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The Australian team behind the small study said the strategy may work by introducing millions of healthy bacteria into the dysfunctional tract.
“Bacteria comprise more than half of the fecal mass, [but] not all poop is created alike,” explained Dr. Arun Swaminath, a U.S. gastroenterologist unconnected to the new research.
In fecal transplant, patients receive stool laden with bacteria from a healthy donor’s microbiome — those internal communities of “good” bacteria, Swaminath said. And that might help restore balance to the digestive tract of people with colitis.
In recent years, “new technology has now allowed us to get a deeper understanding of the microbiome,” Swaminath said. That’s led to whole replacement of the colonic microbiome with donor fecal transplant.
The new Australian research involved 73 adults with mild to moderate active ulcerative colitis. The patients received a few treatments of low intensity fecal microbiota transplantation delivered via colonoscopy.
Patients were divided into two groups: Some received pooled donor fecal matter processed anaerobically (in an oxygen-free environment), while others received their own fecal matter (essentially, a placebo, used for comparison purposes).
The result: The rate of ulcerative colitis remission was 32 percent for the patients who received the pooled donor stool, compared with just 9 percent in the placebo group.
The rate of remission in the patients who received the donor fecal matter was similar to that achieved with the best current treatments, noted a team led by Dr. Sam Costello, a gastroenterologist at The Queen Elizabeth Hospital, in Adelaide.
Costello noted that many current colitis treatments suppress the immune system, and that can lead to potential side effects, such infection or even cancer.
“The most important difference in this trial compared to previous studies is the use of anaerobic (oxygen-free) stool processing,” said Costello, who is also a lecturer at the University of Adelaide’s Medical School.
“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,” Costello explained in a university news release. “We believe that this may be the reason that we had a good therapeutic effect with only a small number of treatments.”
Dr. David Bernstein is a gastroenterologist and director of the department of hepatology at Northwell Health in Manhasset, N.Y. He said the new study is “promising and the results are impressive.” But he stressed that larger studies are needed “to validate these findings.”
In the meantime, Costello’s team has reached an agreement with a company to develop the method used in the study and conduct further studies.
“Our long-term aim is to develop rationally designed microbial therapies that can replace fecal microbiota transplantation,” Costello said. “These will have bacteria in a pill that can carry out the therapeutic effect without the need to take whole feces,” he explained.
“This is obviously a better and less smelly option,” Costello said.
The findings were published Jan. 15 in the Journal of the American Medical Association.
— Robert Preidt
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SOURCES: Arun Swaminath, M.D., director, Inflammatory Bowel Disease Program, Lenox Hill Hospital, New York City; David Bernstein, M.D., gastroenterologist and vice chair of medicine for clinical trials and chief, division of hepatology, Northwell Health, Manhasset, N.Y.; University of Adelaide, news release, Jan. 15, 2019