Would you willingly introduce bacteria into your body? Well, that’s what microbiota transplantation is all about.
Just like heart and liver transplantation, a new set of bacteria can be transplanted inside our body. Commonly this is the aim of prebiotics and probiotics. But in more directed approach, faecal matter can be used for microbiota transplantation! Gross? Yes, it is. Turns out the faeces we excrete has a plenty of bacteria, some of which are beneficial.
Microbiota is a word given to the collective of micro-organisms such as bacteria, virus, fungi and for unlucky few, nematode worms, in a particular niche. Microbiota can be found on the skin and inside us, majorly in the large intestine. Each part of the human body has a different microbiota – so what’s between your toes would not be found on your face.
Fecal Microbiota Transplantation (FMT), also known as “Stool Transplantation”, attempts to change the gut microbiota of the recipient, to positively impact disease outcomes.
A common and painless method for FMT is by the consumption of a capsule containing the freeze-dried fecal matter from a healthy donor. A pill. But the pill goes through the stomach where pH and enzymes can destroy the microbes, so a direct transplant is more effective. This includes methods such as colonoscopy, enema or an orogastric tube. These however are invasive. In one study, Eero Mattila and Team , showed that FMT was effective in the treatment of Clostridium difficile infection (CDI). Due to heavy antibiotic administration, microbiota in diseased individuals is depleted in the gut. Here, FMT has been effective by helping to re-colonize the gut with beneficial bacteria. FMT has also been used to treat Inflammatory Bowel Disease (IBD), ulcerative colitis, obesity, metabolic syndrome and functional gastrointestinal disorders . A strong gut-brain axis has also prompted the use of FMT to treat neurological conditions such as multiple sclerosis and Parkinson’s.
How is FMT done? Fresh stool is preferred, as the viability of the bacteria in the stool is highest when fresh; this is diluted with sterile water or saline. After filtration, the suspension is administered to the recipients through colonoscopy or it is given orally, as a capsule. The healthy bacteria from the suspension acts in a competitive manner with the pathogenic bacteria.
Who can donate the stool? A person who is healthy i.e., free of gut infections, chronic medical diseases etc is recommended as a donor. It is also important that the donor must not have taken antibiotics in 24-48 hours previous to the donation of stool, as antibiotics disrupt microbiota.
Many stool banks have opened across Europe. In 2012, OpenBiome at Massachusetts Institute of Technology became the 1st Stool Bank in the United States. While in 2016, the Asia Microbiota Bank was launched in Hong Kong.
Now it’s time to break the bubble! Our understanding of the microbiota and FMT is still in its infancy, with some transplantations showing adverse effects. In 2019, 2 people from the United States died due to the presence of drug-resistant bacteria in the transplants.
FMT as a concept is not new. Faeces therapy has been described as early as the 4th Century in China by Ge Hong for various treatments including diarrhoea. In Ayurveda too, there is a therapy that can directly impact the gut microbiome. Charaka Samhita, one of the three “Golden Classics” of Ayurveda, states that 50% of all diseases are cured by “Basti Therapy”. Here, patients are administered an enema of herbal infusions, specifically tailored for their disease i.e., it will be different for obesity and Parkinson’s. Alternate cleansing and scrapping infusions are administered for a series of days. Many patients report a feeling of lightness after this process. Research at TDU is underway to understand how Ayurveda treatments might change the gut microbiome.
Author: Ms. Sushmitha HS, Junior Research Fellow, CAB&HN
© 2018 TDU, Bengaluru.