kettering Cancer Centre in New York has also started a proactive stool-banking study. Most of the subjects are patients with leukemia. Before stem cell transplants, patients receive antibiotics and chemotherapy, often wiping out their normal flora or microbiota.
Dr. Eric Palmer, a physician and scientist at Memorial Sloan Kettering, has discovered that the diversity of the microbiota after the stem cell transplant predicts well-being and survival. Those with the least diverse microbiomes after surgery were five times less likely to remain alive three years later, when compared with the most diverse. He feels that it should become a routine part of practice to restore the flora, not just for leukemia patients, but for everyone who receives broad-spectrum antibiotics.
In mice, simply caging an antibiotic-treated animal with a non-treated one will restore its microbiota. This happens because mice actually eat one another’s feces. People don’t do this—or so we would like to think. In reality, for much of our evolution, we shared more of our microbes. The pre-sanitary past was disease ridden, but it may have enabled acquisition of health-promoting microbes.
In the United States, microbiota recovery has become a business. Mark Smith, the founder of the non-profit stool-banking organization called OpenBiome was a doctoral student at M.I.T. His roommate had been sickened by C.difficile. Antibiotics failed to work and his friend actually gave himself a stool transplant, in his own apartment, with stool donated from his roommate. It worked.
Dr. Smith could not understand why this highly effective treatment for a widely recognized infection was relegated to doing it yourself at home. He found that lack of banked, screened fecal matter was one of the main hurdles. So he started OpenBiome, which screens donors and banks stool for use by medical professionals. Business is booming and now people can bank and store their own stool and withdraw it later if needed. However, the Food and Drug of the United States regulates the stool as a drug so it can only be used for C.difficile and not for preventive reconstitution.
Returning to the story of my granddaughter, this process would not work for her because infant microbes change from month to month as they grow. If microbes were stored from December of this year, they may no longer be appropriate by January of 2016.
I’m sure she is happy not to have a fecal transplant and just to continue on with her newer stronger probiotics that she takes every day.