Fecal transplants tested on colitis
Therapy already highly successful for people with C. difficile infections
Stool transplants appear to be a home run in the treatment of recurrent C. difficile infections. Researchers now question whether they would work for other bowel diseases, and even obesity.
The first trials on whether ulcerative colitis could be treated with an infusion of a healthy person’s stool produced confusing results.
One trial was ended early when an analysis concluded the study wasn’t on track to get an answer.
The same happened with a second by researchers at McMaster University in Hamilton. But the data and safety monitoring board assessing the trial told the McMaster team to go ahead with a few patients who hadn’t yet received the treatment or a placebo.
When they were done with those patients, the McMaster study took a surprising turn for the better.
The group, led by Dr. Paul Moayyedi, director of gastroenterology at McMaster medical school, reported recently that they did see a positive outcome. Ulcerative colitis patients who received a stool transplant were more likely to go into remission than patients who received a placebo.
Moayyedi and his colleagues published the results in the journal Gastroenterology.
“The caveats are that this trial was stopped early ... ( and) the sample size isn’t large enough to make a definitive conclusion,” he said.
It appears fecal transplants are unlikely to be as effective for colitis as they are for C. difficile.
Out of 70 patients, 24 per cent of those who received fecal transplants went into remission, compared to five per cent of those who got a placebo.
The journal published an editorial that warned fecal transplants for ulcerative colitis aren’t yet ready for prime time.
“I’m rooting for Moayyedi and his colleagues. I think they did an outstanding job,” said Dr. Ari Grinspan, one of the authors of the editorial and a gastroenterologist at the Icahn School of Medicine at Mount Sinai Hospital in New York.
“But we just need more data. We need more numbers.”
The principle behind fecal transplants is that in gastrointestinal diseases, the armies of bacteria in the GI tract are out of balance. It’s thought the disease can be controlled by replenishing good bacteria that keep the bad actors in check.
It certainly works for C. difficile diarrhea. Grinspan said he’s treated about 100 patients and has a 95 per cent cure rate.
Since ulcerative colitis is caused by an inflammation of the colon lining — as are C. diff infections — it seemed fecal transplants might help here, too.
Moayyedi’s study was set up to allow a data and safety monitoring board to take a look about half way through. If the treatment seemed to be causing harm, the study was to be stopped. The same outcome was to be ordered if the study didn’t seem likely to show a statistically significant benefit.
Grinspan suggested it was a stroke of bad luck that that happened.
“I know these guys. I know they did exactly what they needed to do. But it still calls into question exactly what we’re seeing.”
Grinspan noted that five other studies are underway that will hopefully shed light on whether fecal transplants will work for ulcerative colitis.
Moayyedi insisted the work needs to continue, saying it could eventually lead to a cure for ulcerative colitis.
With C. difficile, the cause of the disease is known. But with ulcerative colitis, it’s not clear what induces the body to turn on the lining of the colon.
If fecal transplants work for some patients, the next step will be trying to figure out what the treatment is fixing — and trying to stop that disease process from occurring in the first place.