A feacal transplant is a procedure in which poo from a healthy patient is implanted into the colon of an unhealthy patient. Unexpectedly, it's been shown to treat a range of intestinal illnesses and infections, but right now it's too expensive and uncomfortable to be used widely.
Officially known as feacal microbiota transplant (FMT), the poo is currently transplanted into the sick patient using a colonoscopy or by feeding a tube down from the nose to the colon - which, as you can imagine, isn't pleasant.
But now researchers from the Massachusetts General Hospital in the US have managed to put frozen feacal matter into capsules that can be taken orally. And small-scale trials show these capsules have a similar 90 percent success rate against the potentially fatal bacteria Clostridium difficile bacteria as traditional poo transplants. The results werepublished in the Journal of the American Medical Association over the weekend.
"The use of capsules simplifies the procedure immensely, potentially making it accessible to a greater population," said Ilan Youngster, a co-author on the paper, in a press release.
C. difficile infection causes 250,000 hospitalisations and 14,000 deaths each year in the U.S. alone, and up to 30 percent of patients infected with it don't respond to antibiotics. Chronic infection can lead to debilitating digestive issues.
In the past, feacal transplants have been shown to have a more than 90 percent success rate in treating these patients. This is because the poo also carries the gut bacteria from the health donor’s gut, and these microbial communities can fight off C. difficile infections within days.
Earlier this year, the same Massachusetts team, led by Elizabeth Hohmann, had previously shown that frozen feacal matter was as effective as fresh samples, and so donations could be made at any time from carefully screened patients, blended with medical-grade saline and filtered as per usual, but then stored for later use.
Now they’ve gone a step further and put that concentrated poo liquid into a capsule.
These pills were tested on 20 patients between the ages of 11 and 84 who all received 15 of the frozen poo pills. If they weren’t feeling better within 72 hours, they were given another 15 pills from the same donor.
Out of the 20 patients, 14 had their symptoms resolved by the first treatment and they showed no recurrence for the next eight weeks. The other six received a second dose of the pills (they took 30 overall) about a week later. Five of those patients had their symptoms resolved, while one didn’t respond to the treatment. Eight weeks later all but one of the patients had showed no signs of reinfection, which is a similarly impressive success rate to traditional poo transplants.
Team leader Hohmann estimates the entire course of this treatment would cost only $500, around one sixth the price of a colonsocopy or a standard course of antibiotics.
Of course, there are still some “gross out” issues to overcome - chiefly the fact that, when it comes down to it, you’re asking people to eat sh*t.
"When I first started doing this I had in my mind that it would be a little red-and-white banded capsule, like a Tylenol capsule," Hohmann told Nancy Shute for NPR. "That was my dream." But unfortunately, the capsules need to be acid-resistant to survive the stomach and make it into the large intestine, and acid-resistant capsules are only available in transparent form.
"So they are sort of brownish-colored capsules," Hohmann admits to NPR. "Fortunately, because they're frozen, when you take them out of the freezer they sort of frost up a bit and they're not too gross."
Larger studies are now needed to prove that this method will be effective for a wider range of patients and is safe, but these are extremely promising initial results. Another 21 people have since been tested by Hohmann’s group, with similar success rates so far.
But Hohnmann stresses that this treatment may not necessarily be for everyone in the future.
"It's a really easy decision to make on a 75-year-old person who's home-bound by diarrhoea they can't get rid of," she told The Washington Post, "but it's another thing to talk about giving the treatment to a toddler. We have a lot to learn — and hopefully, it's all positive."