Generally Ulcerative colitis (UC) is considered incurable. Regular medical approaches to UC involve ongoing sometimes extensive medical or surgical intervention with antibiotic, anti-inflammatory, and/or immunosuppressive drugs. These interventions are supportive rather than curative and can themselves have side effects.
Ohkusa et al, (2005) first showed that treatment with antibiotics can improve UC symptoms, as well as UC colonoscopy and histological disease scores, which suggested that microbes residing in the intestines of UC patients may play a role in manifesting UC disease.
Experiments in animal models of UC show:
- Animals have minimal signs of inflammation if they are germ free, while
- colitis heightens when animals are exposed to microbes.
In human UC patients alterations in gut microbial composition are often found.
Faecal microbial transplantation (FMT) is a unique approach that has been used to try to correct disease-causing alterations in gastrointestinal (GI) microbial populations.
FMT involves doctors taking stool from healthy stool-donors, i.e. people who have been carefully selected using strict screening criteria to ensure that donors are:
- Completely healthy (disease free)
- Free of pathogenic organisms in their stool
Donor stool is then transplanted into the bowels of patients with disease.
FMT has been shown to be a highly effective for treating and correcting the overgrowth of Clostridium difficile bacterium. Donated bacteria control clostridium without the need to antibiotics.
Because of FMT’s demonstrated ability to influence gut microbial composition many researchers have begun to investigate the use of FMT as a first line treatment for UC.
The first successful intervention using FMT for UC was conducted on a patient in 1989, who has remained in remission, and off all UC treatments since.
A recent study looked at a specific method of FMT called ‘short duration FMT’ (SD-FMT) to determine if this newer method could induce remission more successfully in active UC. Previous methods did not prepare stool samples in oxygen free environments. SD-FMT uses anaerobically (oxygen-free) prepared pooled donor-stool suspensions, because most colonic bacteria and archaea are extremely oxygen sensitive and require oxygen free conditions to survive. If donor stool is prepared/processed with oxygen present, these important microbes may be diminished or lost before transplantation can occur. Therefore, anerobic stool preparation may provide more complete transfer of all beneficial donor organisms to the UC patient.
Researchers randomized 73 patients (mean age, 39 years; (33W, 40M), 69 completed the trial. During colonoscopy, 38 patients received 200 mL of faecal suspension from healthy donors, while 35 received autologous (their own) stool as control. In the following 7 days each group then received two further 100-mL aliquots of their respective faecal suspensions, this time administered by enema.
Researchers then monitored disease activity, and collected stool samples from patients at baseline (week 0) and weeks 4, 8, and 52 to examine changes in:
- Microbial composition,
- Microbial metabolism
- Fecal calprotectin – a measure of neutrophil driven bowel inflammation.
Bowel wall Biopsies were taken at colonoscopy at weeks 0 and 8 to determine number of certain white blood cells (mononuclear cells, i.e. dendritic and B cells).
Researchers found that by week 8, steroid-free remission* was achieved by:
- 12 of 38 participants (32%) receiving pooled donor SD-FMT, 5 of these maintained remission after 12 months,
- 3 of the 35 (9%) receiving autologous SD-FMT
Additionally:
- Higher populations of Anaerofilum pentosovorans and Bacteroides coprophilus was strongly associated with disease improvement after SD-FMT.
- FMT had no effect on short chain fatty acid production (SFCAs) including butyrate at week 4 or 8
- SCFA concentrations in stool bore no relation to SD-FMT treatment effects.
- Calprotectin reduced in all groups.
- Although dendritic and B cells numbers were both associated with initial UC severity (total Mayo score) SD-FMT had no effect on B or dendritic cell numbers
Clearly FMT is not a cure all, but for the 13% of people in whom remission was maintained, it would be a god send. The interesting thing here is that no attempt was made in this study to determine effects of or manipulate patient diet or micronutrient intake, both of which may have significant effects on disease, host health and bacterial health and diversity.
Notes
* steroid-free remission is defined as a total Mayo score of ≤2 (range, 0-12) with an endoscopic Mayo score of ≤1 (range, 0-3)
Article Written + Submitted by:
Andreas Klein Nutritionist + Remedial Therapist from Beautiful Health + Wellness
P: 0418 166 269