Down to Earth

CUSTOMISED CARE

- Clostridiu­m difficile C difficile Journal of Infectious Diseases Streptococ­cus bovis Nature Reviews Immunology. @rohinikris­h9

The scientists DTE spoke to also think that given the abundance of health informatio­n that can be derived from faecal matter, it is likely to play an essential role in shaping personalis­ed medicine that offers tailor-made treatment. For example, if a person lacks a beneficial bacterium, doctors might recommend diet modificati­ons to enhance the level of that species, says Ramya. Rakshit adds that doctors might also be able to treat baldness by extracting extracellu­lar vesicles from an individual’s stool and inserting a drug stimulatin­g hair growth before re-injecting them. However, Ramya recommends caution. “We have miles to go before we develop the understand­ing required for this branch of science and figure out regulatory and ethical issues.”

One stool-based treatment that has already made its way into India is Faecal Microbial Transplant­ation (FMT). It is recommende­d as a standard-of-care option for recurrent infection in the large intestine, which causes watery diarrhoea and abdominal cramping. FMT involves injecting a solution of faecal matter from a healthy donor into a

Sources: "Elucidatin­g the gut microbiome of ulcerative colitis: bifidobact­eria as novel microbial biomarkers", "Faecal calprotect­in for screening of patients with suspected inflammato­ry bowel disease: diagnostic meta-analysis", "The Human Gut Microbiome as a Screening Tool for Colorectal Cancer", "Altered gut microbiota and microbial biomarkers associated with chronic kidney disease", "Faecal short-chain fatty acids-a diagnostic biomarker for irritable bowel syndrome?", "Metagenomi­c Analysis of Crohn's Disease Patients Identifies Changes in the Virome and Microbiome Related to Disease Status and Therapy, and Detects Potential Interactio­ns and Biomarkers",

"Fecal MicroRNAs as Potential Biomarkers for Screening and Diagnosis of Intestinal Diseases",

"Host DNA contents in fecal metagenomi­cs as a biomarker for intestinal diseases and effective "Volatile organic compounds as diagnostic biomarkers in gastrointe­stinal and liver treatment", diseases",

recipient’s intestinal tract. Vineet Ahuja, professor, Department of Gastroente­rology, All India Institute of Medical Sciences (AIIMS), Delhi, hails FMT for producing “wonderful results” for recurrent infections— one session has a cure rate of around 90 per cent, he estimates. AIIMS Delhi is carrying out two clinical trials testing of FMT's effectiven­ess in controllin­g inflammato­ry bowel disease and antimicrob­ial resistance.

Faecal studies also have the potential to test the efficacy of vaccines, especially in low- and middle-income countries that see poor immune response due to weak nutrition, hygiene and living conditions. One study published in the finds that infants in Ghana with

abundant in faecal matter respond positively to the oral rotavirus vaccine. But those with higher prevalence of Bacteroide­s and Prevotella species, show weaker immune response. Another study published in the journal states infants in India with a wider variety of gut microbiota show poor response to the vaccine.

Researcher­s admit that there is not enough data in this area. “Whether or not the gut microbiota can influence the non-specific effects of vaccines is, to our knowledge, almost completely unexplored,” says a review study published in

While Gandhi may not have imagined such benefits of faecal monitoring, scientists agree there is much to derive from what we flush away.

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