A FAECAL TRANSPLANT SAVED THIS WOMAN’S LIFE…
Are they a medical game changer?
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.