Inflammatory Bowel Disease 'Cured' With Fecal Transplant

[nogutsnoglory]

Keep in mind that this was in mice, the article suggests 'cure' but I think we just need to be cautiously optimistic that there is a pathway here. Many have had these transplants without improvement.

"Inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, are extremely painful and can lead to colorectal cancer. Now, researchers have effectively cured the conditions in mice, offering hope for human sufferers of so-called IBDs.

Waste material from healthy people is rich in helpful bacteria. When transferred to the digestive tracts of sick individuals, in whom there is an overgrowth of bad bacteria, the fecal matter helps restore the balance of healthy flora.

Some cutting-edge doctors have used so-called fecal transplants to treat severe bacterial infections, including Clostridium difficile or C. diff, which releases toxins as it grows, attacking the lining of the intestines.

Scientists also have found the transplants appear to reverse autoimmune diseases of the bowel.

Crohn’s disease and ulcerative colitis, also known as inflammatory bowel disease or IBD, are life-long disorders that cause severe diarrhea, painful cramps and bleeding.

According to June Round, a professor of medicine at the University of Utah, such diseases are becoming increasingly common around the world, as more and more people eat a low-fiber, high-fat Western diet.

Round also blames the widespread use of antibiotics.

“So, I think a lot about the microbes that naturally reside in our bodies. And antibiotics can not distinguish between what is good and what is bad," she said. "They kind of wipe-out everything. So, there is a very clear-cut correlation between when Western civilization started using the antibiotics and the increased incidence of a lot of these autoimmune diseases.”

Currently, treatments for these conditions are supportive, designed only to ease the symptoms. So, the idea of a potential cure for IBD is very appealing.

In experiments with mice with inflammatory bowel disease, Round and her team found that fecal transplant restored the healthy balance of intestinal flora, returning the intestine to near normal.

But the notion of transferring fecal material from one person to another -- and in the case of mice, through a tube into the stomach -- makes many people say "yuck." So Round said researchers are now trying to identify the helpful bacteria in human waste so they can be put into pill form.

“You know, right now we have to do fecal transplantation because the [bacterial] communities are so complex, and we just do not know what organisms are doing the good thing," she said. "So, we just kind of put it all in there and hope for the best. So, there is no way of getting around it right now, but hopefully in the future there will be.”

The work is published in the journal Cell Host and Microbe."

http://m.voanews.com/a/inflammatory-bowel-disease-cured-with-fecal-transplant/2609711.html#menu

 

[xeridea]

There's got to be something here. I like to look at where investments flow, and in recent months, a lot of financial news is coming out about hundreds of millions of dollars committing to microbiome-related fields and research.

Not holding my breath, but I do like the shift in outlook.

 

[baistuff]

Having had an FMT, and, knock on colon, doing pretty well since (normal FC, ESR, CRP and 3 month scope post FMT) I agree that this can be part of the arsenal in some patients. But to describe it as a "cure" and a potential one size fits all treatment for crohns or UC, is naive and at this point not factual.

In some the dysbiosis triggers the inflammation, in others it could be there other way around. FMT cannot correct the host defect in IBD and does not modulate the immune system. In some IBDers the immune response is so out of whack, restoring bacterial balance probably won't accomplish much. Location of disease is also a major issue. The bacterial populations of the sigmoid/rectum are much different than the TI or areas more proximal. To say that transplanted poop will correct both equally simply doesn't make intuitive sense. Also, in CD, there is a huge difference between garden variety inflammation and fibrostenosing or fistulizing disease.

As with many treatments, and as with many medical conditions, FMT will likely become quite successful for some, a temporary or temporizing option for some, useless for some, and maybe even for some others, a step backwards.

Exciting stuff, yes. But all very preliminary. Studies ongoing in Boston, Chicago, Israel and a few places in Europe. Best way of doing it is through a study- the screening, pre-post follow up is thorough.

 

[xeridea]

... In some the dysbiosis triggers the inflammation, in others it could be there other way around. FMT cannot correct the host defect in IBD and does not modulate the immune system. ...

I don't disagree with your comment. It's the chicken or the egg paradox of this disease.

What I am starting to see in recent research publications is a smarter approach to bacteriotherapy. Rather than the hit-or-miss approach of throwing the kitchen sink at your bowels (a la FMT), they are starting to look at specific and rationally selected bacterial replacement therapies. Essentially, what are the active strains in healthy stool that can contribute to therapeutic outcomes.

For example, the recent Janssen/Vedanta licensing agreement centers around a research platform that was used for careful selection and isolation of Clostridia strains that influence CD4 FOXP3 Treg cell production.

And we'll soon be hearing about another front on the microbiome with the Australian study that was able to use a Lactobacillus strain to cure 80% of their (double blind placebo controlled) study population from severe peanut allergies by modifying the immune response via this adjunctive therapy. Successes like that will spur additional research.

The microbiome studies are definitely an exciting front to have opened on the quest to find a possible cure, or at least, novel and perhaps more effective treatment options for IBD. It sure is more palatable than the immunosuppression research activities.

 

[baistuff]

I don't disagree with your comment. It's the chicken or the egg paradox of this disease.

What I am starting to see in recent research publications is a smarter approach to bacteriotherapy. Rather than the hit-or-miss approach of throwing the kitchen sink at your bowels (a la FMT), they are starting to look at specific and rationally selected bacterial replacement therapies. Essentially, what are the active strains in healthy stool that can contribute to therapeutic outcomes.

For example, the recent Janssen/Vedanta licensing agreement centers around a research platform that was used for careful selection and isolation of Clostridia strains that influence CD4 FOXP3 Treg cell production.

And we'll soon be hearing about another front on the microbiome with the Australian study that was able to use a Lactobacillus strain to cure 80% of their (double blind placebo controlled) study population from severe peanut allergies by modifying the immune response via this adjunctive therapy. Successes like that will spur additional research.

The microbiome studies are definitely an exciting front to have opened on the quest to find a possible cure, or at least, novel and perhaps more effective treatment options for IBD. It sure is more palatable than the immunosuppression research activities.

Absolutely, the microbiome holds a lot of potential. One reason I decided to go ahead with FMT was b/c I developed IBD almost immediately after antibiotics. Never a whiff of it beforehand. Also purely colonic disease. Can't complain about the results. Though despite the good numbers and overall feeling well, I still have some bad days which seem to be diet, sleep, related. I almost feel (and this is not science here) like I've muzzled an angry dog. It's not biting or barking right now, but you still know it's in the backyard. The crohn's is not gone, but on a leash. I am also prettys sure I am left with post inflammatory IBS. No question the colon and surrounding nerves are hypersenstive. I think that will be permanent. But I can't complain at all. The microbiome, and research that can modulate immune responses to GI organisms (SSI vaccine for example) are quite promising.