Fecal Microbiota Transplant

A new treatment for Inflammatory Bowel Diseases

Author: Daniel EscobarContact: gwqqy@boun.cr

IBD are a set of diseases developing into an epidemicThe unusual and recent rise in these kind of diseases most notably on developed countries point to a recent and area specific etiology, not a better healthcare and diagnosis.Recent research are pointing to a healthier immune system and intestinal flora in undeveloped countries and population• First Look at the Microbes of Modern Hunter-Gatherers

Pharma companies are incresing their budget to investigate new drugs to treat Chron’s Disease and Ulcerative Colitis.Sidney, Scotland and Calgary public health services are investigating the rise of these diseases reaching epidemic proportions, specially on children population• IBD on the Rise Worldwide, more on developed countries• Kid’s Chron epidemic in Scotland• IBD on the rise in Ontario specially on children

Research hints flora imbalance as the most probable causeResearchers discover the cause of Irritable Bowel Syndrome.Professor Michael Schemann’s research team at the TUM Department for Human Biology demonstrated that micro-inflammations of the mucosa causes sensitization of the enteric nervous system, which in turn causes irritable bowel syndrome. The researchers used ultrafast optical measuring methods to demonstrate that mediators from mast cells and enterochromaffin cells directly activate the nerve cells in the bowel. The hypersensitivity of the enteric nervous system upsets communication between the gut’s mucosa and its nervous system. Project leader Prof. Schemann explained: “The irritated mucosa releases increased amounts of neuroactive substances such as serotonin, histamine and protease. This cocktail produced by the body could be the real cause of the unpleasant IBS complaints.”The scientists are the first to identify IBS’s cause; up to now, many doctors have dismissed their IBS patients as merely being hypochondriacs. Irritable bowel syndrome makes life miserable for those affected — an estimated ten percent or more of the population. And what irritates many of them even more is that they often are labeled as hypochondriacs, since physical causes for irritable bowel syndrome have never been identified until now.

Sources• Buhner S, Li Q, Vignali S, Barbara G, De Giorgio R, Stanghellini V, Cremon C, Zeller F, Langer R, Daniel H,

Michel K, Schemann M: “Activation of human enteric neurons by supernatants of colonic biopsy specimens from patients with irritable bowel syndrome”. Gastroenterology. 2009; 137: 1425-1434.

• Abstract• Schneider J, Jehle EC, Starlinger MJ, Neunlist M, Michel K, Hoppe S, Schemann M: “Neurotransmitter

coding of enteric neurons in the submucous plexus is changed in non-inflamed rectum of patients with Crohn's disease”. Neurogastroenterol Motil. 2001; 13: 255-264.

• Abstract

Academic Career and Research AreasProf. Schemann’s (b. 1956) research focuses on the neural regulation of gastrointestinal functions. With the aid of ultrafast imaging, he investigates the neurophysiology and neuropharmacology of the human enteric nervous system. As well as exploring basic neurobiological issues, he also examines the role of the enteric nervous system in the pathogenesis of functional and inflammatory diseases of the gut. Another aspect of his work involves identifying new targets to treat these diseases. After studying agricultural biology, Prof. Schemann did his doctorate (1985) and lecturer qualification (1990) at the University of Hohenheim. During that time, a German Research Foundation grant enabled him to work at Ohio State University, USA. He received a Heisenberg grant to work at the Max Planck Institute for Physiological and Clinical Research in Bad Nauheim. In 1994, he became professor of vegetative physiology at the University of Veterinary Medicine in Hannover. Since 2002, he has been full professor of human biology at TUM. Prof. Schemann is a member of the editorial board of Gastroenterology and Gut.

Further research blames extensive use of antibiotics as cause of imbalanceGut Biota Never Recover from Antibiotic Use: Loss Extends to Future GenerationsEvidence shows the mass antibiotics experiment is devastating our children’s health. It may be the reason so many struggle for breath and can’t assimilate food properly.Emerging research shows that the harmful effects of antibiotics go much further than the development of drug resistant diseases. The beneficial bacteria lost to antibiotics, along with disease-inducing bacteria, do not recover fully. Worse, flora lost by a mother is also lost to her babies. The missing beneficial gut bacteria are likely a major factor behind much of the chronic disease experienced today. The continuous use of antibiotics is resulting in each generation experiencing worse health than their parents.Martin Blaser is chair of the Department of Medicine, New York University Langone Medical Center. Is the author of a report in the prestigious journal Nature and he writes:Antibiotics kill the bacteria we do want, as well as those we don’t. These long-term changes to the beneficial bacteria within people’s bodies may even increase our susceptibility to infections and disease.Overuse of antibiotics could be fuelling the dramatic increase in conditions such as obesity, type 1 diabetes, inflammatory bowel disease, allergies and asthma, which have more than doubled in many populations.Aside from the development of superbugs, we’re now seeing clear documentation that the overall long term effects of antibiotics are devastatingly harmful to our health. Speaking to ABC News, Blaser said:Antibiotics are miraculous. They’ve changed health and medicine over the last 70 years. But when doctors prescribe antibiotics, it is based on the belief that there are no long-term effects. We’ve seen evidence that suggests antibiotics may permanently change the beneficial bacteria that we’re carrying.

Sources• Enterotypes of the human gut microbiome• The changing hypothesis of the gut• Antibiotic overuse: Stop the killing of beneficial bacteria

Gastroenterologists worldwide make a breakthroughFecal transplants successful in treating intestinal ailmentAn infusion of feces from a healthy person is much more effective than an antibiotic in treating C. difficile, a recurrent intestinal infection, researchers find.A new study has found that an infusion of feces from a healthy person into an ailing patient's gut was significantly more effective than a traditional antibiotic treatment — raising hopes that the unconventional approach could one day help combat obesity, food allergies and a host of other maladies.The study, published online Wednesday by the New England Journal of Medicine, a reference magazine for the medical community worldwide, demonstrated that the fecal transplant cleared up a recurrent bacterial infection far more reliably than the routinely prescribed medication. In fact, the transplant was so successful that the research trial was ended early so that patients in the control groups could be given the remedy as well.As a treatment for recurrent Clostridium difficile infection — an ailment that affects nearly 1% of patients hospitalized in the U.S. and plays a role in an estimated 100,000 deaths a year — the transplant had a 94% cure rate, three times greater than for those who took only the antibiotic vancomycin."It's a strange concept to use stool, which has always been looked on as something dirty," said Dr. Lawrence Brandt, a gastroenterologist at the Albert Einstein College of Medicine in New York who has conducted transplants for 14 years but wasn't involved in the study. "We're entering a very exciting new chapter in medicine."[…]SourceThe New England Journal of MedicineDuodenal Infusion of Donor Feces for Recurrent Clostridium difficile

Fecal microbiota transplantation for severe enterocolonic fistulizing Crohn's disease.• Authors Zhang FM, et al. Show all Journal• World J Gastroenterol. 2013 Nov 7;19(41):7213-6. doi: 10.3748/wjg.v19.i41.7213.

AffiliationFa-Ming Zhang, Hong-Gang Wang, Min Wang, Bo-Ta Cui, Zhi-Ning Fan, Guo-Zhong Ji, Digestive Endoscopy and Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China. AbstractThe concept of fecal microbiota transplantation (FMT) has been used in traditional Chinese medicine at least since the 4(th) century. Evidence from recent human studies strongly supports the link between intestinal bacteria and inflammatory bowel disease. We proposed that standardized FMT might be a promising rescue therapy for refractory inflammatory bowel disease. However, there were no reports of FMT used in patients with severe Crohn's disease (CD). Here, we report the successful treatment of standardized FMT as a rescue therapy for a case of refractory CD complicated with fistula, residual Barium sulfate and formation of intraperitoneal large inflammatory mass. As far as we know, this is the first case of severe CD treated using FMT through mid-gut.

Sourcehttp://www.ncbi.nlm.nih.gov/m/pubmed/24222969/

Rebiotix Clinical ProgramDeveloping solutions for difficult-to-treat gastrointestinal diseasesRebiotix is pursuing a focused clinical research program to develop new solutions to challenging gastrointestinal diseases.The company’s first target is recurrent Clostridium difficile (C diff), a healthcare-acquired infection that has been termed an urgent public health threat by the US Centers for Disease Control.About RBX2660Lead product, RBX2660 (microbiota suspension) is currently undergoing Phase 2 evaluation in the PUNCH™ CD study.Rebiotix is currently working with the US Food and Drug Administration (FDA) on the design for a Phase 3 study of the product.RBX2660 is a second generation version of fecal transplant therapy featuring a number of refinements designed to improve on a non-antibiotic technique that has been used to treat recurrent C diff successfully.The company is also actively exploring additionalproducts for other gastrointestinal diseases.

The Centre for Digestive Diseases for Research And TreatmentThe Centre for Digestive Diseases (CDD), under the leadership of founder and Medical Director, Professor Thomas Borody, has distinguished itself as a unique medical institution offering novel approaches in researching, diagnosing and treating gastrointestinal (GI) conditions.CDD offers a range of services in the day-procedure unit. Patients undergo a range of procedures in its well-equipped facilities, supported by an ISO 9002 accredited organisation consisting of 38 staff. CDD offers patients a high standard of professional care and service.CDD also houses a Department of Research and Innovation responsible for conducting clinical trials approved by an independent Human Research Ethics Committee (HREC).Located in Sydney Australia, CDD is internationally regarded as a unique medical institution, collaborating with pharmaceutical companies, universities and medical societies in striving to provide excellence in gastroenterology.

Our recent publications and abstracts

• Anti-MAP therapy in the treatment of active Crohn's disease.T.J. Borody, R. Clancy, A. Wettstein, K.J. Herdman, M. Torres, S. Tye, G. Pang, E. Campbell, S. Leis.Journal of Gastroenterology and Hepatology 2005; 20(Suppl): A2. • Bacteriotherapy using fecal flora: toying with human motions.

TJ Borody, EF Warren, SM Leis, R Surace, O Ashman, S Siarakas.J Clin Gastroenteroly 2004; 38(6): 475-83. • Irritable bowel syndrome and Dientamoeba fragilis.

TJ Borody, C Robertson, A Wettstein, E Warren, R Surace.IBIS News and Views. Winter 2002; 4-5. • For a complete list refer to

http://cdd.com.au/pages/publications/publications_abstracts.html

OpenBiome First to Market in the US with Fecal MicrobiotaAbout OpenBiomeOpenBiome is a nonprofit organization dedicated to expanding access to fecal microbiota transplantation (FMT) therapies. Founded by a small team of microbiologists, public health advocates, and concerned citizens, OpenBiome aims to significantly reduce the practical barriers for clinicians providing FMTs, while connecting scientists across studies and disciplines. Why did we launch OpenBiome?Motivated by scientific curiosity and frustration at the struggle of a friend suffering from recurrent C. difficile, we founded the OpenBiome project to give a broader pool of clinicians access to the carefully screened samples necessary to perform FMT.Despite the underlying simplicity and efficacy of FMT, it has become difficult to practice at the scale required due to the challenges of screening donors and processing stool material. OpenBiome is designed to simplify the FMT process by freeing clinicians to focus on providing care and conducting research rather than preparing stool and filing paperwork.

Doctor’s clinical experience on FMTDr. Thomas Borody from the Centre for Digestive Diseases.Fecal Bacteriotherapy (Human Probiotic Infusion) for Clostridium difficile infection.

Dr. Lawrence BrandtLawrence Brandt, MD, professor of medicine and surgery at the Albert Einstein College of Medicine in New York City, discusses a study on the outcomes of fecal microbiota transplants on almost 100 patients across the country with refractory Clostridium difficile colitis. He explains that 91 percent of the patients experienced prompt relief. Including those who underwent a second transplant or a post-transplant course of medication, 98.3 percent of the patients experienced relief.

Dr. Carl V. Crawford

Carl V. Crawford, M.D., a gastroenterologist at the Center for Advanced Digestive Care at NewYork-Presbyterian, explains Fecal Microbiota Transplantation as a treatment for Ulcerative Colitis.

The Power of Poop• Leading website compiling success stories of patients that

have been treated with FMT• http://thepowerofpoop.com/