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FECAL TRANSPLANTS: A Guide

WANT POOP TRANSPLANTS. HERE'S HOW TO MAKE THEM SAFE, Wired Magazine.

https://www.wired.com/story/patients-want-poop-transplants-heres-how-to-make-them-safe/

“If you ask 99 percent of physicians who do this, they will tell you anything that came along to limit access to stool banks would be catastrophic,” he says. Plus, there’s no guarantee the microbiome even can be successfully be pulled apart and put back together in pill form. “People have spent 50 years trying to come up with synthetic blood and we still have a blood bank," says Stollman. "Who’s to say stool will be any different?”
And this is one reason I put a little more hope into full spectrum fecal transplants. As it has been shown in mice experiments, and in human experiments using whole stool, the more depleted the microbes are, the more resistant the community is in accepting any new species into that community. throwing just a few down there might not stick to well as a cure, they'll just pass on through. But throwing a large diverse amount down there, even though it's a little bit of a "crap shoot", might be the best strategy for the time being.

The first report of cure from Crohn's with FMT was a women who received a large volume FMT through nasogastric tube using 3 donors all in the same day, whereas almost every other experiment using a single donor and enemas took 30-80 FMT enemas.
 
Sere's Health reported an analysis of a recent study on their bacterial pill SER-287 , it's kind of like a fecal microbiota transplant pill, showing that the bacteria was successfully engrafted/implanted in the G.I. systems of the patients and that the patients improvements were related to how well these bacteria were transplanted. The bacteria was confirmed to still be present 4 weeks after the last dose. I'm wondering how long those bacteria will stay and which species they actually are.

https://www.businesswire.com/news/home/20180104005427/en/Seres-Therapeutics-Reports-SER-287-Phase-1b-Microbiome
 
I was just reading a new study on IBD microbiome and genetics and they found very little relationship between genetics and the state of the microbiome, this seems to be an important factor in considering causation of the disease suggesting genes have little to do with it and that the composition of the microbiome itself is a force that acts upon the human body. So again if there was a cure it could very well be by manipulating the microbiome composition such as what is being done with Fecal Microbiota Transplants. https://www.nature.com/articles/ctg201758
 
I read this in the news too, Bill. I'm still waiting although it seems tempting to go to South Korea, Japan, or China to get this treatment
 
I'll be taking that one a bit at a time, Bill. Thanks though. I have also sent off for some CBD drops to see if it helps. Some claim it helps with pain and joints although this is the legal version. Can't get the real stuff as it's too expensive and I don't know anyone that can make the cannabis oil. Let's hope it works.
 
Here is a quote which seems to give clues to why performing a fecal transplant might be so difficult at least in IBD, but this was from researchers studying FMT in C. difficile infection. Scientists are wondering to what degree the human microbiome can be separated and put back together, it seems it cannot be separated too much, and that groups of similar bacteria seem to only be implanted at a time. IF you threw a only a few unrelated strains down there it is highly unlikely they would stay down there, so you need multiple similar strains or even the entire microbiome at all at once.

"Furthermore, donor strains within a species engraft in an all-or-nothing manner and previously undetected strains frequently colonize patients receiving FMT."
https://www.genomeweb.com/sequencing/donor-recipient-strain-analyses-offer-fecal-transplant-engraftment-clues

Another article on the same topic.
https://medicalxpress.com/news/2018-02-fecal-transplantation-bacteria-flourish.html
 
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Would this mean that taking mega doses of healthy bacteria, such as 50 billion Immuprobio, won't take hold? Seems to help for 24 hours but unless I take loads of them they don't have much effect and certainly nothing lasting beyond the 24 hours.
 
Would this mean that taking mega doses of healthy bacteria, such as 50 billion Immuprobio, won't take hold? Seems to help for 24 hours but unless I take loads of them they don't have much effect and certainly nothing lasting beyond the 24 hours.
Those supplements aren't anywhere near a fecal transplant, as far as my opinion goes.
 
The study results were very surprising—for most of these clinical measures, the association with bacterial genomes was at least as strong, and in some cases stronger, than the association with the host's human genome. These findings, according to the study investigators, provide solid evidence that understanding the factors that shape our microbiome may be key to understanding and treating many common health problems.

"We cannot change our genes, but we now know that we can affect—and even reshape—the composition of the different kinds of bacteria we host in our bodies,” concluded senior study investigator Eran Segal, Ph.D., a professor in the department of computer science and applied mathematics at the Weizmann Institute. “So, the findings of our research are quite hopeful; they suggest that our microbiome could be a powerful means for improving our health."
https://www.genengnews.com/gen-news-highlights/for-the-microbiome-the-nature-vs-nurture-debate-comes-into-focus/81255542
 
Interesting. I'm just waiting for them to give it the go ahead for Crohn's. I still expect it to be a long way off, and i'm not young. I have lived with it virtually all my life. I think China, Korea and Japan have/had a poo soup for 2,000 years. They know how to deal with this. Quite how, I don't know. But they have had answers for this length of time, but the west is holding out on us. I have thought about researching Korea and poo soup to see how much it cost and could I go there? One day, we'll be cured.

Probably not before my clogs are popped.
Thanks for the link.

PS, have tried to get out to my creative writing class tonight, and hey, guess what? Yep, I had to turn around at the next village and get in quick for the loo. Mind, I was feeling totally exhausted and ill. I should have known better than to even attempt tonight. Wow, we Crohnies miss out on a lot.
 
Mark Davis said FMT is in a state of limbo as it is classified as a drug but can never be licensed as such because the FDA requires every drug to be identical from one dose to the next.

“FMT is not that and it will never be that,” he said, “so they defined it as a drug but a drug that could never be approved.”

Davis said one solution, suggested by other clinicians, would be to reclassify it as a tissue, like blood or bone marrow — something that treats and prevents disease but is never the same in every batch. But, he said, since the product is not composed of human cells, but rather bacterial cells, it couldn’t be defined as tissue by the FDA.

“What I would like the FDA to do is to say, ‘You know what? FMT is not a drug, it’s something else’,” Davis said. “And we should classify it as its own unique thing and give clinicians some more latitude to be able to treat patients with a variety of conditions.”
http://www.kpbs.org/news/2018/mar/06/fecal-transplants-potent-remedy-defies-regulation/
 
I wonder if I could try this.

Most of my inflammation is located in my rectum, and I don't have Cdiff. I am also on a large dose of remicade.
 
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I have not. Is that something new? I've never heard of it.
I don't know much. These are what I had read before:

Rectal Therapy with Prograf Helped Patients with Resistant UC, Study Shows

Patients with resistant ulcerative proctitis, a mild form of ulcerative colitis (UC), respond to therapy with rectal Prograf (tacrolimus) ointment, achieving clinical remission and mucosal healing, according to the results of a small clinical trial.
ibdnewstoday.com/2017/10/17/prograf-tacrolimus-rectal-therapy-resistant-ulcerative-proctitis/

The Clinical Trial
One of the newer medications is the immunosuppressing medication, tacrolimus that has been shown to be effective in UC when taken orally. Unfortunately, the oral use of this medication can have numerous serious side effects. In order to overcome these side effects, the use of topical rectal tacrolimus has been examined. Pilot studies in ulcerative proctitis (inflammation confined to the rectum) resistant to conventional therapies have demonstrated a clinical remission in 75% of patients and although the medication was well absorbed through the lining of the bowel, the levels in the blood were very low and no serious side effects were reported. The findings suggest that this preparation is indeed effective for inflammation in the distal bowel and that the method of administration reduces side effects. Further work, however, now needs to be undertaken to validate the original findings.
clinicaltrials.gov/ct2/show/NCT01418131

The Published Paper of That Trial
www.cghjournal.org/article/S1542-3565(17)30258-6/fulltext

You can search in the forums for more information. I don't know if this treatment is available to patients right now; but it seems worthy of searching about it.

Like yourself, I have been dealing with a very stubborn rectal inflammation (Crohn's) for a long time, and I am starting a new treatment for it: 6mp + Cimzia + rectal mesalazine. I've already been using max. dose of 6mp, and now adding Cimzia and rectal mesalazine. I'll see how well it's going to work in three to four months.

I find drinking bone broth soup helps with my rectal inflammation.

I have a question for you: Does eating fruits (fructose) increase your rectal bleeding? It does that to me.

Have you tried vitamin E enema? SCFA/butyrate enema?
 
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I don't know much. These are what I had read before:

Rectal Therapy with Prograf Helped Patients with Resistant UC, Study Shows

Patients with resistant ulcerative proctitis, a mild form of ulcerative colitis (UC), respond to therapy with rectal Prograf (tacrolimus) ointment, achieving clinical remission and mucosal healing, according to the results of a small clinical trial.
ibdnewstoday.com/2017/10/17/prograf-tacrolimus-rectal-therapy-resistant-ulcerative-proctitis/

The Clinical Trial
One of the newer medications is the immunosuppressing medication, tacrolimus that has been shown to be effective in UC when taken orally. Unfortunately, the oral use of this medication can have numerous serious side effects. In order to overcome these side effects, the use of topical rectal tacrolimus has been examined. Pilot studies in ulcerative proctitis (inflammation confined to the rectum) resistant to conventional therapies have demonstrated a clinical remission in 75% of patients and although the medication was well absorbed through the lining of the bowel, the levels in the blood were very low and no serious side effects were reported. The findings suggest that this preparation is indeed effective for inflammation in the distal bowel and that the method of administration reduces side effects. Further work, however, now needs to be undertaken to validate the original findings.
clinicaltrials.gov/ct2/show/NCT01418131

The Published Paper of That Trial
www.cghjournal.org/article/S1542-3565(17)30258-6/fulltext

You can search in the forums for more information. I don't know if this treatment is available to patients right now; but it seems worthy of searching about it.

Like yourself, I have been dealing with a very stubborn rectal inflammation (Crohn's) for a long time, and I am starting a new treatment for it: 6mp + Cimzia + rectal mesalazine. I've already been using max. dose of 6mp, and now adding Cimzia and rectal mesalazine. I'll see how well it's going to work in three to four months.

I find drinking bone broth soup helps with my rectal inflammation.

I have a question for you: Does eating fruits (fructose) increase your rectal bleeding? It does that to me.

Have you tried vitamin E enema? SCFA/butyrate enema?
i tried a mesalamine enema for a little while about 3-4 years ago, I don't think it helped very much though. I am only on remicade right now.

I've only recently been flaring up. I've been on remicade for a very long time (15+ years), and I've been trying to modify my diet the past 7-8 years.

I was in pretty bad shape a few years ago until I discovered sushi. Sushi has been my miracle food (only the most plain sushi). It's very expensive but its held me in check and has actually helped my stools greatly (honestly to the point where they were the best they've ever been since I was diagnosed). When I'm feeling bad I stick to sushi and white rice and chicken for dinner. I've been getting very cocky though the past couple months and have been eating many things I shouldn't be (red meat, bread, espresso) and have seemed to come down with a flare. My BM's are no longer looking good and I can't seem to get back on the right track, even while sticking to my sushi, white rice and chicken diet.

I usually stay away from fruits, and rough veggies like broccoli. I try to eat things that are soft and not very crunchy. When I'm doing well though and my BM's are looking good I can usually sneak a banana in here and some apples there, and I'm usually fine.

I will ask my GI though next week about the rectal tacrolimus. It seems like an interesting treatment because it seems very specific to that area, and not something so "systemic" like remicade.

These fecal transplants though still interest me, but I feel as if these are things people that are on imunosuppressant drugs should not take.
 
i tried a mesalamine enema for a little while about 3-4 years ago, I don't think it helped very much though. I am only on remicade right now.

I've only recently been flaring up. I've been on remicade for a very long time (15+ years), and I've been trying to modify my diet the past 7-8 years.

I was in pretty bad shape a few years ago until I discovered sushi. Sushi has been my miracle food (only the most plain sushi). It's very expensive but its held me in check and has actually helped my stools greatly (honestly to the point where they were the best they've ever been since I was diagnosed). When I'm feeling bad I stick to sushi and white rice and chicken for dinner. I've been getting very cocky though the past couple months and have been eating many things I shouldn't be (red meat, bread, espresso) and have seemed to come down with a flare. My BM's are no longer looking good and I can't seem to get back on the right track, even while sticking to my sushi, white rice and chicken diet.

I usually stay away from fruits, and rough veggies like broccoli. I try to eat things that are soft and not very crunchy. When I'm doing well though and my BM's are looking good I can usually sneak a banana in here and some apples there, and I'm usually fine.

I will ask my GI though next week about the rectal tacrolimus. It seems like an interesting treatment because it seems very specific to that area, and not something so "systemic" like remicade.

These fecal transplants though still interest me, but I feel as if these are things people that are on imunosuppressant drugs should not take.
Yes, tacrolimus enema looks very good both for effectiveness and safety. If tacrolimus enema is not a available as a treatment yet, then you might want to give mesalazine enemas a longer try again. It takes time to show its full effectiveness.

I remember your thread in the diet section of this forum about how sushi and sushi rice were helping you. I found that intriguing at that time.

Diet is definitely a huge factor. I know what you mean by getting cocky after a while and paying the price for it. That's why after similar experiences like yours I started to stick to a diet no matter how I feel.
This is the diet I've been following: https://www.thepaleomom.com/start-here/the-autoimmune-protocol/
I think it is a good idea to do an elimination diet to know how your body reacts to certain foods.

Regarding bone broth, its effects are almost too good to be true. It decreases the intestinal inflammation like a powerful medicine. You may be surprised if you try it. If you want to try, I suggest you to make it in your house. It's not hard to prepare. Make sure it comes off as jelly-like after you finish cooking. I use a recipe similar to this one: http://whole9life.com/2013/12/whole9-bone-broth-faq/ You don't have to add all those vegetables in the soup. I only use bones, salt, water, vinegar and carrots. I also make it in pressure cooker to make it quickly.

I too find white rice to be very soothing. It greatly decreases diarrhea and never hurts my gut. It's a good carb source. I eat it at every meal.

If you are really struggling, then you can try other treatment options, like Stelara or Stelara+6mp or Humira etc. These variations. I'd still add the rectal mesalazine though.

Another thing you can try is a short course of antibiotics like flagyl, cipro (if you can tolerate this, it can cause serious tendon problems).

Fecal transplants seem more effective for UC patients than Crohn's patients.

If you want to learn more about treating rectal inflammation you might want to ask your questions in the Healingwell UC forum. Folks in there have more experience and knowledge in regards to this issue than Crohn's patients. They might give you new ideas.
 
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I'm intrigued by the idea of using someone with great healthy stool to help others with our health concerns be able to be healthy too. I'm a little frustrated that doctors in Indiana do not seem to take IBSD and these issues seriously. I don't even see my doctor anymore and have been told by my regular doctor I need to go back. I know I do but they don't help me and I'm just wasting money so why go see them? Anyways I also tried the Everlywell blood test to see if there were foods that were making my IBSD worse and I had several show up and now I do not eat gluten or milk products. I know I still have IBSD but at least I know some of what triggers my problem as well.
 
I'm intrigued by the idea of using someone with great healthy stool to help others with our health concerns be able to be healthy too. I'm a little frustrated that doctors in Indiana do not seem to take IBSD and these issues seriously. I don't even see my doctor anymore and have been told by my regular doctor I need to go back. I know I do but they don't help me and I'm just wasting money so why go see them? Anyways I also tried the Everlywell blood test to see if there were foods that were making my IBSD worse and I had several show up and now I do not eat gluten or milk products. I know I still have IBSD but at least I know some of what triggers my problem as well.
There are a few studies using Fecal Microbiota Transplants to treat IBS showing some success, here is one of them. https://www.ncbi.nlm.nih.gov/pubmed/28628918
 
Very large study on FMT in crohn's disease in china.

Brief Summary:
The gut microbiota is considered to constitute a "microbial organ" which has pivotal roles in the intestinal diseases and body's metabolism. Evidence from animal and human studies strongly supports the link between intestinal bacteria and inflammatory bowel diseases (IBD). Dozens of studies reported its efficacy in treatment of severe Clostridium difficile colitis. Preliminary studies using FMT for Ulcerative Colitis (UC), Crohn's diseases (CD), irritable bowel syndrome (IBS) and constipation have also met with some success. However, the results on CD is very limited. This is an initial step into investigating the potential efficacy of fecal bacteriotherapy for CD, the investigators propose to determine the efficiency, durability and safety of FMT in a series of 500 patients with CD in ten years.
 
holy crap.....
The 5 'D's of fecal transplants and not one of those 'd's is diet......
I'll wait till these clueless people work it out...

Compare that to Glenn Taylor of the Taymount (more than 20,000 FMTs),
from a podcast interview....

Getting a New Gut Microbiota via Fecal Transplant with Glenn Taylor
"GT: Let’s make sure everybody understands here. Bacteria are fussier eaters than teenagers. They like their substrate. They’re quite specific about what their enzymes that they produce can actually break down. So they live in an ordered structure.

They have an order in which bacteria, who make hundreds of times more enzymes than we humans can, when substrate food—what we’ve eaten—when substrate allies with them, species take it in turn to crack and break the molecule in the nutritional food substance down as they work their way through.

So a species will leap, and at the top, they’ll start. Other species will come in and say, “Hey, that’s stuff I can use.” They’ll break that. More species, and the whole thing cascades down.

And to make sure the entire food chain is fed, there’s such a structure that goes with it, which,......

And of course, the antibiotics kill bacteria by particular methodologies. And they kill the pathogenic (which their target species are) and similar styles of commensal. They’re killed by exactly the same mechanism.

So you’ve gone in to kill a pathogen. But at the same time, you’ve killed one of your native, commensal species. Now, if each one of those at a critical point in this digestive cascade as it goes from top to bottom is not there to break the food down further, who feeds the little guys below?.......

....... And I’m totally, totally with you on that one. The treatment package when you have your gut microbiota must include, first of all, understanding your own environment and make sure that you’re eating the right foods. At least you’ve got substrate anyway.......

But as you so accurately said, hormones play havoc with your gut bacteria if they start to respond in different strengths. So gut bacteria are affected by somebody’s emotional state, as you say, stress. Everything within in our environment remodels our gut micro flora. It’s very, very sensitive indeed.

And so, yes, it’s not just the last meal you had but the last row you had. And so we have to sit with patients and make sure they totally understand all of the ramifications of lifestyle. And that is every element of it."
https://drruscio.com/getting-new-gut-microbiota-via-fecal-transplant-glenn-taylor/
 
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https://drruscio.com/getting-new-gut-microbiota-via-fecal-transplant-glenn-taylor/

I read some of this and I've become skeptical of glenn taylor from the taymount clinic. He brings up interesting topics but he doesn't sound educated enough to navigate the territory he is trying to navigate and coming from me, that's a bad sign, because even i don't claim to know it all, so that's why I doubt he does either.

It could be the case they are doing successful FMT's for various conditions, but why since 2009 have they not made any official attempt to document their success? It makes one wonder, but I would never get a FMT from the Taymount clinic at this point, nor would I recommend anyone do that.

The page did have an awesome link to a study I was looking for though! https://www.ncbi.nlm.nih.gov/pubmed/28105618
 
Gastroenterol Res Pract. 2018 Apr 3;2018

The Value of Fecal Microbiota Transplantation in the Treatment of Ulcerative Colitis Patients: A Systematic Review and Meta-Analysis.

Abstract
BACKGROUND AND AIMS:
Fecal microbiota transplantation (FMT) has challenged the traditional management of ulcerative colitis (UC) in recent years, while it remained controversial. We aimed to provide a systematic protocol of FMT treatment on UC.

METHODS:
Studies reporting on FMT treatment in UC patients were performed. A fixed-effect model was used to assess the efficacy of FMT.

RESULTS:
Eighteen studies were enrolled (n = 446). A pooled proportion of patients who received FMT had a significant efficacy compared to the placebo group (odds ratio (OR): 2.73, P = 0.002) with a low risk of heterogeneity (P = 0.59, I2 = 0%). The Mayo score decreased to 5 points in a state of mild-moderate activity after FMT treatment, and the optimal range of the Mayo score baseline was 6-9 for FMT administration. Then, the baseline of the Shannon diversity index (SDI) had a negative correlation with the clinical response rate (R = -0.992, P = 0.08) or remission rate (R = -0.998, P = 0.036), and the optimal diversity of bacteria was at 7 days to one month. Moreover, the colonoscopy delivery and unrelated fecal donor had slight superiorities of FMT treatment.

CONCLUSION:
FMT treatment had a higher efficacy and shorter time-point of early assessment of effectiveness on UC patients compared to traditional therapies. And the optimal FMT delivery and donor were colonoscopy delivery and unrelated donor in clinical practice.


https://www.ncbi.nlm.nih.gov/pubmed/29849592
 
Most protocols processing of stool for FMT destroy the bacteria that are needed due to exposure to oxygen. Finally someone is addressing this issue, I've known about this possibility for years now though. For DIY, using a blender to mix stool with saline will likely expose a lot of oxygen to it, mixing it slowly in a freezer bag that has no air might help protect it.

https://www.healio.com/infectious-disease/gastrointestinal-infections/news/online/{bf9c60ca-fa60-49dc-8a03-66f04cbe5030}/video-aspects-of-stool-processing-for-fmt-may-reduce-efficacy
 
more than 150 drug makers globally are working on potential medicines for various disorders that could be linked to the human microbiome, and they have invested more than $2 billion in research, said Mo Langhi, an organizer of this week’s microbiome conference.
It sounds like a preposterous idea: Collect a sample of every type of bacteria that lives in the human gut. But that’s the goal of Bernat Olle, an MIT-trained chemical engineer. Over the past three years, the Cambridge biotech startup he runs, Vedanta Biosciences Inc., has assembled a menagerie of some 60,000 bacteria types.
https://www.bostonglobe.com/business/2018/06/18/microbiome/4qkHpemmUCWcNVO1ERuIyH/story.html
 
WebMD health news: Research Flourishes on Promise of Fecal Transplants, Aug. 1, 2018.

Madelynn Hernandez was in a battle. The California teenager loved to draw, dance, and study math, but her Crohn’s disease was seriously getting in the way.

“I had so much nausea, and my head was often spinning,” she says. “Sometimes I had good days and I was fine, but on the bad days, I just wanted to stay at home and lie on the couch. I was missing a lot of school.”

So last fall, when her doctor talked to her about being part of a study of new treatments for young people with bowel diseases, Hernandez jumped at the chance, even if it meant having someone else’s fecal matter put inside her body.


Since receiving her fecal transplant, Hernandez’s Crohn’s disease remains in remission, and she has stopped taking most of her medications. In the next few months, the now 16-year-old expects to eliminate all of them.

“I feel so much better,” Hernandez says. “No stomach pain, no diarrhea.”
https://www.webmd.com/digestive-disorders/news/20180801/research-flourishes-on-promise-of-fecal-transplants
 
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Two studies characterize the transmission of the microbiome from mother to infant during the first months of life. October 1, 2018 | Andreu Prados

the maternal gut microbiome provided the largest contribution of transmitted strains. It was also found that maternal gut strains were more likely to adapt and persist in the infant gut compared with those acquired from other sources.
http://www.gutmicrobiotaforhealth.com/en/two-studies-characterize-the-transmission-of-the-microbiome-from-mother-to-infant-during-the-first-months-of-life/
 
Bringing order to the ‘wild frontier’ of microbiome medicine.
By BERNAT OLLE, OCTOBER 2, 2018
https://www.statnews.com/2018/10/02/microbiome-medicine-living-drugs/

Several startups and large pharmaceutical companies are doing important work to advance microbiome-related treatments.

But there are still many questions, as the FDA workshop made clear. Here are three big ones: How can we ensure that the bacteria included in living drugs won’t contribute to the spread of antibiotic resistance or virulence genes? What are the appropriate assays to ensure the quality of a living drug that will be used in clinical studies and, hopefully, in treatments? Can we ensure the manufacturing process will create consistent products? The industry must answer these correctly before the FDA will approve living drugs.
Fecal transplants, which are inherently variable mixtures of undefined microbial composition, are no longer the only way to deliver health-promoting microbes to people who need them. Advances in basic science are positioning researchers to use more rigorous and systematic approaches to harnessing the power of the microbiome.

The company I lead, Vedanta Biosciences in Cambridge, Mass., and others are working to develop drugs that consist of carefully defined consortia of bacteria that have been shown to work together to fight off pathogens or to stimulate immune responses via the gut.

There will likely be many approaches to doing this. At Vedanta, we select strains of bacteria to include into possible drugs from a collection of tens of thousands of pure single-strain cultures. Once we have identified the strains we believe will work best together, we grow them separately in growth chambers called fermentors — no fecal donations needed. After extracting the bacteria from their fermentors, we freeze-dry them into stable powders, mix the powdered strains together, and pack the mixture into capsules.

Swallowing such a capsule releases the assemblage of helpful bacteria into the gut, where they are awakened from hibernation. As they colonize the gut and begin fitting in with the existing microbial ecosystem, they can help remodel the patient’s microbiome, creating a more resilient ecosystem better able to fight infections. The right mixtures can also manipulate the immune system in the intestine, either to tone it down (to help those with inflammatory bowel diseases or food allergies) or to rev it up (to help potentiate cancer immunotherapies and vaccines).
 
Hi Wildbill.
I frequently stop by this thread to see what news you have found and relay to us. Te latest research projects conclusions seem promising for the wider acceptance of this treatment option.
Fantastic to ve able to hope options outside immunosuppression.
y GI still refuses FMT has a place in the treatment of IBD but I am warming to the possibility of the DIY approach. Is just that the possibe donors don't do well on the Bristol scale :(
But I digress..

What I really wanted though is to extend a warm thank you to you for gathering the relevant research here.
so thank you!
 
Human transition from hunter gathers to Agriculture is linked to changes in the microbiome.

"the Tharu, the Raute, the Raji and the Chepang -- are longtime residents of the Himalayan foothills, with similar languages, cultural practices and ancestry. Where the four diverge is in their dietary history: The Tharu have practiced agriculture for the past 250 to 300 years; the Raute and the Raji have practiced agriculture for the past 30 to 40 years; and the Chepang are hunter-gatherers. The study found that the composition of the gut microorganisms, or gut microbiome, of each population differed based on whether and how long ago it had departed from a hunter-gatherer lifestyle."
https://www.eurekalert.org/pub_releases/2018-11/sm-vig110918.php
 
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FMT successfully treats colitis brought on by immune checkpoint inhibitor anti-cancer drugs:

https://www.nature.com/articles/s41591-018-0238-9
Yea I saw this the other day, I was under the impression this new t-cell check point cancer therapy was a "miracle" with no side effects. I guess it kind of still is compared to surgery radiation and chemotherapy which have their own set of downsides independent of cancer itself. Hooray for FMT!! yet again!!

I also recently became aware of newly discovered relationships between cancer, the microbiome and t cell checkpoint therapy. A study in mice found certain probiotics suppressed cancer just as well as the checkpoint therapy. These are commercially available strains commonly found in yogurt. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873287/

In a recent human study, it was found that differences in the gastrointestinal microbiome could enhance anticancer power of checkpoint therapy and explained the difference in response rates. https://news.uchicago.edu/story/specific-microbes-digestive-tract-can-boost-success-cancer-immunotherapy

So it's reasonable to see that the restoration of the human microbiome via FMT even has applications in cancer treatment.
 
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A recent study gave 7 colonoscopic Fecal transplants to ulcerative colitis patients showed a benefit, 46% or 19 patients achieved steroid free remission. They were previously dependent on steroids.


Efficacy of fecal microbiota therapy in steroid dependent ulcerative colitis: a real world intention-to-treat analysis.

Intest Res. 2018 Nov 20.
doi: 10.5217/ir.2018.00089.

Abstract
BACKGROUND/AIMS:
Four high-quality randomized controlled trials have proven the efficacy of fecal microbiota transplantation (FMT) in active ulcerative colitis (UC). We assessed the efficacy of FMT in a real-world setting involving steroid-dependent patients with UC.

METHODS:
This was a single-center prospective analysis of data from steroid-dependent patients with UC treated with FMT from September 2015 to September 2017 at the Dayanand Medical College, a tertiary care center in India. Fecal samples from random unrelated donors were administered through colonoscopy at weeks 0, 2, 6, 10, 14, 18, and 22. The primary outcome was achievement of steroid-free clinical remission, and the secondary outcomes were clinical response and endoscopic remission at 24 weeks. Modified intention-to-treat analysis was performed, which included subjects who underwent at least 1 FMT.

RESULTS:
Of 345 patients with UC treated during the study period, 49 (14.2%) had steroid-dependent UC. Of these 49 patients, 41 underwent FMT: 33 completed 7 sessions over 22 weeks according to the protocol, and 8 discontinued treatment (non-response, 5; lost to follow-up, 2; and fear of adverse effects, 1). At week 24, steroid-free clinical remission was achieved in 19 out of 41 (46.3%) patients, whereas clinical response and endoscopic remission were achieved in 31 out of 41 (75.6%) and 26 out of 41 (63.4%) patients, respectively. All patients with clinical response were able to withdraw steroids. There were no serious adverse events necessitating discontinuation.

CONCLUSIONS:
A multisession FMT via the colonoscopic route is a promising therapeutic option for patients with steroid-dependent UC, as it can induce clinical remission and aid in steroid withdrawal.

https://www.ncbi.nlm.nih.gov/pubmed/30449078
 
This is the one we have been waiting for, a clinical study now begins testing Vedanta biosciences VE202, a bacterial pill taken orally for IBD which would replenish clostridia bacteria that regulate the inflammatory response.

These bacteria have been shown to consistently be lower in diversity in microbiome studies of IBD patients. It's a more targeted approach compared to using whole stool. One of my concerns is whether the pill has enough strains to make an impact and whether they will readily and permanently inhabit the microbiome, but chances are pretty good they will. One recent study on FMT in U.C. associated remission in patients who's clostridium bacterial diversity had increased after FMT, this suggests these are the bacteria responsible for efficacy of FMT in IBD.

https://www.pharmaceutical-business-review.com/news/vedanta-biosciences-ve202-trial/
 
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A new article on microbiome research linking increasing industrialization, modern medicine/antibiotics to lower diversity of microbes when comparing microbiomes of less industrialized societies to more developed ones.

This is related to fecal transplantation and IBD in that the ibd microbiome is less diverse then a healthy person and FMT increases the overall diversity, and reduces symptoms.
https://phys.org/news/2019-01-diversity-rural-african-populations-microbiomes.html
 
That's interesting, Bill. Thanks. Somehow i fully expected those in tribes or more remote areas to have healthier gut flora. My Crohn's is now at the point where i need surgery.... again!
 
That's interesting, Bill. Thanks. Somehow i fully expected those in tribes or more remote areas to have healthier gut flora. My Crohn's is now at the point where i need surgery.... again!
I'll have to get all the details again but generally the people of Botswana are not a remote tribe, this is a recently modernized country, which could include food industrialization and the toxic additives that come with it and modern medicine which include, antibiotics.
 
An update on bill gates involvement in microbiome science.
https://www.businessinsider.my/bill-gates-diet-breakthrough-microbiome-2019-2/

Gates’ interest in digestion goes beyond the disgusting and debilitating kinds of bacteria in our systems. The billionaire investor recently said he thinks we can revamp the inner workings of our guts by seeding the microbial colonies that live inside us.

“One thing that people are not expecting a breakthrough in that I’m quite optimistic we will get a breakthrough in is understanding nutrition,” Gates said during a conversation last week at the 92nd Street Y in New York. He thinks hacking the microbiome is the way to do it.
 
Just a reconfirmation of previously known facts on the susceptibility of the bacteria in the G.I. microbiome to oxygen, in other words, oxygen kills them.

Bacterial viability in faecal transplants: Which bacteria survive?

EBioMedicine. 2019 Feb 19. pii: S2352-3964(19)30095-7. doi: 10.1016/j.ebiom.2019.02.023. [Epub ahead of print]
Abstract

BACKGROUND:
The therapeutic potential of faecal microbiota transplantation (FMT) is under investigation for a range of inflammatory conditions. While mechanisms of benefit are poorly understood, most models rely on the viability of transplanted microbes. We hypothesised that protocols commonly used in the preparation of faecal transplants will substantially reduce the number, diversity and functional potential of viable microbes.

METHODS:
Stools from eight screened donors were processed under strict anaerobic conditions, in ambient air, and freeze-thawed. Propidium monoazide (PMA) sample treatment was combined with quantitative PCR, 16S rRNA gene amplicon sequencing and short-chain fatty acid (SCFA) analysis to define the viable microbiota composition and functional potential.

FINDINGS:
Approximately 50% of bacterial content of stool processed immediately under strict anaerobic conditions was non-viable. Homogenisation in ambient air or freeze-thaw reduced viability to 19% and 23% respectively. Processing of samples in ambient air resulted in up to 12-fold reductions in the abundance of important commensal taxa, including the highly butyrogenic species Faecalibacterium prausnitzii, Subdoligranulum variable, and Eubacterium hallii. The adverse impact of atmospheric oxygen exposure on the capacity of the transplanted microbiota to support SCFA biosynthesis was demonstrated by significantly reduced butyrate and acetate production by faecal slurries processed in ambient air. In contrast, while reducing overall levels of viable bacteria, freeze-thaw did not significantly alter viable microbiota composition.

INTERPRETATION:
The practice of preparing material for faecal transplantation in ambient air profoundly affects viable microbial content, disproportionately reducing the abundance of anaerobic commensals and the capacity for biosynthesis of important anti-inflammatory metabolites.
 
This new study prospectively examined the fecal microbiota in adult CD patients with changing or stable disease course over time.
It concludes that while CD patients have an altered microbiota, quote: "The altered microbiota composition and stability in CD was neither associated with disease activity nor long-term disease course, questioning its involvement in the development of an exacerbation".

https://www.ncbi.nlm.nih.gov/m/pubmed/30810207/
 
This new study prospectively examined the fecal microbiota in adult CD patients with changing or stable disease course over time.
It concludes that while CD patients have an altered microbiota, quote: "The altered microbiota composition and stability in CD was neither associated with disease activity nor long-term disease course, questioning its involvement in the development of an exacerbation".

https://www.ncbi.nlm.nih.gov/m/pubmed/30810207/
Yea that is interesting. I don't think it is strong enough to contradict all the research that exists though. The conclusion may also be limited to how they tracked the microbiome, I don't know enough about all the tools or ways that exist but I do know there are advantages and disadvantages to each method, in this one I think they used 16srna.

Either way, this study also acknowledges less overall diversity of the crohns/IBD microbiome compared to healthy control, so this is in agreement with many other observations, seems to be a general consensus on that fact, that somehow, the microbiome is involved in IBD.

There also seems to be a growing acknowledgement of the involvement of other organisms like fungi and viruses, so if they were only looking at bacteria, they may not have observed much differences during exacerbation of symptoms. I know a little bit but I'm not an absolute expert. So far I'm still sticking with the concept that our microbiome is messed up and restoring it will lead to a cure.
 
Exp Ther Med. 2019 Apr;17(4):2581-2586. doi: 10.3892/etm.2019.7263. Epub 2019 Feb 13.

Effect of fecal microbiota transplantation on experimental colitis in mice.

Abstract

The aim of the present study was to investigate the effect of fecal microbiota transplantation (FMT) on the acute inflammatory response in a murine model of dextran sulfate sodium (DSS)-induced colitis, and to delineate the putative underlying mechanism(s). Mice were divided into four groups, namely the normal control, DSS, 5-aminosalicylic acid (5-ASA) and FMT group. Mice in the DSS, 5-ASA and FMT groups were orally administered 3% DSS (w/v) solution for 7 days to induce colitis. On days 1, 3, 5 and 7, mice in the DSS, 5-ASA and FMT groups were respectively administered 0.5% carboxymethylcellulose sodium, 5-ASA suspension and fecal suspension by enema. The disease activity index of each mouse was calculated on a daily basis. All mice were sacrificed on day 8, and the length of their colons was measured.

Myeloperoxidase (MPO) activity, and the levels of tumor necrosis factor α (TNF-α), interleukin (IL)-1β and IL-10 in the colon tissues of each group were also measured. Compared with that in the DSS group, FMT ameliorated the severity of inflammation due to ulcerative colitis in mice, which was accompanied by a significantly decreased MPO activity, reduced levels of TNF-α and IL-1β, and an increased level of IL-10 in colon tissue (all P<0.05). Taken together, these results demonstrated that FMT exerted a therapeutic effect on experimental colitis in mice, and the associated mechanism is likely to involve the remodeling of the intestinal flora and regulation of intestinal T-cell immunity homeostasis.

https://www.ncbi.nlm.nih.gov/pubmed/30906449
 
This is one of the first studies using FMT pills for U.C, but it's a little disappointing. I wish I had all the details like how they made the pills, were they whole spectrum? just bacteria? and what was the CFU and were there any diet recommendations. Then perhaps id have a better understanding of why it wasn't successful or not.

It's certainly not enough information to make me give on the the concept with so much other information that is better that supports the merit of FMT for IBD.

https://www.ncbi.nlm.nih.gov/pubmed/30946615
 
Autism symptoms reduced nearly 50% 2 years after fecal transplant.

In a new study, “Long-Term Benefit of Microbiota Transfer Therapy in Autism Symptoms and Gut Microbiota,” published in Scientific Reports, Arizona State University researchers Rosa Krajmalnik-Brown, James Adams and lead author Dae-Wook Kang demonstrate long-term beneficial effects for children diagnosed with ASD through a revolutionary technique known as Microbiota Transfer Therapy (MTT), a special type of fecal transplant originally pioneered by Australian gastroenterologist Thomas Borody. Remarkably, improvements in gut health and autism symptoms appear to persist long after treatment.
https://asunow.asu.edu/20190409-discoveries-autism-symptoms-reduced-nearly-50-percent-two-years-after-fecal-transplant
 
Hmm, i'm really Aspberger's. Another reason for them to hurry up with fecal transplant. Thanks, Wildbill. Mind, gonna have to try that cbd with thc as I am pretty sure I have cancer now. Ladies cancer, btw. I'm researching like mad at the moment. I'm in the UK, I've never had any luck with my health. I've just sent off for some that has a 16.5% thc, I hope it helps.
 
Hmm, i'm really Aspberger's. Another reason for them to hurry up with fecal transplant. Thanks, Wildbill. Mind, gonna have to try that cbd with thc as I am pretty sure I have cancer now. Ladies cancer, btw. I'm researching like mad at the moment. I'm in the UK, I've never had any luck with my health. I've just sent off for some that has a 16.5% thc, I hope it helps.
I really hope you don't have cancer, if this is a concern then I just want you to know that melatonin has been shown to be effective in wide range of different cancers in a human study done 20 years ago. https://www.ncbi.nlm.nih.gov/pubmed/10674014

many other papers written on the potential for melatonin, and perhaps you are aware this is a hormone our body produces in response to darkness.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412427/


Here is information on the most powerful cancer fighting foods:

https://nutritionfacts.org/video/1-anticancer-vegetable/
https://nutritionfacts.org/video/which-fruit-fights-cancer-better/
https://nutritionfacts.org/video/which-nut-fights-cancer-better/
https://nutritionfacts.org/video/cancer-interrupted-garlic-flavonoids/
 
A company that is developing microbiome based drugs made of bacteria, recently had their patents challenged by competing companies, but they were allowed to keep the patent. They have a broad patent on clostridial species which are important to the gut and regulation of inflammation in the gut. Microbiome studies in IBD shows these species are less diverse compared to healthy patients.

https://www.apnews.com/Business Wire/dc1c35a728b9409b8fee7b0ab33deea2

https://www.vedantabio.com/news-media/press-releases/detail/2568/vedanta-biosciences-key-microbiome-patent-upheld-in
 
I've always wanted to try FMT. Is it still only used for Cdiff? Anyway we can do this without getting government or doctor approval?
If you have a healthy donor, there isn't much else stopping you from doing it, other then its kind of hard to do successfully, its the bacteria sensitivity to oxygen that is an obstacle so don't mix it in a blender.

And the donor should follow a chemical free high fiber diet 2-3 weeks before hand. Then you can give yourself some FMT enemas and see what happens. I suggest you just plug your nose and swallow it on an empty stomach followed by a high fiber meal 20min afterwards, but that's pretty disgusting. Mix it with saline solution in a freezer bag with as much air squeezed out as possible.
 
In search of stool donors: a multicenter study of prior knowledge, perceptions, motivators, and deterrents among potential donors for fecal microbiota transplantation.

Abstract

Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent Clostridioides difficile infection. Stool donors are essential, but difficult to recruit and retain. We aimed to identify factors influencing willingness to donate stool.

We conclude that 1) blood donors and males are more willing to consider stool donation; 2) altruism, economic compensation, and positive feedback are motivators; and 3) screening process, high donation frequency, logistics of collection/transporting feces, lack of public awareness, and negative social perception are deterrents. Considering these variables could maximize donor recruitment and retention.


https://www.ncbi.nlm.nih.gov/pubmed/31122134
 
Wow, Wild Bill. Thanks for all your research. I'm in the San Francisco Bay area and am actively seeking an FMT donor.

So this is my idea:
A group of us in the San Francisco Bay Area (or other parts of California) can "share" our donors. That way each of us can have more bacterial diversity. All of us need to have a healthy donor who is expertly and verifiably screened. We would pay a specified amount for each "donation".
If this works out, and we recruit more donors, we can invite other people to join who really need FMTs. Let's help each other! I'd love to hear your feedback. Let's start a movement... so to speak. :)
 
Wow, Wild Bill. Thanks for all your research. I'm in the San Francisco Bay area and am actively seeking an FMT donor.

So this is my idea:
A group of us in the San Francisco Bay Area (or other parts of California) can "share" our donors. That way each of us can have more bacterial diversity. All of us need to have a healthy donor who is expertly and verifiably screened. We would pay a specified amount for each "donation".
If this works out, and we recruit more donors, we can invite other people to join who really need FMTs. Let's help each other! I'd love to hear your feedback. Let's start a movement... so to speak. :)
A Movement!! very nice! I do like the idea, I'm not in this mindset at the moment but that's where I was when I posted this years ago. There is a FMT facebook group I one posted there too. Wish you the best of luck!!

Oxygen is a very big variable to a successful transplant not sure how much you know at this moment, but diversity is too, as the only woman to have been cured of crohn's used 3 donors at once with a nasogastric tube. Mixing in a freezer bag instead of a blender is how you could limit exposure to oxygen for an enema. learning to use a nasogastric tube is one option, just drinking the solution is another.
 
FDA warns on FMT:
  • Two immunocompromised adults who received investigational FMT developed invasive infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E.coli). One of the individuals died.
  • FMT used in these two individuals were prepared from stool obtained from the same donor.
  • The donor stool and resulting FMT used in these two individuals were not tested for ESBL-producing gram-negative organisms prior to use. After these adverse events occurred, stored preparations of FMT from this stool donor were tested and found to be positive for ESBL-producing E. coli identical to the organisms isolated from the two patients.

https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/important-safety-alert-regarding-use-fecal-microbiota-transplantation-and-risk-serious-adverse
 
FDA warns on FMT:
  • Two immunocompromised adults who received investigational FMT developed invasive infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E.coli). One of the individuals died.
  • FMT used in these two individuals were prepared from stool obtained from the same donor.
  • The donor stool and resulting FMT used in these two individuals were not tested for ESBL-producing gram-negative organisms prior to use. After these adverse events occurred, stored preparations of FMT from this stool donor were tested and found to be positive for ESBL-producing E. coli identical to the organisms isolated from the two patients.
https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/important-safety-alert-regarding-use-fecal-microbiota-transplantation-and-risk-serious-adverse

You see it isn't that simple when you read the study below reporting FMT being safe in immunocompromised patients in 2016. There were so many variables as to why one of those patients died but most importantly the donor must be screened to some degree and healthy beyond all measures we cannot conclude all FMTs are going to kill people when so many have been done at this point in the tens of thousands now for c diff since it was approved.
Int J Colorectal Dis. 2016 May; 31(5): 1059–1060.
Fecal transplant is as effective and safe in immunocompromised as non-immunocompromised patients for Clostridium difficile
 
why can't the donor just drop their stool directly into a bath of salt water? and then that would be put directly in a baggie.
well it would be saline which is a defined concentration of salt water as far as I recall. I forget the details but too much salt and that could negatively affect things perhaps. You can make saline yourself though, and generally it just gets mixed with the stool and yes you should do it in a freezer bag to limit exposure to oxygen.
 
You see it isn't that simple when you read the study below reporting FMT being safe in immunocompromised patients in 2016. There were so many variables as to why one of those patients died but most importantly the donor must be screened to some degree and healthy beyond all measures we cannot conclude all FMTs are going to kill people when so many have been done at this point in the tens of thousands now for c diff since it was approved.
No one is saying that "all FMTs are going to kill people." FDA is saying that in light of these new findings that caution must be used and certain donor screening protocols need to be implemented.

From the FDA warning:

Because of these serious adverse reactions that occurred with investigational FMT, FDA has determined that the following protections are needed for any investigational use of FMT:
  • Donor screening with questions that specifically address risk factors for colonization with MDROs, and exclusion of individuals at higher risk of colonization with MDROs.
  • MDRO testing of donor stool and exclusion of stool that tests positive for MDRO. FDA scientists have determined the specific MDRO testing and frequency that should be implemented.
 
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