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One Man's Poo Is Another Man's Prescription

Posted: 08/17/2013 12:38 pm

In the last few years, organ donation has gained significant prominence thanks to campaigns such as #beanorgandonor and Outlive Yourself. In return, the number of people who have signed up to donate a vital part of their bodies to help others has risen. Despite this, organ donation is a rather grim topic as those who choose to donate their heart, lungs, livers and eyes must first face their own demise before they can hope to save another.

There is another type of organ transplantation that does not require death in order for it to occur. Yet until recently, it was rarely used despite its incredibly positive benefits to a recipient. But thanks to a combination of necessity and drive, fecal transplantation has gone from disgusting to desirable.

In order to get a better idea of this type of donation, which is officially known as fecal microbiota therapy, or FMT, I reached out to one of Canada's known experts, Dr. Emma Allen-Vercoe at the University of Guelph. She is a microbial ecologist and believes that much like the re-introduction of beneficial species in nature, the re-introduction of good bacteria into the body is a very good thing.

"Your gut microbiota is like a rainforest -- a veritable jungle of around 1000 different species. For the most part, these microbes live and thrive in a happy symbiosis with us. But damage to this ecosystem, for example caused by antibiotic use, which is similar to the slashing and burning of a rainforest, that can leave it damaged beyond repair. Enter FMT."

Most of us have only recently heard of FMT though the procedure has been around for millennia. According to Allen-Vercoe, the process dates back to early Chinese dynasties where drinking fecal tea was a means to treat dysentery and was used as a last resort against diarrhea in the 1950s. But the 'poopularity' of the procedure was due to the increase in Clostridium difficile.

"When C. difficile is present in high enough numbers in the gut, it starts to produce toxins that damage the gut and cause painful diarrhea. Treatment for infections is usually with a course of antibiotics, which is counter-intuitive given that this is a disease caused by antibiotic use. FMT is a very simple technique (which some determined patients have even managed at their own homes), and works very quickly -- within hours -- to cure infection. What's better is that it seems to have a long-lasting, protective effect against further problems."

The evidence supporting FMT is growing as is the list of diseases that may be cured by this procedure. Yet Allen-Vercoe is not entirely happy. For her, there is one obstacle that is preventing her and many of her colleagues from making the difference they know they can do.

"FMT's appearance comes at the chagrin of hospital administrators who are finding it impossible to evaluate the risk of the practice. To them, there many problems, not least of which is finding a suitable donor; how do you really know who's healthy? There are no really clear, universal metrics to define gut microbiota health."

But while administrators can offer concern, regulators such as the FDA can order it to be stopped or bog it down with paperwork. This is already happening in the United States. Allen-Vercoe suggests that this should be expected. "Regulators have a hard time with FMT because feces will vary widely from person to person and additionally contain microbial species that are unstudied; how can we be sure we are doing more good than harm? Bearing in mind that more and more diseases are now associated with the gut microbiota, how do we know that FMT is not just a case of swapping one problem for another that may manifest later in life?"

To overcome these hurdles, Alle-Vercoe and her colleague, Dr. Elaine Petrof at Queens University, have worked together to develop an alternative to FMT, which they call MET or Microbial Ecosystem Therapeutic. In the public, however, it has a catchier name: RePOOPulate.

"RePOOPulate is a prototype gut microbial ecosystem, a very simple subset of 33 strains from our healthy donor that we used in a small proof-of-principle trial to treat - and cure - two cases of recurrent C. difficile. It's better than FMT for regulators because it has defined constituent microbes and can be made to order, just like a regular therapeutic. It's also safer than FMT as there is no risk of pathogens and we can monitor a recipient for any signs of adverse effects after the procedure. But the best part about RePOOPulate is that it doesn't look or smell like regular fecal matter. That in itself is a definite aesthetic plus!"

The promise of RePOOPulate and MET is evident although there needs to be more evidence before it can be widely used. Based on the recommendations of a Canadian working group studying MET, more clinical trials and other evidence is required before it can get Health Canada approval. But for Allen-Vercoe, who is on the working group, this isn't a setback.

"RePOOPulate is a prototype ecosystem - we are currently developing more complex and robust microbe mixtures to treat not just C. diffcile infection, but also as potential therapies for other diseases such as ulcerative colitis. We are at the beginning of a new era and from where I stand, MET can only get better."

What has become clear is that fecal therapy, whether FMT or MET, is here to stay. With the number of options to treat acute and chronic gastrointestinal disorders shrinking, a means to not only treat but also cure cannot be disregarded. There may be battles ahead for regulatory approval but Allen-Vercoe is ready and knows she will have public support. "People may never get used to the smell of FMT and MET, but I know they'll definitely get used to the benefits."

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  • Take A Trip?

    Psychedelics like lysergic acid diethylamide (LSD) have a complicated history of being used as potential treatments for mental illness. Researchers studied <a href="http://query.nytimes.com/gst/fullpage.html?res=950DE6DC1730F931A15757C0A9649D8B63">LSD therapy</a> in the 1950s and 1960s, and published numerous clinical papers involving more than 40,000 patients. The <a href="http://www.fda.gov/regulatoryinformation/legislation/ucm148726.htm">Controlled Substances Act</a> of 1970 then prohibited the drug's medical use.

  • Tapeworm Diet?

    The "<a href="http://articles.latimes.com/2007/feb/19/health/he-esoterica19">tapeworm diet</a>" appeared in the early 20th century. Once thought to be an effective way to lose weight, but some tapeworm species are linked with malnutrition, nausea, vomiting, diarrhea, anemia and other health risks.

  • Medical Vibrators?

    The vibrator emerged as an "<a href="http://www.nytimes.com/books/first/m/maines-technology.html">electromechanical medical instrument</a>" at the end of the 19th century to treat so-called <a href="http://bigthink.com/ideas/18074">female hysteria</a>, of which symptoms included nervousness and trouble sleeping. Advertisements for vibrators could have even been seen in the pages of a Sears, Roebuck and Company catalog.

  • Dog Poop?

    A make-it-yourself remedy to ease a sore throat once included the strange ingredient of Album graecum (which is dried dog dung), as written in the book "<a href="http://books.google.com/books?id=D7KFvTUAVhwC&pg=PA105&lpg=PA105&dq=Album+graecum+sore+throat&source=bl&ots=KMP7gLhMlE&sig=j1aBh7lzrNwhtH1un5A8jVcAEVI&hl=en&sa=X&ei=fJ5gUNOVOarHigK39ICoAQ&ved=0CDcQ6AEwAQ#v=onepage&q=Album graecum sore throat&f=false">The Popularization of Medicine, 1650-1850</a>."

  • Coca-Cola As 'Healthy?'

    Coca-Cola was originally created by <a href="http://voices.yahoo.com/a-quick-history-coca-cola-pepsi-soft-drinks-537657.html" target="_hplink">Dr. John Pemberton around 1886</a> as a "medicinal" formula and marketed as a "health" drink (<a href="http://www.huffingtonpost.com/2011/02/15/coke-recipe-found_n_823552.html">it once contained cocaine</a>, but the ingredient was later removed in 1903). Soda dispensers were even installed in some pharmacies in 1948.

  • Shock & Lobotomy?

    <a href="http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml">Electroconvulsive therapy</a> (which was first developed around 1938) and <a href="http://scienceblogs.com/neurophilosophy/2007/07/24/inventing-the-lobotomy/">lobotomy</a> (first performed on humans in the 1890s) were both procedures <a href="http://www.apa.org/monitor/2011/02/myth-buster.aspx">thought to "cure" homosexuality</a>. Of course, contemporary science does not classify homosexuality an illness. Electroconvulsive therapy is, however, still a legitimate treatment for severe depression.

  • Smoke For Your Health?

    Before anti-smoking ads became commonplace, there were pro-smoking ads. During the late 19th and early 20th centuries, the inhalation of fumes from burning tobacco was a <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844275/">suggested therapy for asthma</a>.

  • Virgin Cleansing?

    The troubling myth that someone infected with a STD can transfer the disease by having sex with a virgin, thus curing themselves, dates back to at least <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)16288-0/fulltext">the 16th Century</a>, when the practice was first documented in relation to syphilis and gonorrhea in Europe. <a href="http://articles.cnn.com/2009-06-04/living/cnnheroes.betty.makoni_1_young-girls-raped-youngest-girl?_s=PM:LIVING">The myth continues</a> in some parts of Africa, leading to many cases of reported child rape.

  • Heroin As Cough Medicine?

    Heroin, chemically known as diacetylmorphine, was once prescribed to treat common ailments such as coughs, colds and pain--the drug was manufactured for such treatment by Bayer starting in 1898, according to <em><a href="http://news.bbc.co.uk/2/hi/uk_news/magazine/4647018.stm">BBC News</a></em>.

  • Ketchup As Medicine?

    In the late 1830s, <a href="http://books.google.com/books?id=e82QWB89_sIC&pg=PA107&lpg=PA107&dq=Dr.+Miles+tomato&source=bl&ots=arnopqhZJW&sig=blTANCDmjbAfY57zjYck2G4dFbU&hl=en&sa=X&ei=supgUITVCYfxiwLb_oDABQ&ved=0CCAQ6AEwAA#v=onepage&q=Dr.%20Miles%20tomato&f=false">Dr. Archibald Miles</a> claimed to have extracted a substance from tomatoes to help ailments such as diarrhea and indigestion. The pills named "<a href="http://www.cleveland.com/taste/index.ssf/2008/08/post.html">Dr. Miles' Compound Extract of Tomato</a>" were later declared a hoax.

  • Ecstasy Therapy?

    The drug <a href="http://www.drugabuse.gov/publications/research-reports/mdma-ecstasy-abuse/brief-history-mdma">MDMA</a> (commonly known as ecstasy) dates back to the early 20th century. During the 1970s, some psychiatrists even suggested using the drug for psychotherapy. Even though the drug is now controlled, proponents of <a href="http://healthland.time.com/2011/02/18/ecstasy-as-therapy-have-some-of-its-negative-effects-been-overblown/">ecstasy therapy have reemerged</a> in recent years.

  • Radium Therapy?

    An advertisement that touts preparing radioactive drinking water at home was one of many promotions for radiation therapy around 1913. Now radium is understood to be a <a href="http://www.epa.gov/rpdweb00/radionuclides/radium.html#affecthealth">health hazard</a>--for example, long-term exposure increases the risk of developing several diseases.

  • Bloodletting?

    Throughout history, <a href="http://www.ncbi.nlm.nih.gov/pubmed/15926663">bloodletting</a> (sometimes with the aid of a leech) was practiced to both cure and prevent illness. But this treatment wasn't all bad--<a href="http://www.msnbc.msn.com/id/5319129/ns/health-health_care/t/fda-approves-leeches-medical-devices/#.UGH6QaRSTox">medical leeches</a> are now sometimes suggested <a href="http://articles.baltimoresun.com/2011-01-23/health/bs-hs-medical-leeches-20110116_1_leeches-medical-devices-medical-science">to help with blood circulation or draining blood</a> during surgeries.

  • Mummy Powder?

    Across medieval Europe and the Middle East, corpses were ground into powder and used as medicine. This "<a href="http://www.aol.com/video/mummy-powder-/517406504/">mummy powder</a>" was thought to cure common ailments, such as <a href="http://io9.com/5917027/powdered-mummy-gladiator-blood-and-other-historical-medicines-made-from-human-corpses">headaches and stomach ulcers</a>.

  • Mercury To Treat Syphilis?

    Mercury was used as a <a href="http://ocp.hul.harvard.edu/contagion/syphilis.html">treatment for syphilis</a> until the early 20th century. Side effects of such mercury treatments could include tooth loss, ulcerations, neurological damage or even death.

  • Shark Cartilage To Treat Cancer?

    The suggestion of using shark cartilage to treat cancer emerged around the 1950s, stemming from research by <a href="http://www.nytimes.com/1998/09/29/nyregion/john-f-prudden-78-surgeon-and-researcher.html">Dr. John Prudden</a>. But recent studies have found no health effects in taking shark cartilage, according to the <a href="http://www.cancer.gov/cancertopics/pdq/cam/cartilage/HealthProfessional/page5">National Cancer Institute</a>.

  • Soothing Syrup?

    Mrs. Winslow's "<a href="http://www.ncbi.nlm.nih.gov/pubmed/11806256">soothing syrup</a>" was a popular formula that emerged in the late 1800s to help ease the teething process for young children. What was in this special syrup? Alcohol and morphine sulfate. The syrup was taken off the market in the 1930s.

 

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