A FAE­CAL TRANS­PLANT SAVED THIS WOMAN’S LIFE…

Are they a med­i­cal game changer?

Sunday Territorian - - FRONTIER -

Wel­come to the fu­ture of medicine, where hu­man waste could treat ev­ery­thing from autism to alope­cia. By Kylie Steven­son

When Rachel Challen fell chron­i­cally ill as a teenager, her dad Jeremy do­nated part of him to help her get well. But it wasn’t his blood or an or­gan Jeremy gave Rachel – it was his poo, and she says it saved her life.

From the age of 15, Rachel suf­fered from chronic con­sti­pa­tion. She saw mul­ti­ple GPs and spe­cial­ists, who pre­scribed dif­fer­ent medicines and rec­om­mended elim­i­na­tion di­ets, but the nau­sea, bloat­ing and cramps con­tin­ued to plague her fi­nal years of high school.

“There were days when I was in so much pain, I’d just have to go back to bed,” she says.

Rachel was ad­mit­ted to hos­pi­tal on sev­eral oc­ca­sions and her men­tal health suf­fered. How­ever, a fae­cal mi­cro­biota trans­plant ( FMT) in 2013, at the age of 18, changed all that.

“Dad al­ways teased me when I was con­sti­pated,” she says. “He’d say, ‘I’m like clock­work’. So when we were look­ing for a [ FMT] donor, I said, ‘Hey, you al­ways say your bowel is like clock­work...’”

Thanks to her dad’s do­na­tion, Rachel’s gut flora was “re­trained”. Now 21, she’s study­ing ra­di­og­ra­phy at univer­sity. “My con­di­tion no longer rules my life. If my health went down­hill, I’d def­i­nitely do it again.”

Fae­cal trans­plants are noth­ing new. In fact, they’ve been around in China for hun­dreds of years. It makes sense that re­plac­ing bad gut bac­te­ria with healthy bac­te­ria could make a dif­fer­ence to bowel is­sues. But, in­creas­ingly, ex­perts are find­ing the im­pli­ca­tions are much wider, and healthy gut flora could be the key to treat­ing many other con­di­tions.

Pro­fes­sor Thomas Borody from the Cen­tre for Di­ges­tive Dis­eases in Syd­ney, who treated Rachel, has seen many other pa­tients cured of a va­ri­ety of con­di­tions fol­low­ing a fae­cal trans­plant.

“We’re deal­ing with an area that’s prob­a­bly as big as an­tibi­otics in 1947-48 which will im­pact medicine tremen­dously, but we don’t even know what we’re do­ing with it yet,” he says. “We’re stand­ing at the be­gin­ning of a whole age of ex­plo­sions of, for ex­am­ple, re­vers­ing stuff such as schizophre­nia, de­pres­sion and se­vere anx­i­ety.”

HOW FAE­CAL TRANS­PLANTS WORK

Borody was the first in Aus­tralia to em­brace fae­cal trans­plants. In 1988 he had a pa­tient with col­i­tis who had been ad­mit­ted to a men­tal in­sti­tu­tion as a re­sult of her con­di­tion.

“I could tell just by lis­ten­ing to her that she had caught some­thing in her bowel so

I thought why don’t we flush her out and re­plen­ish her bowel with healthy flora,” Borody says. “She was dra­mat­i­cally fixed on the first day.”

Since then, Borody’s Syd­ney clinic has per­formed more than 8000 FMTs. The treat­ment in­volves trans­fer­ring fae­cal mat­ter, con­tain­ing bac­te­ria and other micro­organ­isms, from a healthy donor to pa­tients to re­store the miss­ing com­po­nents of their gut flora. This re­places good bac­te­ria that has been killed or sup­pressed, caus­ing bad bac­te­ria to over­pop­u­late the colon. It can be done via a colonoscop­y, en­ema or na­so­je­ju­nal tube (through the stom­ach).

For Rachel’s trans­plants, each morn­ing Jeremy would make a de­posit for Rachel to take into the clinic. There, it would be mixed with saline in a blender to form a paste. Ini­tially, the poo was ad­min­is­tered to Rachel via colonoscop­y in day surgery, then ev­ery sec­ond day for the next fort­night, she would visit the clinic for a “top up” via an en­ema.

The ther­apy in­cludes a spe­cial low-fi­bre diet prior to the trans­plant and a course of an­tibi­otics to kill off as many bad bac­te­ria as pos­si­ble.

FMT is ex­pen­sive if an anony­mous donor is used – so of­ten a fam­ily mem­ber comes to the res­cue in­stead, as Jeremy did.

COULD IT TREAT DE­PRES­SION?

FMT is clin­i­cally proven to be use­ful in treat­ing Clostrid­ium dif­fi­cile ( C. diff) – a bac­te­ria that at­tacks the lin­ing of the in­tes­tine, caus­ing di­ar­rhoea and se­vere ab­dom­i­nal pain – and there’s doc­u­mented suc­cess with colon-re­lated ill­nesses such as di­ar­rhoea and con­sti­pa­tion. But there are many more po­ten­tial ap­pli­ca­tions, says Dr Michael Con­lon, se­nior re­search sci­en­tist in health and biose­cu­rity at the CSIRO, in­clud­ing brain be­haviour, mood be­haviour, obe­sity, rheuma­toid arthri­tis and autism. “There is po­ten­tial [that] gut mi­crobes play a wider role and there is prom­ise this might work for a lot of things, we just need that op­por­tu­nity to re­search us­ing mi­cro­biota to al­ter other con­di­tions,” he says. US doc­tors have re­ported FMT suc­cess with fi­bromyal­gia, alope­cia and chronic fa­tigue.

Gas­troen­terol­o­gist Dr Colleen Kelly, who is also as­sis­tant pro­fes­sor of medicine at Brown Medicine Gas­troen­terol­ogy and Liver Re­search in the US, says she has seen un­ex­pected out­comes af­ter FMT. “A gen­tle­man with alope­cia uni­ver­salis for over 20 years started to grow hair again on his face and head af­ter FMT to treat an un­usual case of re­cur­rent C. dif­fi­cile in­fec­tion of the small in­tes­tine.

“A col­league in Chicago had a pa­tient with alope­cia re­grow hair af­ter FMT. Pa­tients with in­flam­ma­tory bowel dis­ease have had dis­ease flares af­ter FMT ( about 15 per cent of the time), which shows that there can be ad­verse con­se­quences too,” she says.

Borody said he has used FMT to treat pa­tients who have C. diff along­side other con­di­tions, such as col­i­tis or Crohn’s dis­ease – and it has made a dif­fer­ence in those ill­nesses. He has also re­ported im­prove­ments in acne, de­pres­sion, MS and Parkin­son’s dis­ease. “When we treat pa­tients’ bowel symp­toms, some­times other con­di­tions seem to go away or markedly im­prove,” he says. “Two got up out of their wheel­chairs and walked. The other just needed a cane.” Of those three, 15 years later two pa­tients re­main well. The third had the same suc­cess, but has since died of un­re­lated causes.

There are many tri­als in the US in­ves­ti­gat­ing FMT’s po­ten­tial to treat di­a­betes, Crohn’s and HIV, and here in Aus­tralia the CSIRO is cur­rently do­ing a trial on pa­tients with ul­cer­a­tive col­i­tis.

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