Just one more interesting thing about this study on MS microbiome:Fecal Transplant could help Multiple sclerosis.
Dr borody treated a man with MS for constipation with a fecal transplant and afterwards his MS improved, which suggested the FMT help or cured it. So borody may have done it again!! I hope more studies will be done to prove it.
Clostridial bacteria also are found lacking diversity in IBD microbiome and at first I was afraid this information would contradict the theory that the bacteria missing in IBD is the first and prime cause of the disease, but it seems the theory still stands and restoring the bacteria with an FMT is likely to cure BOTH conditions as the bacteria missing either in IBD or MS are distinct but have similar sounding names.These taxa comprised primarily of clostridial species belonging to Clostridia clusters XIVa and IV and Bacteroidetes. The phylogenetic tree analysis revealed that none of the clostridial species that were significantly reduced in the gut microbiota of patients with MS overlapped with other spore-forming clostridial species capable of inducing colonic regulatory T cells (Treg), which prevent autoimmunity and allergies; this suggests that many of the clostridial species associated with MS might be distinct from those broadly associated with autoimmune conditions
Just my 2 cents,Fecal Transplant could help Multiple sclerosis.
Dr borody treated a man with MS for constipation with a fecal transplant and afterwards his MS improved, which suggested the FMT help or cured it. So borody may have done it again!! I hope more studies will be done to prove it.
You bring up a good point and this is something I'm aware of. without a pill giving the precise amount of bacteria needed, factors like the disease state of the patient will begin to outweigh a DIY protocol and you will not achieve success. Achieving success with an at home DIY Fecal transplant is difficult, can it ever be done successfully? I'm not sure yet but I'm convinced it's difficult at this point.Just my 2 cents,
You do have to understand, its not only bacteria that you can replace,
Its also the curent enviroment in the gut that plays a massive part.
I have done the fmt with perfect donors orally, and failed on multiple occasions.
And i always corelate back to the various studies,
2 variables always play apart in the other fmt studies that are succesful...
1)antibiotics - though i disagree with this method as, eradicating the current gut flora, doesnt automatically switch off innflammation...its takes time for inflammation to go down for sure.
2) in the studies, the docs never take them of steroids... they might taper them off slowly... but even at the end of the fmt weeks... they still use minute amounts of steroids ..
In my opinion, i really think the environment plays the biggest factor in allowing the donors flora to take part..
People who often have the constipation side of bowel problems... do not have uncontrollable levels of gut inflammation!
Easier to help them with fmt.. higher success rate.
Lastly, i would like to say, i have seen studies showing, when inflammation is quelled thiugh steroids or any other drugs people may use... if inflammtion goes down, the gut flora reverses very quickly to closely resemble those of control patients.
I do not believe is just a coincidence that the bacteria missing in IBD play a large role in regulating inflammatory response. This strongly suggests, the microbiota was damaged and immune system went out of whack, and restoring these bacteia with a Fecal Microbiota Transplant, can reverse/cure IBD. If it were the case that these bacteria that were missing had a complelet unrelated function, then i would consider an alternative theory, and see these missing bacteria as insignificant in explaining IBD.One thing that plays a critical role is the host immune system. It can act like an herbicide and kill off a good portion of the gut flora, or negatively impact the mucus membrane which provides much of the nutrients to the bacteria. It's the chicken or the egg causality dilemma. We don't know which came first, an imbalance in the bacteria triggering an immune response, or an off-kilter immune system disrupting normal flora.
Studies so far suggest FMT as an enema and in any form is more effective in UC when compared to crohn's. Oral route's seem better for crohn's affecting small intestine, most studys are in the first post of this thread. Borodys experiment with FMt in 5 uc patients usining enemas used antibiotics prior to lower pathogenic bacteria and to encourage new bacteria to take hold better, this study wasn't enough to demonstrate it was more effective then without using antibiotics so really it is unknown whether this would improve FMT efficacy. In my opinion the antibiotic would have to be very precise to target pathogens and leave the good bacteria unharmed to have any benefit, other wise it's probably better not to use them at all so you can possibly preserve some of your own microbes that have been passed down through your family, antibiotics could also cause further damage since we know how important bacteria are for our health now. AMAT has shown efficacy, maybe it would help to use this prior to FMT, But FMT just need's to be available in pill form and most of these questions will be unimportant as we gain more control over how much bacteria and in what ratios a patient will recieve.Does FMT work better in UC or Crohn's where the colon is involved? If disease is limited to the small intestine, would the route of FMT need to be oral vs. via enema? In Crohn's patients that have tested positive for a pathogenic mycobacteria through Aitken's lab, do you think a course of AMAT followed by (or run concurrent with) FMT would be beneficial? Kind of a double whammie - killing the bad bug plus restoring the beneficial bacteria which seems to be impaired in CD.
I dont think using a store bought probiotic as an enema will have more benefit over consuming it orally, these bacteria need fiber from food anyways to grow and make beneficial compounds so eating it with a meal will have much more impact. Store bought probiotics will definitely not be comparable to a real FMT as the bacteria we need is not available which you probably know already, its only in healthy people's poop at the moment.I think the biggest issue with both of these is that they're both difficult for the average patient to obtain. GI's won't generally touch AMAT, and FMT has to be done correctly with supervision of a knowledgeable doc and correct donor matter. Did I hear Dr. Borody was working on a pill? So both could be beneficial if done right I believe. Also, do you think in the interim FMT could be done on people with colon disease using fivelac or other probiotic enema instead of fecal matter? Another member here had huge success with that in CD.
Your welcome!All very interesting and exciting. Thanks for the thread! I hope you are well.
http://journals.lww.com/jcge/Fulltext/2015/11001/Fecal_Microbiota_Transplant__Respice,_Adspice,.16.aspxThe vast majority of FMTs were performed without any oversight or regulation until early 2013, when the Food and Drug Administration (FDA) ruled that stool fell within the definition of a biological product and drug.
A selection of bacteria or in other words, synthetic, would be the safest option. But we still don't know exactly which bacteria we need, most likely clostridia. Open biome is making Fecal transplant pill's on a large scale that contain the full spectrum of human bacteria. I'm hoping someone uses these to treat IBD, i think there is study underway for crohn's using FMT pills but dont have the link handy though, ill look for it.wow a synthetic pill that would be awesome. It is news such as these that keep me enthousiastic, thrilled, hopeful and confident there is going to be a friendly solution to our problems in the near future. I so wish to give a kick in the gut to these %#@#$%% meds I have to take!!!
Awesome, thanks for sharing.Just had a follow up scope this week. I am 1.5 years removed from an FMT done as part of a clinical trial. Couple of disclaimers- 1) I've had a mild course throughout my crohns journey 2) at the time of the FMT I was not doing too badly.
Scope grossly was normal- per the GI- "if this were your first time here I'd never know you have IBD." Biopsies are still pending.
Still have to avoid gluten/dairy. Both are in essense immunogenic and, in some ways promote IBS type sxs in those with any gut issues (some more than others.) They still cause a ton of gas, urgency, loud bowel sounds, and stool changes- certainly related to amount ingested.
I don't think I'll ever be able to know whether it was the FMT, havnig a mild course to begin with, having the FMT during relative quiescense, or who knows what. But a normal scope 1.5 years later only on VSL and watching diet- I'll take it.
Do not ask me to claim FMT is a cure. It isn't. I'm not cured. For NOW, I'm healed. I don't doubt this disease will show its ugl face again. I think of FMT as an OPTION. For those with mild colonic disease, dysbiosis symptoms- maybe give it a whirl.
Good luck to all. Hope everyone heals and feels well soon.
Awesome, thanks for sharing.
It is an experimental treatment, so it is too soon to conclude whether it is a cure or not. It's not a simple issue because there are official reports of people being cured already. At this time the treatment must be improved, there are variables to FMT success such as how it is administered, the health of the donor, the diet of the donor, the severity of the patient, the diet of the patient, the amount of stool(bacteria) used, whether it was performed as an enema, nasogastric tube, how many treatments did the patient receive, did they use FMT pills. There are so many question's to be answered still which more research should be able to answer. The main goal here is to restore the good bacteria that is missing by obtaining it from a healthy donor, it's something so new, it's hard to do at the moment but we will get there soon.
How was the Fecal Microbiota Transplant you had administered?
Also have you ever considered that it is not the gluten that increases your symptoms but glyphosate(Roundup) residues on the wheat? or even the yeast used to leaven the bread? anti Saccharomyces cerevisiae antibodies are found in crohn's disease patients which means your immune systems see it as an invader and wants to kill it. I eat alot of homemade wheat products that cause no issues whatsoever, but some brands of wheat do cause issues, gold medal brand whole wheat causes no issues for me.
Dr. Jessica R. Allegretti, a physician at Brigham and Women’s Hospital in Boston, is putting together trials of the capsules against Crohn’s disease, obesity and primary C. difficile.
http://www.cbs8.com/story/30932362/seres-therapeutics-announces-strategic-collaboration-with-nestl-health-science-for-microbiome-based-clostridium-difficile-and-inflammatory-bowelSeres granted Nestlé Health Science commercial rights in global markets outside of the United States and Canada to SER-109 and SER-262 for CDI, and SER-287 and SER-301 for IBD. The U.S. Food and Drug Administration (FDA) has granted SER-109 Orphan Drug, as well as Breakthrough Therapy, designations. In exchange for commercial rights, Nestlé Health Science agreed to provide Seres with an upfront payment of $120 million in cash and a series of contingent payments for development and sales milestones and tiered royalties on sales ranging from the high single digits percentages up to the high teens for all products.
Nestlé Health Science agreed to contribute to certain development efforts, including 33 percent of expenses for potential global Phase 3 studies for SER-287, SER-301 and SER-262.
You can read the first post in this thread for more information, but in general the procedure requires a stool sample from a healthy person. this is mixed in saline and given to the patient via enema or nasogastric tube or colonoscopy. Still waiting on pill form. The idea is the restore bacteria that have become extinct in the patient intestines, by obtaining it from healthy people.wildbill_52280 sorry for me asking this maybe even a dumb question but how do you do the fmt? Im just curious to know as this is interesting
I wholeheartedly believe much of the suffering in those with IBD/IBS/celiac/etc. is caused by nutrient deficiencies, because our diets are so restricted and they suffer from malabsorption. My quality of life has definitely improved follow my four FMTs, and therefore I recommend FMTs to those suffering from any GI/autoimmune-related conditions. Just make sure you find a healthy donor. If you're rich, you can run tests on both the donor's and your microbiome, and determine which species are in greatest abundance in both of your stools. Then, post-FMT, you can test donor engraftment by running another test on your stool and seeing how many of the donor species took root in your GI tract.I always loved fruit and veg and miss them badly. Actually I would give anything to eat anything and everything.
http://www.cell.com/cell-reports/abstract/S2211-1247(16)00029-2Our data reveal that mice recovering from antibiotic treatment or C. difficile infection retain lingering signatures of inflammation, despite compositional normalization of the microbiota, and host responses could be rapidly and durably relieved through fecal transplant.
Thanks, Wild Bill,
I have not taken Rob Knight's coursera course, interested though.Thanks, Wild Bill,
Rob Knight is my hero. Have you taken the Coursera course online? It was put out by the Rob Knight Lab while it was at University of Colorado. It is still available on demand. It's called something like- Exploring your Gut- the Microbiome. I'm sure a Google search will locate it. Fabulous course, can be audited, all, or in part and certificate can be earned.
"This oral microbial preparation that contains a small fraction of the total microbiome works as well as, if not better than, FMT," says Elizabeth Hohmann, MD, of the Massachusetts General Hospital (MGH) Infectious Diseases Division, senior author of the study. "These few key species seem to work in restoring a healthy microbiome, and other, beneficial species not in the capsules return, while harmful bacteria are removed. The product is also designed to be safer than FMT, by eliminating the potential for transmission of pathogens that might be present in donor fecal material."
http://medicalxpress.com/news/2016-02-oral-capsule-bacterial-spores-effective.html"This oral microbial preparation that contains a small fraction of the total microbiome works as well as, if not better than, FMT," says Elizabeth Hohmann, MD, of the Massachusetts General Hospital (MGH) Infectious Diseases Division, senior author of the study. "These few key species seem to work in restoring a healthy microbiome, and other, beneficial species not in the capsules return, while harmful bacteria are removed. The product is also designed to be safer than FMT, by eliminating the potential for transmission of pathogens that might be present in donor fecal material."
I read a report (I can't find the link ATM) that says it's expected that the microbiome treatment/diagnostic field will grow by about 75% a year over the next decade or so. Over the past couple years there's been about $1 billion venture capital flowing into the field. And that's expected to grow as well. There's a lot more players in the field now than there was a couple years ago. There might be some exciting developments coming along in the next couple of years. Research into treating recurrent CDI seems to be the short term objective, but CD and UC seem to be on the horizon.FMT pill used to treat C.difficile is very successful, similar pills are currently being studied to be used for Crohn's and U.C. pills will be safer and easier then a fecal transplant, and may even be more effective at repairing a damaged microbiome.
C.diff may have been a priority because people more frequently die from it. Much of the knowledge about c. diff will further support the concept of Bacteriotherapy for Crohn's. Its hard to understand which companies products will survive, they seem to be all treating the same diseases though, kind of a wild west of sorts, with different strategies. Some products aren't even using bacteria but metabolites of bacteria and I'm absolutely not interested in any of that knowing what I know about the disease and the probabability of curing it by restoring the microbiome permanately. I almost feel like investing in these companies myself!!I read a report (I can't find the link ATM) that says it's expected that the microbiome treatment/diagnostic field will grow by about 75% a year over the next decade or so. Over the past couple years there's been about $1 billion venture capital flowing into the field. And that's expected to grow as well. There's a lot more players in the field now than there was a couple years ago. There might be some exciting developments coming along in the next couple of years. Research into treating recurrent CDI seems to be the short term objective, but CD and UC seem to be on the horizon.
Since know one has tried this method before(treating disease with live/dormant probiotic bacteria), know one knows for sure whether restoring the microbiome with bacteria will cure IBD, the current research strongly suggests this is what could happen but these companies will have to consider it an unexpected side effect of the medication. I'm sure the people who are making these pills are generally aware of this possibility, but to say something is a cure needs to have very good evidence to support that claim and we just aren't there yet. We have maybe 7 cases of IBD that seems to be cured, that's very small number but some good evidence to suggest it could happen.We just need to wait until big pharma can make enough from this. then we will all be fine, so long as we keep taking their weakened down form in the pill. The magical cure one wouldn't bring them enough me thinks. But i'm still hopeful and just biding my time.
http://www.fdanewsalert.com/seres-therapeutics-incorporated-nasdaqmcrb-shorts-decreased-by-7-23-after-short-covering/8513489/Seres Therapeutics Inc (NASDAQ:MCRB) has declined 36.70% since July 10, 2015 and is downtrending. It has underperformed by 26.50% the S&P500.
It has been 13 months since my 10-day FMT treatment ended. I have been putting-off this 12 month report since it's not good news. Unfortunately, I'm back to symptoms similar to before my FMT. The quoted post will give you the background on the protocol I followed just over a year ago, and here I will report what has happened since. Right now I am under control, but I'm taking the maximum dose (4.2g) mesalamine, and also using the mesalamine suspension nightly.It has been 6 months since my 10-day FMT treatment ended and I am in good health, despite having significantly reduced my medication. I was at a crossroads with my UC: to impede my immune system with expensive drugs that have serious side-effects, or battle what was causing my immune system to react. I obviously chose the latter. So far, so good!
In those with IBD, bacterial diversity returns to pre-FMT baseline by 6 months, suggesting IBD host-related mechanisms modify faecal microbiome diversity."
Read the first post of this thread, some early experiments it took 30-60 FMT enemas in crohn's patients to get remission, also some cases using single FMT via nasogastric tube achieved long remissions without drugs which some consider to be a cured since they have been confirmed to be free of crohn's from follow up colonoscopy 13 years later.Hi Wild Bill,
"IBD requires multiple FMT's to have an effect" Do you have a reference for how many FMT's are most effective? Do they need to be done on consecutive days or could they be done say once a week for a given number?
Again it all depends on the health of the donor, 25% is still pretty low for any adverse event. This is why a FMT pill with only the good bacteria will be superior, using whole stool can potentially contain pathogenic bacteria as well as the good bacteria we need to restore the microbiome, while a pill could contain only the good.from the previous article in the conclusion: '' More than 25% of patients with IBD have a disease flare following FMT.''
Scary and unfortunate...
but how soon we forget the great things we already know!! 76% of patients achieved remission within one month following single oral FMT for refractory crohn's disease, these may be the most dramatic turnarounds ever observed in science. The study you commented on was for colonoscopic FMT, please note again I have been promoting the idea of oral FMT as more promising for quite a few years now.from the previous article in the conclusion: '' More than 25% of patients with IBD have a disease flare following FMT.''
Scary and unfortunate...
http://today.uconn.edu/2016/03/uconn-jax-partnership-begins-to-bear-fruit/“You have in your gut this tremendous fermenter,” says microbiologist George Weinstock, Evnin family chair and director of microbial genetics at the Jackson Laboratory. “Full of species as diverse as a tropical rainforest.” And, much like a tropical rainforest, many of these organisms are obscure, unknown to science because their native habitat is hard to explore and the organisms hard to breed in a lab. Weinstock and fellow microbiome researcher Julia Oh have developed bioreactors at the Jackson Laboratory in Farmington that can grow these fragile organisms and reproduce entire artificial microbiotic communities.
They’ve been happy to partner with UConn Health gastroenterologist Dr. Tom Devers and nurse Lynn Baccaro. Devers and Baccaro have been treating patients with life-threatening gut infections since 2012 using fecal transplants. They take the bacteria-rich intestinal contents (otherwise known as poop) from a healthy person and put it in the colon of someone who’s sick with C. difficile, a terrible bacteria that ravages the gut. And 95 percent of the time, the person is cured within days.
Devers and Baccaro also want to know why their patients get healthy. What is it about the microbiome population of a healthy person that so quickly rescues the gut of someone suffering from C. difficile? And could they possibly make an extract of pure bacterial strains that a patient could swallow, instead of enduring a fecal transplant?
Weinstock and Oh think the answer to that last question is yes. They’ve developed a collection of four bacteria types that, when swallowed by a mouse with C. difficile, cure the mouse. Will it work in humans? Baccaro and Devers would like to do a study to find out."
HAHA! my thoughts exactly. IBD patients are next in line though, I assure you. Surprisingly this may be kind of a new benefit of getting c. diffcile when you also have IBD and suddenly one of the most deadly diseases... is in high demand! Remember though, the dosage that clears c diff, may not correct IBD, it could take a week treatment rather then a day, we just have to have the experimental data and we are waiting on that.If they don't want to make a Crohn's FMT pill we are gonna have to surreptitiously find a way to get all of us on this forum to get infected with C-Diff.
They all started out with an empty colon and they did plenty of infusions using multiple donors. It was an "open label" study, though. It doesn't say what the placebo group did...maybe they gave them sterilized (killed) FMTs? I can't imagine why someone would knowingly go through 40 worthless enemas. It does say that 37 (of the 40) in the placebo group switched to live FMTs after 8 weeks. Maybe the option to switch is why they did 40 worthless ones.Forty-one adults were treated with an initial fecal microbiota transplantation, delivered by colonoscopy, followed by five active enemas per week for 8 weeks.
I agree, maybe they were glad to have the opportunity to get the real treatment after the placebo enemas, the fact that they began to respond to real stool helped emphasize the effect of FMT. For the record, right now FMT is still an experimental treatment option for IBD that's being explored and not ready for everyone to do, except for some well informed adventurous folks like myself.This is the first trial that I've seen that "does it right", with respect to number of infusions. They all started out with an empty colon and they did plenty of infusions using multiple donors. It was an "open label" study, though. It doesn't say what the placebo group did...maybe they gave them sterilized (killed) FMTs? I can't imagine why someone would knowingly go through 40 worthless enemas. It does say that 37 (of the 40) in the placebo group switched to live FMTs after 8 weeks. Maybe the option to switch is why they did 40 worthless ones.
The study says that 37% got a response and 17% got remission of their UC. Of those that switched at week 8, 27% got a response (compared to the 37%).
To me, this is essential information if someone with UC is considering the FMT route since it gives them an idea of how likely it is that they will get benefit (in the 30% range). It's still a roll of the dice, but it's better than the sketchy information I had a few years ago.
Improvements for the next study might include being double blind, large, and possibly using Borody's antibiotic cocktail the week before.