Prescription poop could be the future of medicine

Insulin, selective serotonin reuptake inhibitors, poop. You probably don’t think of the latter as medicine, but there’s good reason to think that’s about to change. Last month, the FDA approved a stool-based treatment for the first time. The drug Rebyota is approved for people with recurrent bacterial infections of Clostridium difficile. c. the difference Causes diarrhea and inflammation of the colon; It is responsible for thousands of deaths in the United States each year.

Despite the recent, first-time approval of stool softener drugs, doctors have been using stool microbial transplants — in which stool from a donor is transplanted to alter the microbial community in the recipient’s colon — for years. This approval is likely the start of a promising future for prescription poop.

The gut microbiome is a colony of trillions of microbes, including bacteria, viruses and fungi, that live in our digestive tract. Over the past decade, research into the gut microbiome has suggested that this colonization contributes to a variety of conditions and diseases. Injecting a healthy donor’s gut microbes into the recipient’s gut can help alleviate diseases affected by the gut microbiome, Ivan Vuzkovic-Civzin, Biomedical Sciences, Gastroenterology, and F. Widjaja, assistant professor of inflammatory bowel disease research at Cedars-Sinai, said opposite

What conditions can fecal-microbial transplant (FTM) treat?

Amy Berto, associate professor of medicine at Duke and director of its Fecal Microbiota Transplantation Program, says opposite That works for FMT C. diff Antibiotic-like treatment “because it uses an intact microbiome present in a healthy donor’s stool to help restore the recipient’s microbiome,” she says. “Antibiotics are used to treat it C. difficult Bacteria eliminate it only in the active phase. Spores often persist and can become reactivated leading to recurrence of infection.” By then, damage to the microbiome has already occurred and a more global approach is needed, which FMT can provide.

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Also C. diff, “there is relatively strong evidence that FMT works well for a subset of patients with ulcerative colitis,” says Vujkovic-Civjin. For example, a 2015 randomized controlled trial published in the journal Gastroenterology found that after seven weeks of FMT, 24 percent of 70 people with ulcerative colitis were in clinical and endoscopic remission (ie no evidence of inflammation or disease) compared to five percent of the placebo group. A 2017 randomized controlled trial was published The Lancet found that after 8 weeks of treatment, 44 percent of the FMT group was in clinical remission from ulcerative colitis, and 54 percent had a clinical response to treatment; In the placebo group, these numbers were 20 percent and 23 percent, respectively.

In addition to ulcerative colitis, early studies show “promising results for fecal microbiota transplants for autism, cancer immunotherapy, and other conditions.”Getty/Skipro

In addition to ulcerative colitis, early studies “show promising results for FMT in autism, cancer immunotherapy and other conditions,” Vujkovic-Civjin said. He cautions that although small, preliminary studies for the latter condition are promising, larger, randomized controlled trials need to be performed before the effectiveness of FMT can be firmly understood.

Why FMT may be able to treat conditions that other medications cannot

Vujkovic-Civzin said prescription drugs can be so promising for difficult-to-treat conditions because many challenging diseases are “multi-factorial,” meaning that multiple biological systems are aberrant or uncontrolled in a way that allows the disease to manifest. Many of the current treatments for such diseases only attack part of the problem, resulting in partially or even marginally effective treatments.

In contrast, “the microbiome appears to have its own unique role in many diseases, and so if we also address this important organ, we may improve treatment outcomes,” he says. “FMT is one of the first techniques in the field to modify the microbiome, and the promising results we see in various diseases are exciting and push us to learn more.”

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Barto agrees, saying that disruption of the microbiome, called dysbiosis, can lead to a cascade of events that can create a pro-inflammatory state that affects the entire body.

“This pro-inflammatory state can potentially affect multiple disease processes in the body,” she says. “In the future, FMT may be used in some form to modify or treat these or other conditions. This is the most exciting aspect of microbiome-based therapy: the opportunity to unlock its full potential.”

What will the future treatment look like with bowel movements?

For newly approved FMT treatments c. the difference As it is a colonial enema, it will not necessarily be its future form. FMT enemas are most meaningful for diseases that primarily affect the colon c. the difference infection, says Vujkovic-Civzin. Interestingly, he adds, FMT for repetition C. diff Not necessarily there is be in the form of an enema; “Ceres Therapeutics also has one[n oral] microbiome product for recurrent CDI that will likely be approved by the FDA soon.”

For conditions involving the small intestine, non-enema methods of delivery would likely be preferable, because “this community of bacteria is both different from the colon and has a different effect on our metabolism and immune system,” explains Vujkovic-Civzin. “It is likely that some diseases would benefit from changing the microbiota of the small intestine, and thus nasogastric or pill-form microbiome therapeutics might be more effective for those diseases.”

These are routes that have previously been examined in some FMT studies. For example, a 2016 case study evaluated the nasogastric administration of FMT in two patients with multiple organ dysfunction syndrome (MODS) and diarrhea due to septic shock — a serious bloodstream infection. In nasogastric administration, a doctor inserts a tube through the nose and into the stomach, so they can deliver the medicine more effectively.

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Doctors gave patients an infusion of sterile stool from a healthy donor through a nasogastric tube. After administering it, patients’ fever subsided and their other symptoms stabilised. In addition, the researchers found that some colonies of beneficial bacteria increased in the gut microbiome of patients following FMT.

How close are we to the pill?

Vujkovic-Civzin says she sees FMT as a tool to assess the role of the microbiome in human disease.

“When we see FMT working for a particular disease, it gives us strong evidence that the microbiome is important in that setting and that we should continue our efforts to better understand its role,” he says.

“One of the challenges of microbiome-based therapies is that success in clinical trials for more chronic conditions such as obesity or ulcerative colitis appears to be short-lived,” Barto said. “This is likely due to the overall complexity of the microbiome, influenced by multiple ongoing internal and external factors.”

Additionally, as with many treatments, especially those that are still being fully understood, FMT carries some risks. Vujkovic-Civzin says these risks include “inadvertent transfer of infectious organisms to recipients that are not detected in a healthy donor.” In some cases, these infectious microbes may be held at bay by the donor’s health but will have a more significant effect on a less healthy person.

Additionally, some FMTs are still a bit unpredictable. “We don’t know which recipient microbes will colonize the host and which recipient microbes will be displaced,” he says. “Importantly, FMT also does not always displace the same microbes in each recipient.”

Once scientists learn which gut microbes are most important in a given disease, more targeted microbiome-mediated treatments than FMT can be developed.

However, for conditions as complex and traditionally difficult to treat as ulcerative colitis, c. the differenceAnd even for potential sepsis, prescription poop can be a sophisticated and life-saving treatment.


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