Precious Poop

(March 7th, 2016) Faecal implants may still make most of us go yuck but for patients suffering from chronic and repetitive gut infections, it is often the last hope. Now, Europe’s first donor faeces bank has opened in the Netherlands.

Donations of blood and semen are widely accepted but what about if you were asked to donate your poop? This is exactly what Dutch researchers have done by opening the first “poop bank” in the country. This centre was inspired by the positive results obtained in a study conducted by the same team testing whether faecal implants donated by healthy donors could help patients suffering from recurrent Clostridium difficile infections. After the study, explains Edward Kuijper, professor of microbiology at Leiden University, “We obtained a grant to implement the faeces transplantation on national level.” As a result, the Netherland Donor Faeces Bank is now up and running, and can collect, process and store stool samples, which may be distributed to hospitals as needed.

All potential donors approaching the centre are screened for any potential transmissible diseases and their blood tested for a variety of conditions, including HIV and hepatitis. If accepted, “Stools of healthy donors are processed to a liquid suspension, stored at -80°C and thawed when a patient needs treatment. It is administered by a nasogastric tube to patients,” explains Kuijper. Not surprisingly, given the risk associated with the infusion, this screening is extensive and extremely strict. “Approximately 90% of donors are not suitable, due to their living conditions and tests of blood and stools,” adds the researcher.

Currently, the bank is open purposely to help patients with multiple relapsing C. difficile infections. Typically, these patients receive long courses of antibiotic vancomycin but the efficacy of this approach is variable and decreases significantly with multiple recurrences. In these difficult cases, a faecal transplant may be the most viable alternative: in the paper that sparked this work, over 90% of the participating patients resolved their C. difficile infection after one or two infusions, compared to much lower efficacy rates in patients receiving only the standard vancomycin treatment.

According to the researchers, transplants of faecal matter introduce healthy bacteria into the body of patients suffering the consequences of multiple C. difficile infections, leaving them with a feeble and lethargic microbiota, dominated by harmful bacteria. In this good vs bad bacteria battle, as the numbers of healthy bugs start to increase, they can reverse the trend and re-establish a normal and diverse gut population.

More specifically, the team detected a rise in Bacteroidetes species and Clostridium clusters IV and XIVa (Firmicutes), accompanied by a drop in Proteobacteria species. This is certainly good news, as the first can help their respective new host obtain energy from difficult to reach carbohydrate sources, while the latter include notable pathogens such as Escherichia and Salmonella.

Stool donations may not yet be as widely accepted as blood donations but it’s likely just a matter of time, until donors realise they can provide a secure treatment for patients with a complex and potentially fatal condition. Not surprisingly, recipients seem much more willing to accept these transplants. “For patients with severe and relapsing disease, it has been accepted,” concludes Kuijper.

Alex Reis

Photo: Greyling

Last Changes: 04.08.2016