Beyond the yuck factor
GMT is proving effective in the treatment of debilitating infections.
Gut microbiota transfers have been used in traditional medicine for hundreds of years. In China in the fourth century, human faeces were used to treat food poisoning, and in the 16th century, suspensions of faecal matter were known there as “yellow soup”.
It’s not yet used as an obesity treatment, but it’s proved remarkably effective in the treatment of the debilitating and recurrent diarrhoea caused by the Clostridium difficile bacterium, which usually occurs in elderly patients who have had prolonged antibiotic therapy.
Counties Manukau Health microbiologist Dr David Holland says the technique involves obtaining a stool from a healthy donor – usually the patient’s partner – mixing it with saline, then simply pouring the liquid through a tube into the rectum, as in an enema. The first patient whose procedure he supervised, in 2013, said she started feeling better almost immediately after six months of relapsing diarrhoea.
“There was no guidebook on how to do it, but it worked and it has worked ever since,” he says. He reported 12 cases that followed, which had a 100% success rate. The procedure isn’t common here, but neither is it rare: several dozen have been performed in the past five years.
Patients who have researched their infection online aren’t surprised when the unusual therapy is recommended. Although they’d rather avoid it, most are at the point where they are willing to give it a go.
“Most people really don’t want to think about a faecal microbiome transfer; there’s a bit of a yuck factor, and patients would much rather take a pill.”
Holland has a consulting role with the Liggins study and says he hopes the process will ultimately provide an off-theshelf pill of healthy donors’ gut bacteria so any potential stigma associated with the treatment is removed.
He says patients with other inflammatory bowel conditions of unknown cause have approached him about using GMT, but the evidence in clinical trials is not convincing enough to warrant its use.
The capsules in the Liggins study can be produced on site within the hour, so about 70-80% of the bacteria survive the process.
It’s not an overly complicated process. In effect, the stool is blended, before going through a series of washes and filtrations. Finally, the bacterial component is packaged into capsules and frozen before being safety-checked. Slow or inefficient processing can kill the gut bugs.
Each teen in the Liggins obesity study will take 30 capsules over one or two days, produced from a mix of donors.
The dosage is based on the clostridium therapy – one bowel motion, which effectively treats the condition, produces the equivalent of 30 capsules.