The success stories of using fecal transplants—that is, taking stool and the bacteria that comes with it from a healthy person and transplanting it to someone else—to treat recurring Clostridium difficult (C.diff) infections has sparked considerable interest in using the procedure to treat other gastrointestinal conditions such as Crohn’s and ulcertative colitis.
But David Rubin, MD, co-director of the Inflammatory Bowel Disease Center at the University of Chicago Medicine says just because a treatment seems “natural” doesn’t mean it will work for other conditions—or is even safe.
“We have no clue what we’re doing by filling people’s sick colons with the bacteria from someone else,” he said. “Just because it comes from another colon doesn’t mean in any regard that it’s necessarily safe for the recipient.”
In the normal bowel, more than 1,000 different strains of bacteria co-exist peacefully. Sometimes though, especially after the use of antibiotics, this delicate balance gets out of whack, allowing aggressive strains like C. diff to take over, leading to severe diarrhea, abdominal pain and intestinal damage.
A fecal microbiota transplant (FMT) is believed to treat this “dysbiosis,” or bacterial imbalance, by replacing the damaged bacterial population with one from a healthy person, like clearing away a house damaged in a storm and building a new one in its place.
Patients with inflammatory bowel diseases (IBD), including Crohn’s and ulcerative colitis, can also suffer from dysbiosis, leading some to think that FMT might relieve their symptoms too. But despite the enthusiasm, there is very little scientific evidence so far that this is effective, or even safe, for patients with IBD.
Rubin, who is also the interim section chief of gastroenterology, hepatology and nutrition, said there have been a handful of case reports published that show some success, but nothing on the level of a large, controlled clinical trial. In fact, in a recent study of FMT in five patients with ulcerative colitis (PDF) by a group of researchers from Austria, none of the patients achieved clinical remission, and only one showed some improvement. Several actually got worse.
In an editorial accompanying the study (PDF) in the American Journal of Gastroenterology, Rubin summarized the Austrian findings: “Unfortunately, we are learning that FMT for IBD is not the panacea many hoped it would be.”
He’s concerned that despite the lack of clinical evidence, some providers and patients will continue to experiment with FMT on their own because the “materials” are free and readily available at home. There’s even a burgeoning community online giving people instructions on how to administer FMT themselves.
Rubin and Stacy Kahn, MD, who Science Life spoke to last year about changing attitudes toward FMT, are conducting a phase 1 clinical trial of FMT in patients with mild to moderate ulcerative colitis to assess the basic safety of the therapy, just as they would with any other drug. Rubin said that if it looks like it’s working, they’ll consider expanding the protocol to sicker patients. But he stressed that it’s just the first step in a careful, scientific process.
“We need to be careful,” he said. “It doesn’t mean you can’t be enthusiastic. But we need to be thoughtful, and can’t abandon our principles when it comes to thinking about scientific advances.”
Rubin D.T. (2013). Editorial: Curbing our Enthusiasm for Fecal Transplantation in Ulcerative Colitis, The American Journal of Gastroenterology, 108 (10) 1631-1633. DOI: 10.1038/ajg.2013.279
Angelberger S., Reinisch W., Makristathis A., Lichtenberger C., Dejaco C., Papay P., Novacek G., Trauner M., Loy A. & Berry D. & (2013). Temporal Bacterial Community Dynamics Vary Among Ulcerative Colitis Patients After Fecal Microbiota Transplantation, The American Journal of Gastroenterology, 108 (10) 1620-1630. DOI: 10.1038/ajg.2013.257