transplants of stool as cure the diarrhea caused by the rebellious bacterium ‘Clostridium difficile’. And this is only the beginning: experts are already studying how to apply them to other evils such as irritable bowel syndrome, Crohn’s disease, or even multiple sclerosis
Elizabeth never imagined that something that you all despise every day to be able to cure and restore quality of life. His salvation was the transplantation fecal we did in march to treat a resistant infection caused by the bacterium Clostridium difficile. She wore five long and endless months with severe abdominal pain and constant. “I couldn’t leave the house for diarrhea, recurrent”, account. “There were days that I was going to the toilet up to 30 times.” They even had to get it in the hospital on six occasions with risk of malnutrition. A situation very desperate does not always respond to the action of the antibiotics. And when this happens, the stools cease to be a simple human waste to become the best treatment. “Something so natural, so cheap, and that we all pulled together…” says the patient.
The effectiveness of the stool to resolve this infection is so striking as blunt. Even are formulated as oral capsules for ease of administration in international schools and hospitals such as the Gregorio Marañón of Madrid. But its potential does not end here: several research groups are already studying the transplantation of fecal to treat maladies as diverse as Crohn’s disease, irritable bowel syndrome or even multiple sclerosis. Although some investigations are still in their early stages, experts predict a future very hopeful, to the point of weighing the idea of storing and freezing of the fecal microbiota of the entire population so that each one of us has a treatment to the letter when you are sick.
The active principle is a powerful concentrated extract on the microbes stool of a healthy person. Are these the people in charge of rebuild the intestinal flora of the affected. “It is a preparation that helps to restore the beneficial bacteria reduced or eliminated by Clostridium difficile, one of the infections most important and resistant in the hospital environment,” explains Consolation Merino, department of Internal Medicine of the University Hospital of La Ribera (Valencia). This bacterium is a rebel when it dwells in the microbiota of people who suffer from some problem that impairs your immune system, or that destroys your intestinal flora, as can be the intake of antibiotics.
In these situations of vulnerability, the invader takes advantage of it to colonize the intestine and begins to devastarlo as, in fact, was doing in the case of Isabel. None of the attempts therapeutic with various antibiotics worked, so there only remained one option: the transplantation of fecal microbiota. “My quality of life was null and void, and as I had read on the internet about this approach, the proposal does not surprised me anything,” recalls the patient.
It is studying the role of the transplant stool as therapy for diseases such as irritable bowel syndrome
Although it was already announced successful cases of Clostridium difficile treated with transplantation of fecal in the united States, it was in 2013, when a clinical trial published in the prestigious New England Journal of Medicine found efficacy final of this technique in this type of infections. The researchers, from the University of Amsterdam (the Netherlands), compared the results of transplantation of fecal with the conventional treatment (vancomycin). “The superiority was so great (94% cure compared to 27%) that it was not considered ethical that half of the patients would be left without the transplant, so they ended up doing at all”, explains Jordi Guardiola, chief of Digestive, Hospital de Bellvitge (Barcelona), one of the leading centers for transplantation of fecal microbiota, next to the hospital Gregorio Marañon and Ramon y Cajal of Madrid.
from those spectacular results, in Spain began to make the first transfers of microorganisms in sewage and the European Society of Infectious Diseases included in this intervention as a very valid option in the disease of Clostridium difficile refractory-relapsed.
this Is one of the infections most important in the field hospital, about 6.5 episodes per 10,000 days of stay, according to a study led by Emilio Bouza, chief of service of Microbiology and Infectious Diseases Hospital Gregorio Marañón. About 75% gets rid of the bacteria with antibiotics, but the remaining 25% falls and your chances of having a third episode increase by almost 40%. “Normally, in the fourth episode, we set ourselves the transplant stool,” says Javier Cobo Reinoso, service of Infectious Diseases Hospital Ramón y Cajal. But now, says Patricia Muñoz, of the service of microbiology Hospital Gregorio Maranon, “we will start a clinical trial to see the results of the transplant stool on the first episode”.
As argued by Merino, “the idea you can take back to the people, who are accustomed to blood, but not to the stool. However, once we break the psychological barrier, explaining the technique, the challenge is to find a suitable donor”. According to estimates american, “in the end, less than 5% of the potential volunteers is effective,” explained Cobo.
The researchers are raised in the future to freeze the microbiota to design a probiotic to the letter,
The selection process is very demanding. Or the husband of Isabel, or any other family could be a donor. Any condition that has been related to alteration of the microbiota justifies the exclusion of the person willing to help you with your contribution. For example: diabetes, obesity, autoimmune diseases or a history of cancer. Each time you discover more pathologies related with alterations in the intestinal microbiota (in the field of neurology, psychiatry, endocrinology, and digestive), although this does not mean, nor is the cause or that involves a future treatment.
in the Face of doubt, by protocol, any condition related to the microbiome exclude the donor. Even so, apostille Elena there she, pharmaceutical specialist in microbiology
Gregorio Marañón, “there may be some disease whose association with the microbiota do not know. Hence, the objective is to try to study the profile of micro-organisms ideal for not transplanting any profile of obesity or any other pathology, but the proposals have not gotten results yet”.
tests Are also performed serology (to rule out hepatitis or HIV, for example), microbiological analysis of feces, and a questionnaire of general health. “We take into account the sexual behaviours of risk, if they have had a tattoo, or have traveled in the last six months and we reject the carriers of germs resistant or pathogens in the stool,” says Guardiola.
Banks in stool
A long list of conditions that only exceeded by a friend of Elizabeth. In the words of Guardiola, “the search task can last for weeks and it would mean a considerable delay in the start of the treatment. Hence the importance of having a bank of stools”. In Spain there are two, in the Hospital Bellvitge and at the Gregorio Marañon, but unlike the united States and the Netherlands, are only for internal use, with the purpose of health care, do not feed to other hospitals.
Both the madrid as barcelona operate from the donations of family members and some health committed. In the case of Gregorio Maranon, is also open to external contributions. The candidates have to pass the same tests and once more, they must deliver the material in a maximum time of two hours, in order to initiate a proper process of purification.
it Is about transforming the stool into an extract of fecal microbiota. How? From a minimum of 50 grams, “is diluted in saline, is performed a process of homogenizing, several filtrations and centrifugations, we try to eliminate impurities and keep the bacteria in a 200-300 milliliters,” explains the microbiologist of the Gregorio Marañón. This preparation takes the unit of endoscopy, divided into five syringes of sixty milliliters each to proceed to colonoscopy (with sedation), which is usually the route of administration is more usual.
“very, very carefully, reaches the end of the colon and in that point is released, through the working channel of the endoscope, the preparation which we have brought of microbiology”, exposes Consolation Merino, who was the one who coordinated the intervention of Elizabeth. “The patient was able to return home the next day, no symptoms.” According to Isabel, “and the pains disappeared 40 hours”.
If the extract of fecal is going to freeze, then, points to Guardiola, also “is added preservatives to maintain the viability of the bacteria and finally he froze to -80 degrees celsius”.
fecal Microbiota, in capsules
Some hospitals, such as Gregorio Marañón in Spain, reformulating this content in oral capsules, for the route of administration to be more simple, less invasive, since it has been demonstrated the same effectiveness as with the colonoscopy. To do this, centrifuge a lot to condense it even more. Initially, this methodology consisted of taking 30 pills in two days. “We’ve now got to concentrate more and turn it into powder down to four pills,” says Muñoz.
In one way or another, they travel billions of bacteria able to repopulate a gut devastated. And, as stated by Cobo, “waiting for the incorporation in the pharmacy hospital of new antibiotics (fidaxomicina and bezlotoxumab) to treat Clostridium difficile, which are having many barriers because of the high price, the transplantation of fecal is positioned as a option effective, safe, and inexpensive”. For the moment, only has an indication in the clinical practice, but are developing several tests to verify its role as a therapy for diseases such as ulcerative colitis or irritable colon. According to forecasts Guardiola, “probably, the most next is the treatment of infections by pathogens multidrug resistant. We already have done so humanely in a patient.”
And here do not end the hopes deposited in the fecal material. According to the analysis on healthy people, “it is clear that there is great variability between individuals. The microbiota is very personal,” stresses Borja Sánchez, researcher at the Centro Superior de Investigaciones Científicas (CSIC) in the Institute of Dairy Products of Asturias. So much that it would be ideal that in the future “could be stored and frozen when we are healthy to treat diseases later by using an auto-transplant. So, diseñaríamos a probiotic to the letter”. All a revolution from a material that we dispose of each day.
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