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Innovations in Organic Transplants

Posted By Prucia Buscell, Thursday, December 04, 2014

Healthy human excrement is becoming a valuable commodity.

OpenBiome, a nonprofit launched by MIT graduate students almost two years ago, is the nation's first stool bank. Its mission is to provide doctors and hospitals with safe fecal material from screened donors for use in the growing number of fecal transplant procedures. Microbiologist Mark Smith, a co-founder, explains in a Boston.com story by Chelsea Rice that the organization is modeled after the Red Cross, to make a medical commodity available in a standardized way.

Fecal transplants-known as fecal microbiota transplants, or FMT, have been found extraordinarily effective in treating patients with Clostridium difficile infections that afflict half a million patients a year with intestinal pain and disabling diarrhea. Most are hospital patients who have been treated with antibiotics that wipe out healthy gut bacteria along with targeted pathogens. With the microbial competition wiped out, C. diff takes over, producing toxins that can cause severe and sometimes fatal illness. With introduction of donated stool into the patient's intestine or colon, healthy bacteria fight the C. diff and the normal microbial gut community can be reestablished. The Mayo Clinic first used FMT to treat a C. diff patient in 2011 and the Cleveland Clinic called FMT one of the top medical innovations of 2013.

In The New Yorker story "The Excrement Experiment," Emily Eakin traces the past and current understanding of fecal microbiota, describes its potential for treating several autoimmune disorders, and reports on recent research suggesting the mysteries of the gut biome may hold keys to many medical conditions, including obesity and mental health. Researchers at Washington University in St. Louis found that gut bacteria plays a significant role in obesity in mice. Mice implanted with gut bacteria from a fat human gained weight while those injected with gut bacteria from a thin human stayed slim even when both groups ate the same diet. Research also suggests gut bacteria influences our moods, minds and emotions.

The average human digestive tract hosts at least 100 trillion bacterial, fungal, viral and archaeal organisms that collectively makeup the gut biome. Much of the research focuses on stool, which Eakins explains "remains our best proxy for the brimming universe within." Smith told Eakin part of his inspiration for OpenBiome was a friend who cured his extreme suffering from C. diff by transplanting his room-mate's stool into himself. Transplanting can be done using enemas, colonoscopies or a turkey baster. OpenBiome absorbs the cost of screening donors, whose blood is tested for several diseases, and whose initial stool samples are screened for known harmful pathogens. It is now sending specimens of clinically prepared excrement to dozens of hospitals across the country. Boston.com reports screened doors are paid $40 a day for their contributions. To lighten a gross topic, donors, who are anonymous to recipients, are given code names such as Winnie the Poo, Poop King, and Vladimir Pootin. Note the Boston.com graphic.

Meanwhile, for-profit biotech companies are competing to get stool-based therapies through trials and into the market. Scientists are also designing fecal capsules, which some entrepreneurs call "crapsules," that will be more appealing to patients. And the FDA will have to decide what regulatory measures should be in place. The FDA has viewed medically used stool as a drug. Smith and others hope it will be reclassified as a tissue, which has to meet stringent standards but does not have to go through clinical trials required for FDA drug approval. Read the New Yorker story here.

Tags:  bacteria  buscell  complexity matters  health 

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