Our digestive system relies heavily on certain bacteria to help absorb nutrients into our body, as well as digest our food. However, there are medical conditions, health factors, and even antibiotics that destroy these good bacteria in our body that we depend on to perform those functions. One way to reintroduce these good bacteria in our body is through a fecal transplant as a way of transplanting, well, feces, from a healthy donor into another person in an effort to restore the equilibrium of bacteria in their guts.
What is a fecal transplant?
Our guts are home to millions of bacteria, also known as a microbiome. Our gut microbiome–the environment of the large intestine or colon–is a complex network of microbes (bacterial cells) that plays a massive role in maintaining our health. Antibiotics or underlying conditions, such as inflammatory bowel diseases, can disrupt the balance in our microbiome. These changes in our gut’s environment and imbalance can lead to disease, most commonly the C. diff (also known as Clostridioides difficile or C. difficile) infection, and can cause the development of other intestinal problems and diarrhea.
Fecal transplants have been performed in animals for well over a century, with the first human transplant occurring in 1958.
A fecal transplant, also known as bacteriotherapy or fecal microbiota transplantation, occurs when a doctor transplants the feces from a healthy donor to help restore balance to the bacteria in the patient’s gut. The doctor will first screen donors to ensure that their guts are healthy while testing them for various diseases as well. When it comes time for the actual procedure, the doctor will typically deliver the donor’s feces through a colonoscope to perform the transplant in an effort to encourage the recipient’s body to grow healthy bacteria to aid in curing infection and reduce those gut health troubles.
How do these transplants work?
Because 80-90% of infections that are caused by C. diff do not respond to antibiotics, a fecal transplant is an innovative way that doctors have been using to resolve some of these infections. While there are multiple routes of administering the transplant, such as through a colonoscopy, capsules, or a naso-enteric tube, each has its own set of benefits and risks. It’s theorized that fecal transplants work as a way of repopulating a patient’s microbiome with diverse microorganisms that exclude C. diff.
In a healthy gut environment, C. diff is out-completed by other species. But, if a patient receives antibiotic treatment, it can disrupt this environment and kills off protective bacteria, allowing C. diff to form spores that are antibiotic-resistant, thus making them no longer out-competed. They can begin to produce toxins that lead to symptoms of abdominal pain, diarrhea, and fever. When a healthy donor’s healthy feces is transplanted, an infusion of bacteria occurs to regenerate the gut environment, which makes C. diff once again out-competed and helps strengthen the patient’s gut against future infections.
What can a transplant treat?
A fecal transplant can be used to treat severe diarrhea in patients as C. diff bacteria can cause serious intestinal issues including colitis and diarrhea in addition to fever, nausea, and loss of appetite. Hospitals like the Cleveland Clinic, the Mayo Clinic, NYU Langone specialists are considering fecal transplants in patients who have a C. diff infection that was caused by antibiotic treatment. It’s important to note that these transplants are still being considered as a last resort treatment and not everyone is a good candidate for the procedure, especially those who are taking any medications that suppress the immune system, have had a bone marrow or organ transplant, or have cirrhosis of the liver.
In a recent study as a collaboration between researchers at the National Cancer Institute Center for Cancer Research, part of the National Institutes of Health, and investigators from UPMC Hillman Cancer Center at the University of Pittsburgh, it suggested that fecal transplants could help patients with cancer who do not respond to immunotherapy drugs. Based on the findings of the study, researchers are suggesting that larger clinical trials be conducted to confirm the results in addition to finding biological markers that could be used in the future to find patients who could benefit from these types of treatment that alter their gut microbiome and environment.
