I couldn't find the proper place to put this - I think there is a thread on FHT here somewhere. Feel free to move this or cross post.
I just registered on this forum and the forum keeps new members from posting URL's. To find the original just search "Fecal transplants may be effective for IBD".
Drug & Device Development
Fecal transplants may be effective for IBD
Last Updated: 2011-11-02 16:07:30 -0400 (Reuters Health)
By Anne Harding
NEW YORK (Reuters Health) - Repeated fecal microbiota transplants (FMTs) can reverse severe mixed inflammatory bowel disease (IBD), a small new report suggests.
Dr. Thomas Borody of the Center for Digestive Diseases in Five Dock, New South Wales, Australia, presented a case series Monday at the American College of Gastroenterology's annual meeting in Washington, DC.
FMT involves placing stool from a healthy donor in the colon of an ill person, via colonoscopy or enema, and has been shown to be effective for treating refractory Clostridium difficile infection.
Dr. Borody's group and a few other research teams are now investigating whether IBD could respond to this approach as well.
Dr. Borody and his team first began performing FMT for IBD in 2003, in patients who were failing every other treatment. "We did a few patients, and sure enough some of them were cured," he told Reuters Health. Those patients were given just one, two, or three transplants.
"Initially we used to give up after three weeks," he added. He and his colleagues then began having patients self-treat for a longer time, until their symptoms had completely resolved.
At the ACG meeting he reported on three such patients. One, a 19-year-old woman with an 11-year history of severe ulcerative disease and Crohn's disease, underwent her first FMT via colonoscopy in 2009. She then received FMTs via enema daily for one week, and then weekly for 26 weeks. Within several days, her symptoms had sharply improved, and follow-up colonoscopy found no inflammation or edema; the patient is still "clinically well."
The second patient, a 23-year-old male, had been having more than 20 episodes of bloody diarrhea daily, severe abdominal and joint pain, and anal fissures. His UC/CD colitis had not responded to steroids or anti-TNF alpha drugs. He received daily FMT rectally for one month, with frequency lessening gradually until he was receiving one FMT every six weeks. His bleeding had resolved within one to two weeks after FMTs began, Borody and his team report. One year after treatment began, he was symptom-free, and colonoscopy revealed no inflammation, although the patient did have "occasional pseudopolyps."
Finally, the third patient, a 57-year-old woman, had suffered from ulcerative proctitis refractory to 5-ASA, antibiotics, probiotics, and immunosuppressants for nine years. The woman performed a total of 69 rectal FMTs, initially daily and then weekly. Symptom resolution was "virtually immediate," the researchers found, and the patient has been off therapy and healthy for the past four years.
It's still unclear why FMT works for IBD, Dr. Borody told Reuters Health. Nevertheless, he added, it does. "It's like raising Lazarus from my point of view. We've been sitting on this for years," he added, pointing out that the first FMT, for C. difficile, was performed in 1958.
"Initially," he recalled, "no more than 10% were dramatically better and I stopped doing them due to (a) low response with three to six infusions. By chance a patient kept repeatedly infusing and taught us that with initial daily then second daily, etc, then weekly, then even monthly infusions...we can with perseverance induce a profound remission in most if not all ulcerative colitis patients."
To date, he has treated 40 IBD patients with FMT. "Some appear to completely lose all inflammation. Others maintain well with occasional infusions. At this stage I would be guessing what percentage can be cured (normal, off all therapy for more than two years, histology normal)," Dr. Borody said, "but we have at least six cured of the 40 or so to date. It may increase."
Dr. David You and colleagues at the U.S. Naval Medical Center in San Diego reported at the ACG meeting FMT in a patient with severe Crohn's disease and refractory C. difficile. The doctors said they treated her with fecal bacteriotherapy through a nasogastric tube using her husband's stool, "as a potential salvage therapy prior to colectomy." She had one treatment; two days afterward, C. difficile had disappeared from her blood, and "we could then address the patient's underlying Crohn's disease with immunosuppressive therapy," the researchers wrote in their abstract for the meeting.
Dr. Alexander Khoruts of the University of Minnesota, who wasn't involved with either presentation but studies FMT for C. difficile and IBD, told Reuters Health he and his colleagues have developed strategies for making the therapy more practical, including recruiting unpaid and "absolutely healthy" donors and finding a way to freeze and rethaw donor stool without losing clinical efficacy.
Dr. Khoruts and his colleagues were the first to genotype the microbial community in a patient's colon before and after FMT, to demonstrate that the donor's fecal microbiota had indeed engrafted. The findings, in a successfully treated patient with severe refractory C. difficile, were published in the Journal of Clinical Gastroenterology last year.
While there's little doubt that FMT works for C. difficile, Dr. Khoruts said, "with IBD it's not as straightforward. We really need systematic trials, and to do that this therapy has to jump through some regulatory barriers."
For example, he pointed out, donor selection may be "much more critical" for treating IBD patients, while the best way to condition patients before the procedure is still not clear.
"The patients are really demanding this to be done, this level of desperation is really high," he added. "They've read about it on the Internet, they're accepting of this therapy... (but) for a trial to be done in the United States, it has to go through the IRB process, and the IRB requires an FDA process."
Dr. Khoruts and his colleagues have been funded "in principle" to do a randomized clinical trial of FMT for ulcerative colitis, he added, and are awaiting completion of regulatory paperwork.
I just registered on this forum and the forum keeps new members from posting URL's. To find the original just search "Fecal transplants may be effective for IBD".
Drug & Device Development
Fecal transplants may be effective for IBD
Last Updated: 2011-11-02 16:07:30 -0400 (Reuters Health)
By Anne Harding
NEW YORK (Reuters Health) - Repeated fecal microbiota transplants (FMTs) can reverse severe mixed inflammatory bowel disease (IBD), a small new report suggests.
Dr. Thomas Borody of the Center for Digestive Diseases in Five Dock, New South Wales, Australia, presented a case series Monday at the American College of Gastroenterology's annual meeting in Washington, DC.
FMT involves placing stool from a healthy donor in the colon of an ill person, via colonoscopy or enema, and has been shown to be effective for treating refractory Clostridium difficile infection.
Dr. Borody's group and a few other research teams are now investigating whether IBD could respond to this approach as well.
Dr. Borody and his team first began performing FMT for IBD in 2003, in patients who were failing every other treatment. "We did a few patients, and sure enough some of them were cured," he told Reuters Health. Those patients were given just one, two, or three transplants.
"Initially we used to give up after three weeks," he added. He and his colleagues then began having patients self-treat for a longer time, until their symptoms had completely resolved.
At the ACG meeting he reported on three such patients. One, a 19-year-old woman with an 11-year history of severe ulcerative disease and Crohn's disease, underwent her first FMT via colonoscopy in 2009. She then received FMTs via enema daily for one week, and then weekly for 26 weeks. Within several days, her symptoms had sharply improved, and follow-up colonoscopy found no inflammation or edema; the patient is still "clinically well."
The second patient, a 23-year-old male, had been having more than 20 episodes of bloody diarrhea daily, severe abdominal and joint pain, and anal fissures. His UC/CD colitis had not responded to steroids or anti-TNF alpha drugs. He received daily FMT rectally for one month, with frequency lessening gradually until he was receiving one FMT every six weeks. His bleeding had resolved within one to two weeks after FMTs began, Borody and his team report. One year after treatment began, he was symptom-free, and colonoscopy revealed no inflammation, although the patient did have "occasional pseudopolyps."
Finally, the third patient, a 57-year-old woman, had suffered from ulcerative proctitis refractory to 5-ASA, antibiotics, probiotics, and immunosuppressants for nine years. The woman performed a total of 69 rectal FMTs, initially daily and then weekly. Symptom resolution was "virtually immediate," the researchers found, and the patient has been off therapy and healthy for the past four years.
It's still unclear why FMT works for IBD, Dr. Borody told Reuters Health. Nevertheless, he added, it does. "It's like raising Lazarus from my point of view. We've been sitting on this for years," he added, pointing out that the first FMT, for C. difficile, was performed in 1958.
"Initially," he recalled, "no more than 10% were dramatically better and I stopped doing them due to (a) low response with three to six infusions. By chance a patient kept repeatedly infusing and taught us that with initial daily then second daily, etc, then weekly, then even monthly infusions...we can with perseverance induce a profound remission in most if not all ulcerative colitis patients."
To date, he has treated 40 IBD patients with FMT. "Some appear to completely lose all inflammation. Others maintain well with occasional infusions. At this stage I would be guessing what percentage can be cured (normal, off all therapy for more than two years, histology normal)," Dr. Borody said, "but we have at least six cured of the 40 or so to date. It may increase."
Dr. David You and colleagues at the U.S. Naval Medical Center in San Diego reported at the ACG meeting FMT in a patient with severe Crohn's disease and refractory C. difficile. The doctors said they treated her with fecal bacteriotherapy through a nasogastric tube using her husband's stool, "as a potential salvage therapy prior to colectomy." She had one treatment; two days afterward, C. difficile had disappeared from her blood, and "we could then address the patient's underlying Crohn's disease with immunosuppressive therapy," the researchers wrote in their abstract for the meeting.
Dr. Alexander Khoruts of the University of Minnesota, who wasn't involved with either presentation but studies FMT for C. difficile and IBD, told Reuters Health he and his colleagues have developed strategies for making the therapy more practical, including recruiting unpaid and "absolutely healthy" donors and finding a way to freeze and rethaw donor stool without losing clinical efficacy.
Dr. Khoruts and his colleagues were the first to genotype the microbial community in a patient's colon before and after FMT, to demonstrate that the donor's fecal microbiota had indeed engrafted. The findings, in a successfully treated patient with severe refractory C. difficile, were published in the Journal of Clinical Gastroenterology last year.
While there's little doubt that FMT works for C. difficile, Dr. Khoruts said, "with IBD it's not as straightforward. We really need systematic trials, and to do that this therapy has to jump through some regulatory barriers."
For example, he pointed out, donor selection may be "much more critical" for treating IBD patients, while the best way to condition patients before the procedure is still not clear.
"The patients are really demanding this to be done, this level of desperation is really high," he added. "They've read about it on the Internet, they're accepting of this therapy... (but) for a trial to be done in the United States, it has to go through the IRB process, and the IRB requires an FDA process."
Dr. Khoruts and his colleagues have been funded "in principle" to do a randomized clinical trial of FMT for ulcerative colitis, he added, and are awaiting completion of regulatory paperwork.
