Treatment of intestinal diseases with feces. Fecal transplant: what is it and why is it needed?

A stool transplant, or fecal microflora (feces) transplant, involves taking stool from a healthy person and introducing it into the patient.

The human body contains many friendly and even beneficial bacteria, particularly in the gastrointestinal tract (GIT). A stool transplant, or fecal microflora transplant, involves taking stool from a healthy person and introducing it to a person suffering from a disease caused by. Today, the range of applications of fecal transplantation is actively expanding: if earlier, through fecal transplantation, it was proposed to treat mainly gastrointestinal diseases, now this method of treatment is used for autoimmune and neurological diseases. Treatment of obesity, metabolic syndrome, diabetes, multiple sclerosis and Parkinson's disease will also likely soon include fecal transplantation. Scientists around the world are actively looking for areas of application of this unusual technique and ways to modernize it.

This is an emerging treatment, but not a new one. In Chinese medicine, as early as 1500, the consumption of small doses of feces served as a method of treating certain diseases. The first description of fecal transplantation was published in 1958 by Ben Eiseman and his colleagues, surgeons in Colorado who treated four critically ill patients with fulminant pseudomembranous colitis, an infectious inflammatory bowel disease caused by the microorganism Clostridium difficile. Doctors did not know how to help dying patients and gave them fecal enemas, which turned out to be an effective treatment method.

After Ben Eiseman's success, various medical institutions began to use fecal microflora transplantation as a treatment for various diseases. The Center for Digestive Diseases in Sydney, Australia, has offered fecal microbiota transplantation as a treatment option for over 20 years.

Fecal microflora transplantation has many synonyms: fecal bacteriotherapy, fecal transfusion, fecal transplantation, fecal transplant, fecal enema, etc.

To date, there are more than 200 clinical cases in the world described in the medical literature, from which we can conclude that fecal microbiota transplantation is effective in 90 - 95% of cases. In a study by British scientists, the results of which were published in The New England Journal of Medicine, 94% of patients were cured by fecal microbiota transplantation, while other treatments helped only 27% of study participants. The results were so stunning that the researchers interrupted the study in order to treat all patients with a fecal microflora transplant.

People who may be eligible for fecal microflora transplantation

Fecal microflora transplantation has been recognized as an effective treatment for patients suffering from clostridiosis, an acute, anthroponotic, anaerobic infection caused by the bacteria Clostridium difficile (C. Diff).

The main cause of clostridiosis is antibiotic therapy. According to numerous studies, even a single dose of broad-spectrum antibiotics can cause the development of diarrhea and pseudomembranous colitis caused by Clostridium difficile. The hypothesis of the effectiveness of fecal bacteriotherapy is based on the concept of bacterial intervention, which is based on the neutralization of pathogenic microorganisms by beneficial bacteria.

In the United States alone, scientists estimate that about 3 million new cases of clostridiosis are diagnosed annually. According to the US Centers for Disease Control and Prevention, there are about 14,000 deaths a year in the country caused by the bacteria Clostridium difficile.

Donors for fecal microflora transplantation

Donors for such a transplant must be healthy people who have not received any in the last 90 days. Most patients choose their closest relatives for transplantation, but it is worth noting that a person who is not related to the patient can become a donor.

Potential donors with risk factors for HIV and viral hepatitis are excluded. Persons with serious diseases of the gastrointestinal tract, autoimmune diseases or malignant neoplasms cannot become donors. Potential donors are required to undergo screening for HIV, hepatitis A, B and C, syphilis, and undergo a stool test.

In some cases, it will be much more effective to introduce donor feces into the patient’s intestines. This procedure is called a fecal transplant, and it has much more promise in medicine than meets the eye.

The human body is home to about 100 trillion bacterial cells: 10 times more than our own. Most bacteria live in the intestines, helping to decompose complex substances, providing us with energy, vitamins and protecting us from infections. If a person is rid of bacteria, he will inevitably die. Similar risks await patients whose microflora is infected or damaged.

To displace pathogenic microorganisms from the intestines, “replacing” them with harmless bacteria, medicine uses stool transplantation, a form of bacteriotherapy.

Origins of fecal transplantation

Stool transplantation is an ancient procedure. Its origins must be sought in Ancient China: in the 3rd century AD, the Taoist scientist and alchemist Ge Hong treated his patients for diarrhea with the feces of healthy people. Later, in the 16th century, the influential pharmacologist Li Shizhen used fresh, dried or fermented feces to treat diseases of the abdominal organs.

The effectiveness and safety of Chinese therapy cannot be verified, but during the Second World War, during the North African military campaign, German soldiers willingly used a Bedouin cure for bacillary dysentery - fresh camel dung.

Thus, the use of feces to treat gastrointestinal diseases is not experimental, but a very ancient method that modern scientists are trying to rehabilitate.

How does a stool transplant work?

Stool transplantation is a very simple procedure. It all starts with selecting a healthy donor who donates a stool sample. The stool is then mixed with a solids removal solution, placed in a capsule and given to the patient. Sometimes instead of capsules, doctors use enemas, endoscopy, colonoscopy and sigmoidoscopy. None of the methods has proven to be better than the others, so it all depends on the needs and impressionability of each individual patient.

This is how therapeutic capsules for fecal transplantation are created.

The goal of fecal transplantation is to create diversity of microorganisms in the intestines, combat disease and prevent future illnesses.

Stool transplantation seems unhygienic, but sterility is a bad friend for the immune system. Some (multiple sclerosis, rheumatoid arthritis) are known to be less common in countries with lower hygiene standards.

Are feces better than antibiotics?

Currently, stool transplantation is most often used to treat pseudomembranous enterocolitis. The causative agent of this disease is the bacteria Clostridium difficile (clostridia). They are part of the intestinal microflora, but due to a lack of beneficial bacteria, they actively multiply, affect the mucous membrane, cause severe inflammation, abdominal pain and diarrhea.

People usually develop pseudomembranous enterocolitis after a long course of antibiotics. US statistics show that the infection takes the lives of 14 thousand patients every year. To treat it in 2011, scientists decided to use stool transplantation from healthy people, but clinical trials had to be stopped for an unexpected reason.

23% of patients took placebo and self-healed. The result of taking antibiotics (vancomycin) was slightly better - 31% recovery. And with fecal transplantation, almost everyone was cured - 94% of patients. Clinical trials were stopped because the new drug turned out to be too effective: not giving it to patients from other groups would be a crime.

Prospects for fecal transplantation

Over 5 years, scientists conducted more than 30 clinical trials of stool transplantation. They want to use the procedure to treat obesity, ulcerative colitis, Crohn's disease, autism, multiple sclerosis and diabetes.

Human stool contains trillions of bacteria. It is not yet known which of them are useful, which are dangerous, and which have no effect on the intestinal flora. But clinicians need to know how to ensure the safety of patients receiving stool donations. There is a known case where a woman developed obesity after a fecal transplant. Similar complications were not observed in other recipients, but the risk exists, and the task of scientists is to minimize it.

There is a known case where a woman developed obesity after a fecal transplant.

Methods for stool transplantation are not currently standardized: more research is needed to characterize the ideal donor stool and the optimal route of administration. Does the prospect of being treated with feces seem unpleasant? Researchers are already developing synthetic stool from bacterial cultures. They are going to package it in gelatin capsules, making treatment easy and enjoyable.

You will be interested.

Numerous studies have already shown that fecal microbiota transplantation (FMT) is effective in treating and preventing relapses of intestinal infections caused by Clostridium difficile bacteria, such as pseudomembranous enterocolitis. It is a disease of the rectum that often occurs when the intestinal microflora is disrupted due to the use of antibiotics, and the most common symptoms are severe diarrhea, nausea and vomiting. In the United States alone, antibiotic-resistant strains of Clostridium difficile are responsible for approximately 250,000 hospitalizations and 14,000 deaths. Currently, the antibiotics metronidazole and vancomycin are used to treat this disease; in severe cases, it is necessary to remove the affected part of the intestine surgically. Considering that antibiotics also destroy the normal intestinal microflora, treating this infection with them can only worsen the situation of patients. According to animal studies, fecal bacteria transplantation can restore normal intestinal microflora by 90%. This method of treating diarrhea has been known throughout the world for more than half a century, there are about 500 scientific publications proving its effectiveness, but properly designed clinical trials of the FMT method have begun only recently. A remedy for diarrhea, Parkinson's disease and excess weight. In recent years, clinical research on fecal microbiota transplantation has been actively conducted. So, in 2012, researchers from Henry Ford Hospital conducted a study involving 49 patients suffering from severe recurrent diarrhea caused by Clostridium difficile. To carry out the procedure, an endoscope was used, through which a homogenized and filtered solution, which included warm water and 30 to 50 grams of feces taken from healthy donors, was injected into the patients' colon. In some cases, the solution was administered during the colonoscopy procedure. As a result, 90% of patients developed an appetite within two hours after the procedure, within 24 hours they felt a significant improvement in their condition, and after a week they felt completely healthy. However, within three months after therapy, they did not develop any complications or side effects of this treatment method. Another study conducted last year by scientists from the University of Amsterdam showed that stool transplantation into the gastrointestinal tract was three to four times more effective antibiotics. According to an article published in the New England Journal of Medicine, the researchers initially planned to recruit 120 patients to participate in the trial, but ultimately decided to stop the trial due to obvious differences in the health of both groups of volunteers. Of the 16 members of the stool transplant group, 13 recovered completely after the first procedure, two more after the second (94%), while of the 26 patients who received vancomycin, only seven recovered (27%). The rest of the group asked doctors to give them the same procedure and recovered after one or two infusions. Also in February of this year, the world's first fecal sample bank was launched in the United States to treat patients suffering from severe recurrent diarrhea caused by an antibiotic-resistant strain of the Clostridium bacterium difficile. In addition to treating intestinal infections, fecal bacteria transplants from donors can help reduce excess weight, according to an article published in the journal Science Translational Medicine. Researchers hope, through further experiments, to determine the mechanism by which bacteria influence the weight loss process and, perhaps, to offer a new, non-surgical method of weight loss. A few years ago, Australian scientists proposed treating patients suffering from both Parkinson's disease and constipation using stool transplants. As the results of the study showed, thanks to experimental therapy, patients experienced a decrease in the severity of symptoms of the underlying disease, including parkinsonism, multiple sclerosis, rheumatoid arthritis and chronic fatigue syndrome. According to the scientists’ hypothesis, when the composition of the microflora is disrupted, various antigens enter the bloodstream. They cause an excessive immune response, which affects the development of parkinsonism and autoimmune diseases. These assumptions are confirmed by other studies. In particular, according to Dutch experts, fecal transplantation increases insulin sensitivity in patients with metabolic syndrome. Scientific progress: feces in capsules Existing methods of fecal microbiota transplantation - transplanting feces taken from healthy donors through a colonoscope, nasogastric tube or enema - have potential risks damage to the gastrointestinal tract and cause some discomfort to patients. Therefore, American scientists have proposed an oral method of stool transplantation (through the mouth) in the treatment of intestinal infections. The study, published in JAMA, found that frozen stool capsules were as effective and safe in controlling Clostridium difficile diarrhea as stool infusions through a colonoscope or nasogastric tube. The new approach involves freezing the feces of healthy donors, then packing the resulting mixture of intestinal bacteria into acid-resistant capsules for oral administration. A preliminary laboratory analysis of fecal samples is carried out for various infections and allergens. The pilot study involved 20 people aged 11 to 84 years with an intestinal infection caused by C. difficile. For two days, each subject took 15 capsules with fecal contents. In 14 people, experimental therapy led to complete disappearance of symptoms of the disease after a single two-day course. The remaining six study participants underwent a second course of treatment, after which the patients' condition also returned to normal. During the trial, no side effects of the drug were noted. As the study authors note, patients who required a second course of therapy had worse initial health than other patients. “The preliminary data obtained indicate the safety and effectiveness of the new approach,” the researchers noted. “We can now conduct larger, more extensive studies to confirm these data and identify the most effective oral bacterial mixtures.”

In recent years, the international medical community has begun to seriously discuss the positive effects of stool transplantation (fecal transplantation) from a healthy person to a patient with certain intestinal ailments. Thus, studies began to appear that clearly demonstrated good results from the use of this seemingly exotic method of treatment in patients with pseudomembranous colitis caused by antibiotics, as well as. Moreover, the technique is relatively simple and does not require significant expenses.

Fecal transplantation involves the transplantation of feces from a donor who does not have pathology of the digestive tract (or from several donors at once) to a sick person - a recipient suffering from a disease associated with disorders of the intestinal microflora. In this case, the beneficial microbes contained in the donor’s stool will be:

• positively influence the recipient’s intestinal microflora, restoring the balance between normal and opportunistic microorganisms;
• reduce existing inflammatory changes in the intestinal mucosa;
• increase the content of beneficial anti-inflammatory and antitumor substances (for example, butyrate);
• increase the formation of essential amino acids;
• stimulate healing and restoration of the intestinal mucosa.

Encouraging results are emerging showing the effectiveness of stool transplants in patients with recurrent pseudomembranous colitis (a serious condition that develops after antibiotics and is associated with excessive growth of microbes called clostridia in the intestines). For example, within 3 days after the transplantation procedure, positive changes in well-being were observed in 74% of patients. Subsequently, diarrhea stopped in 81% of patients. Similar data are observed in the treatment of fecal transplantation in patients with Crohn's disease, ulcerative colitis, as well as patients with these ailments who have undergone major surgery to remove part of the diseased intestine and have inflammatory complications in the remaining intestine. Foreign doctors recorded stable remission (a period without exacerbations) in more than half of their patients. Moreover, in some patients its duration reaches 12-13 years.

History of the method

Some modern scientists and clinicians call fecal transplantation an innovative and advanced method. Meanwhile, fecal transplantation has a very long history. According to meticulous historians of world medicine, it was already actively used by Chinese healers in the 4th century, calling the stool solution “yellow soup.” They introduced fresh feces mixed with water into the anus of patients with dysentery or offered patients to drink them. Medieval oriental healers preferred to use animal feces. So, the Bedouins used the feces of their camels. Doctors first returned to the ancient method in 1958, performing a fecal transplant on a patient with severe pseudomembranous colitis.

Nowadays, this unusual method of treatment has again begun to be actively studied from the standpoint of evidence-based medicine. Pundits are clarifying and improving methods for introducing feces into the intestines, determining the requirements for the necessary stool donors, studying the safety and consequences of feces transplantation, deciding which feces are more useful (frozen or fresh), trying to explain the mechanisms of the therapeutic effect and develop the optimal administration regimen.

Requirements for stool collection from a donor

According to scientists who are fans of stool transplantation, the key to its effectiveness is the careful selection of donors. Their requirements continue to be determined. But now researchers believe that suppliers of therapeutic biological material (feces) can only be donors who, over the next 3 months:

• were not treated with any antibiotics;
• didn't get a tattoo:
• did not receive blood products;
• did not have new sexual partners.

These people should not have any inflammatory bowel diseases, constipation, intestinal polyps, obesity, allergic diseases, immune problems, or chronic fatigue. Before collecting stool samples, they are examined to exclude infection with Giardia, worms, rotaviruses, Helicobacter pylori, isospores, cryptosporidium, hepatitis, etc.

Fecal transplant technique

Stool collected from donors is used as transplant material within the next 6-8 hours or frozen at a temperature of minus 80 degrees. In the latter case, it is successfully stored for 1-8 weeks. Before the transplantation procedure itself, it should be thawed well, this will take some time (2-4 hours). A special liquid suspension is prepared from the feces of one or several donors (their number can reach 7) and physiological solution. It is administered to patients using:

• regular enema;
• gastroscope or colonoscope (endoscopic device);
• probe (passed through the nose into the stomach or small intestine).

The amount of administered fecal suspension ranges from 150 to 500 ml.

Abroad, work is currently underway to create capsules with donor stool that can be swallowed.

Complications of the method

Despite its effectiveness, in addition to psychological discomfort, fecal transplantation can also have negative consequences. The doctors involved observed the following complications of the procedure:

• entry of feces into the respiratory tract;
• transmission of infections (usually viral);
• nausea with vomiting;
• abdominal pain;
• temporary rise in temperature;
• bloating.

As a rule, they are explained by insufficiently careful selection of donors, individual intolerance or technical difficulties. Fecal transplantation continues to be considered a promising alternative treatment option. It continues to be actively studied for intestinal ailments and more. So, some researchers suggest using stool transplants in patients.

A research program for the treatment of inflammatory bowel diseases and antibiotic-associated diarrhea using intestinal (fecal) microbiota transplantation (FMT) has been opened at the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia. FMT is a new type of treatment for diseases associated with the activity of the bacterium Clostridium difficile, used in cases where other treatment methods are ineffective.

Clostridium difficile infection causes antibiotic-associated diarrhea and causes its most severe form, pseudomembranous colitis. This is an acute inflammation of the large intestine, the symptoms of which are prolonged diarrhea, abdominal pain in combination with symptoms of general intoxication.

Gut microflora transplantation involves the delivery of fecal matter from a healthy person to the gastrointestinal tract of another person with the goal of restoring a stable microbial community in the intestine. The most common is delivery through an endoscope which is passed into the colon to the point where it connects to the small intestine.

The administration of a suspension of human feces to patients with food poisoning and severe diarrhea was first described in the 4th century AD. e. in China. In the 16th century, Chinese physician and pharmacologist Li Shizhen used various stool products to treat diarrhea, fever, pain, vomiting and constipation. In the 17th century, animals were treated with this method. A renaissance occurred in the 20th century when the use of fecal enemas in humans to treat pseudomembranous enterocolitis was reported in 1958.

To date, clinical guidelines have been approved for the use of FMT in patients with diseases associated with the activity of the bacterium Clostridium difficile. Research is also being conducted on its use in ulcerative colitis, Crohn's disease, diabetes mellitus, and excess weight.

We invite healthy individuals to participate in the program as donors of intestinal microbiota. Persons admitted to donation and their relatives will receive special conditions for examination and treatment at the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia.

How to become a donor

1. Answer three simple questions:

• Your age is from 16 to 55 years?
• Body mass index - 19-26?
• At the time of donation, do you live in Moscow or the Moscow region?

If you answered yes to each question, go to step 2.

2. Take the form () from the registration desk or download it here. Answer the survey questions. If you answered no to all questions in the questionnaire, send it by email [email protected] .

3. Come to the first interview. Interviewing is free of charge.

4. If the result of the interview is favorable, you will need to be examined by a doctor, undergo a series of tests and then undergo a second interview.

5. If your health condition and laboratory test results correspond to the norm, you will be allowed to undergo the quarantine period.

What is the quarantine period?

Within 60 days, 5 times a week it will be necessary to submit samples of intestinal contents to the EnterBiom laboratory; Blood will be drawn once every 7 days. During the quarantine period, a break of more than 2 days is not allowed when submitting biota samples. If the visit schedule is violated, repeated interviews and laboratory testing will be required.

6. After 60 days, a third interview will take place, and random examinations of intestinal contents and blood samples will be performed. If the result is positive, you are allowed to donate.

Conditions for persons admitted to donate intestinal biota

Delivery of intestinal biota at least once a day, 5 days a week. After 60 days, the donor must undergo an interview and laboratory diagnostics of blood and intestinal biota.

Such serious requirements for intestinal microbiota Donors are determined by the data of global clinical recommendations, the results of scientific research, and provide maximum protection for patients participating in the treatment program using intestinal microbiota transplantation.

Persons approved for intestinal microbiota donation will receive special treatment and examination conditions at the Federal Scientific and Clinical Center of the Federal Medical and Biological Agency of Russia. The benefit can be used for a family member or relative.