Experimental fecal transplants could revolutionize treatment of bowel diseases
Karolyn Coorsh, CTVNews.ca
Published Sunday, September 8, 2013 10:20PM EDT
Last Updated Sunday, September 8, 2013 11:27PM EDT
A Canadian study examining the treatment of inflammatory bowel diseases with human fecal transplants is showing some promising early results.
The experimental therapy involves injecting fecal matter into the GI tract of sufferers of ulcerative colitis. The therapy is being conducted by researchers at McMaster University in Hamilton, Ont.
The study is attempting to find a way to treat Crohn’s and colitis. About a quarter of a million Canadians suffer from the diseases, and while some sufferers are able to control them with medications, others live in constant pain.
Uwe Richter, 40, was in the latter category. Several years ago, the apple farmer from southern Ontario started developing severe pain in his abdomen, sometimes rendering him unable to work. Then he developed severe diarrhea.
"I was (always) looking for the washroom," he said in an interview with CTV News.
After he was diagnosed with ulcerative colitis, he tried a number of drugs but they failed to suppress the symptoms. Eventually, physicians advised him to remove part of the colon.
His wife Jeannine had heard of an experimental treatment called fecal transplantation. They came upon the McMaster study and Richter enrolled.
At first, he was placed on placebo, but when doctors started him on transplants of healthy fecal bacteria from a screened donor, he noticed a difference.
"It started after the second or so treatment," he said. "I didn’t have to go to the washroom that often anymore."
His health improved, his wife said, and he gained weight.
It’s those signs of healing that researchers are aiming for.
With a 95 per cent cure rate, the fecal transplants are already showing major success in treating the deadly C. difficile bug. Recent studies also suggest bowel bacteria from healthy people may also help treat obesity.
Researchers aren’t sure why it works, but they’re hoping to find out.
What they do know is bowels are filled with bacteria that govern the immune system. So far, therapy to treat inflammatory bowel disease like colitis has focused on trying to suppress the immune system because it is overactive in these diseases.
There is also evidence that shows Crohn's and colitis sufferers may have less ‘beneficial’ bacteria in their guts, which is why researchers are looking at whether placing 'good' bacteria into the bowels may essentially reset a hyperactive immune system.
In the McMaster study, 120 participants suffering from ulcerative colitis receive fecal material from specially screened donors, while others receive a placebo mixture. Similar to an enema, the mixtures are infused into their colon with a syringe.
About 60 patients have been treated so far, and researchers are hoping to recruit additional patients for the placebo-controlled trial.
Dr. Paul Moayyedi, of the Farncombe Family Digestive Health Research Institute at McMaster University, said some patients have done extremely well.
"The longest patient has been in remission is for about six months now," he said.
The Hamilton study is using only two donors, one of whom appears to have particularly robust fecal matter that is linked to many remissions.
"In this trial, unfortunately it’s not 100 per cent successful," said Michael Surette, a McMaster University microbiologist who is studying the dozens of bugs found in the stool samples from donors.
"We are starting to analyze some of the microbiology, and I think we will have some information on what’s effective and what’s not."
While researchers try to understand how it works, a second study in Alberta is trying to learn about how much fecal matter is needed, how often and why it doesn’t work in some individuals.
"You have to keep doing the transplants. It looks like the resilience, or the longevity, is not forever," said Dr. Richard Fedorak, a professor of gastroenterology at the University of Alberta who initiated the study.
The 'yuck' factor
There are also concerns about the "ick" factor surrounding the use of fecal matter, but that aspect doesn’t bother Anna Fernandez.
The 39-year-old says she is in “100 percent remission” from painful ulcerative colitis after taking part in the McMaster study last fall.
"I feel great, I feel like I can do whatever I want, go wherever I want, eat whatever," she said.
Those who say it’s "gross" to treat diseases with material usually flushed away are missing the point, Fernandez said.
"It is bacteria that you have and I don’t and I need, so if they found a way of getting a healthy person’s bacteria into my body then that is good enough for me," she said.
Other questions also remain about the fecal transplants, including whether synthetic material may be used. Researchers in Guelph, Ont., are trying to bioengineer fecal transplantation material.
If studies continue to uncover the healing properties of human waste, Canadian doctors are hoping to have final results of the studies in two years to begin treating ulcerative colitis.
Those interested in participating in the McMaster study can contact research associate Melanie Wolfe at firstname.lastname@example.org
With a report from CTV medical specialist Avis Favaro and producer Elizabeth St. Philip