BioEd Online

NewsFlash: Fecal Transplant Pill May Bring Balance to Microbiomes

Our gut flora, 100 trillion microorganisms in our intestines also known as the gut microbiome, does much more than help us to digest food. It plays an important role in promoting overall health by regulating inflammation and metabolism, and by controlling infection.

One such infection is caused by the bacterium, C. difficile. Each year, about 500,000 people in the US become infected by C. difficile, and about 14,000 die. C. difficile is naturally present (and non-harmful) in a small percentage of the population, but it can be spread to anyone through resilient spores sometimes found in hospitals and nursing homes. Infection can disrupt the normal gut microbiome. No surprise, then, that people with C. difficile infection can experience fever and serious intestinal problems, including nausea, cramping and severe diarrhea. In extreme cases or particularly vulnerable patients, infection can lead even to death.

Initial treatment consists of certain antibiotics, but the infection sometimes proves resistant to these medications. Fortunately, alternative treatments using fecal transplants have shown success in clearing persistent C. difficile infections. However, these treatments require the placement of tubes down a patient’s nose or the use of enemas to introduce the transplanted material, so they are uncomfortable, and sometimes impractical.

An even newer development comes in the form of a pill. Donor stool, usually from a relative, is processed to extract the resident microflora, encapsulated, and then triple-coated in gelatin to ensure the pills reach the intestines before dissolving. The full dose (ranging from 24 to 34 capsules) appears to promote the resurgence of diverse and health intestinal flora. A notable drawback to this treatment is that the pills must be custom processed for each patient just before treatment, with microflora collected from a very specific donor.

Given the large number of people who suffer from C. difficile and other intestinal disruptions (such as ulcerative colitis and Crohn’s Disease), there actually had been a significant “do-it-yourself” market for fecal microbiota therapy (fecal transplants), despite the potential “gross-out” factor. Recently, however, the US Food and Drug Administration identified the pills as an investigational drug. So future access to these treatments are likely to be regulated by federal processes and oversight. As research into the human microbiome progresses, doctors and scientists hope to produce a pill that encompasses the full diversity of healthy intestinal flora, and/or identify characteristics a “universal donor” to provide safe and effective treatment for C. difficile and other intestinal disruptions.

Extension Activities
The Variety and Roles of Microbes - Students use a set of cards to categorize microbes’ roles and uses, and learn that some microbes have characteristics that are associated with more than one group. After completing the activity ask, What are some beneficial uses of bacteria? (Some bacteria help us to process our food). Ask, What can happen if the bacteria in our gut is disrupted? (When the helpful microbes within our bodies are depleted, other harmful microbes can take their place and cause illness.) Explain that by helping to replenish normal, beneficial gut bacteria, fecal transplants can help prevent harmful bacteria from infecting the body. Point out all food and other extra particles are removed from fecal material before it is transplanted. Remind students that it is very important always to complete the full course of antibiotics, as this minimizes the proliferation of antibiotic-resistant bacteria.