Stool donation: faece to faece, so to speak

21. May 2012

The final option is sometimes not paved in marble, but smeared with excrement. When the intestinal flora has been damaged and germs attack the body, if nothing else works, a stool donation is said to achieve remarkable success.

The thought might be disgusting, but is anything other than absurd, for that which lives within us is not just body cells. We share the body with microorganisms. About one to two kilograms of our body weight is made up of intestinal bacteria alone. 100 trillion bacteria that line the colon in particular like a second skin.

Sophisticated symbiosis with the body

They usually do not need to be feared. They live in a sophisticated symbiosis with the body. Although they help themselves to chyme that is passed through the gut, they help with digestion, deliver vitamins, protect us from disease-causing pathogens and train the immune system. Without the tiny beings, we would barely be able to survive and be defenceless in the face of many attackers. But every once in a while this peaceful coexistence is disturbed. Antibiotics for instance eliminate not only pathogens, they also kill the beneficial bacteria.

Normally digestion recovers from the clean-up action within the following weeks. Sometimes however, the less harmless intestinal bacteria such as Clostridium difficile use the chance to spread en-masse and displace the healthgiving residents of the intestine.
While a Clostridium infection in earlier times had been only rarely a cause of problems, it is today one of the most common hospital-acquired infections in Europe. The consequences are severe diarrhea and inflammatory infections. In extreme cases, parts of the intestines are removed; in some cases, patients do not survive such an infection. In the U.S., statisticians have calculated that each year approximately 14,000 deaths are added to the tally of this intestinal inhabitant. The majority of patients are over 65 years old and have caught the infection in hospital or in nursing homes. While C. difficile colonises the gut of four percent of healthy people at most, it is to be found in 20 to 40 percent of patients in hospitals.

Maneuvered by enema into the intestine

Antibiotics were indeed able to bring this germ to a halt, but over time some representatives of the group have developed effective resistance mechanisms. With the usual methods of treatment, in 25 percent of all cases the infection recurs within a month. Therefore, scientists around the world are trying to find alternative treatments. If the germ develops into a continuous trouble-maker, bacterial treatment should provide a remedy. This method, which a number of physicians in the U.S., Canada and Australia already successfully employ, has brought attention not only in the scientific community.

This is not a genetic engineering methodology, nor does it involve stem cells or use a complex device. No, it is simply the stool of a healthy donor mixed with saline solution and then maneuvered by enema into the intestine. By way of a tube via the nose is possible as well. Once inside the intestine, the donated intestinal bacteria should help to restore a natural and healthy intestinal flora with a good mix of various intestinal bacteria. So easy the method, so great the success. Doctors from the U.S., Canada or Australia report that they have been able to help up to 90 percent of their patients. Although the patients suffered for many months from their disease, treatment usually hit the mark in a matter of days. What the effect is based on, whether the bacteria actually settle in or only set off messengers for the healing process, is not yet clear.

In Germany, the procedure is not applied. To many there the method seems uncertain. Further, there are no large studies that independently evaluate the success and compare it with other methods. In addition, while the stool of the donors is tested for some diseases, what long term effects the bacteria have on the receiver however can not be predicted. The natural flora with its microbes influence not only digestion, it also influences a variety of metabolic processes and is implicated in diseases such as diabetes and multiple sclerosis. The bowel even has an influence on the mind. Changing this microsystem somewhat at random raises at the very least some medical and ethical questions. Many physicians, therefore, hope to identify the bacteria that are responsible for the beneficial effects and to use them or their agents as a targeted drug.

Meanwhile, supporters of stool transfer are going one step further. They can foresee such therapy for people with ulcerative colitis, severe symptoms of irritable bowel syndrome and Parkinsons disease.

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