21 January 2019

New poo transplant therapy for ulcerative colitis

Gastro Patients Research

The case for poo transplants is firming up, with new Australian research showing the unconventional approach can deliver remission in one third of ulcerative colitis patients.

A new technique, which involves anaerobically preparing the stool samples, looks set to drastically improve the patients’ experience.

In the small number of previous studies supporting faecal microbiota transplantation (FMT) for this condition, patients were forced to undergo colonoscopies and enemas up to five days per week for two months.

This new regimen is for one week only.

“The most important difference in this trial compared to previous studies is the use of anaerobic (oxygen-free) stool processing,” study leader and gastroenterologist Dr Sam Costello, a lecturer at University of Adelaide, said in a statement.

“Many gut bacteria die with exposure to oxygen and we know that with anaerobic stool processing a large number of donor bacteria survive so that they can be administered to the patient.”

The team conducted a randomised, double-blind study on 73 adults with mild to moderately active ulcerative colitis, where half the group were given this new type of FMT and the control group were given their own stool via colonoscopy, followed by two enemas over the course of a week.

Two months after treatment, one in three patients receiving the anaerobically prepared poo transfer achieved remission compared with one in 10 in the placebo group.

This rate of improvement is on par with the best therapies currently available to patients with ulcerative colitis, yet avoids the common side effects that come with the immune suppressants.

Almost half of those who managed to get steroid-free remission at week eight with this new technique stayed in remission a year later.

The team believed that anaerobic stool processing might have been behind the good therapeutic effect they found with only a small number of treatments, Dr Costello said.

The treatment group overwhelmingly approved of the therapy, which was likely due to it being shorter and less intense.

“Our long-term aim is to develop rationally designed microbial therapies that can replace FMT,’’ Dr Costello said.

“These will have bacteria in a pill that can carry out the therapeutic effect without the need to take whole faeces.

“This is obviously a better, and less smelly, option.”

The study was funded by the NHMRC and the Gutsy Foundation. Treatments are currently in development for commercial use.

JAMA 2019; online 15 January