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Fecal Transplant Pills Could Become a New Cutting-Edge Treatment for Infections

From TIME - November 28, 2017

Human waste has long been thought of as just that: everything the body doesnt want or need. But new research is showing that feces may contain valuable organisms that can actually treat disease.

In a new paper published in JAMA, researchers led by Dr. Dina Kao, a gastroenterologist at the University of Alberta in Canada, and her colleagues report that fecal matter manufactured into a capsule was no worse than fecal matter transplanted by colonoscopy. Both procedures successfully reduced risk of repeated C. difficile infections by more than 90%. C. difficile (C. diff) infections can be caused by bacteria that are resistant to many antibiotics.

The advantages of a capsule over a colonoscopy, which is an invasive procedure that requires mild sedation, are clear. Any time people are sedated, there is a risk that their breathing will slow too much. Colonoscopy also comes with the risk of puncturing the intestinal wall, which can introduce infections that could be life threatening. The benefits of swallowing a capsule are also undeniable compared to swallowingor trying to swallowa feeding tube through which a slurry of fecal matter is flowing through. (Thats the way that doctors testing fecal transplants originally administered their doses.) That carries the risk of aspirating some of the fecal slurry into the lungsnot to mention the unpleasantness of introducing feces to the mouth area and accidentally breathing it in.

Fecal transplants are part of the burgeoning field of research involving the microbiome: the living universe of microbes, including bacteria, that live on and in the body. Unlike their disease-causing counterparts, these microbes work to improve human health. Certain bacteria, for example, are linked to lower rates of conditions like allergies, asthma, obesity and even some types of mental illnesses.

Studies have found that certain microbes in the digestive tract are linked to lower rates of C. difficile infection, which is mainly acquired in health care settings like hospitals and nursing homes. About 90% of people who receive fecal transplant by colonoscopy do not experience recurrent infections. Antibiotics can treat the infection, but anywhere from 10% to 30% of people will develop further infections, and each recurrence increases the risk of another one.

While certain microbiome populations can lower the risk of infection, its not clear whether the amount of bacteria in the gut is the key factor, or whether its the type of bacteria or even how the bacteria is delivered. In the study, Kao focused on understanding whether the way the gut bugs are delivered makes a difference. The biggest question in this area has always been, whats the best way to deliver the transplant? she says. I think with this study, we can see that maybe the capsule delivery format is the way to go if you are going to give this type of microbiome-based therapy.

MORE: Fecal Transplants May Soon Be Available in a Pill

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