Colon flora transplantation

[galvania]

Yesterday I heard an interesting topic on the radio.  Some surgeons are looking into transplanting colon flora from healthy donors to patients suffering with certain diseases, including a certain type of Crohn's disease.  Don't ask me the details - I was driving at the time and dindn't hear all of it.  But my first reaction was - what will happen to the ABO groups and the Lewis groups?  Has anyone heard anything about this?  I'm curious

anna

[David Saikin]

I have heard of this for treating CDiff.

[Dr. Pepper]

It is indeed in use to treat C diff. It made a brief media stir a while back since the usual response to the concept is "Yew". We joked about it, that after artificial blood is perfected we'll be relegated to stool banking. One of the microbiologists imagined herself walking into the stool bank, surveying the selection, then saying, "I think I'd like to try the well-formed tan one on the left.............."

 

And there's always directed donations from relatives (isn't there one in every family who thinks their poop doesn't stink?), or maybe autologous programs so you can donate before you go into a C diff-laden nursing home.

[aafrin]

Yes, it is known as fecal transplantation (or bacteriotherapy)or Fecal microbiota transplantation (FMT)or stool transplant. It entails transfer of stool from a healthy donor into the gastrointestinal tract of a patient for the purpose of treating recurrent C. difficile colitis,- a complication of antibiotic therapy, that may be associated with diarrhea, abdominal cramping and sometimes fever. I believe it is quite commonly done these days.

[Malcolm Needs ☆]

Yeuk. To an untrained microbiologist and an untrained surgeon (amongst many other things), this sounds like the cure could be worse than the original condition!!!!!!!!!!!!!!!!

[Mabel Adams]

I am sure they will soon find a way to make a commercial probiotic type suppository of it and charge a fortune for it.  I am pretty sure our hospital has a procedure for it although I don't know that we have had to do it yet.

[galvania]

Thank you everyone - it was more the affect this could have on the ABO antibodies that interested me - rather than the indications and the gory details.  Anyone see anything on this?

[Mabel Adams]

I would think that the person would have had more or less the same flora before they developed C diff that their "donor" has so would already have been exposed to organisms that would make them make ABO antibodies.  They don't quit making them when their flora is altered do they?  At least I would think it would take a long time for the antibody titers to decrease from lack of re-stimulation. Am I following your thinking at all?

[EDibble]

I have heard of this for treating CDiff.

As have I David. I believe they are doing it at Brigham and Woman's in Boston.

[David Saikin]

 

Thank you everyone - it was more the affect this could have on the ABO antibodies that interested me - rather than the indications and the gory details.  Anyone see anything on this?

 

I can't imagine this would impact ABO abs . . . there are other sources of stimulation that are constants.

[galvania]

Thanks everyone.  I just don't know.  I just think thatmaybe there could be an interaction between the bacterial 'ABO groups' (yes, I DO know they haven't really got ABO groups' and the anti-A/B that we already have.  I am thinking it could work both ways - that maybe, for exaple B substance in a patient could neutralise the bacterial function if they've got B sugars on their surface; on the other hand, as they are definitely 'foreign', would they trigger off an IgG anti-A /anti-B in the appropriate people.  I really have no idea wheter even theoretically that's possible.  But maybe if there's someone out there looking for a project.....?

[tkakin]

galvania sorry I am not commenting on the ABO aspect of your post. I just wanted to share that we have recently implemented a blender in the micro dept for prep of transplant specimens.  Poor girl doing this task will never look at a blender the same way.  If I am not mistaken I  heard they are comming out with a pill for establishing normal flora.  For the miro aid the sooner the better.

[aafrin]

Here's Top Story from AABB SmartBrief dated Feb. 16.

 

Nation's first fecal bank raises issues of research, regulation
OpenBiome has been established as the first fecal bank in the U.S., providing hospitals with screened material for fecal microbiota transplant to treat patients with Clostridium difficile infections. Despite its promise, experts are reluctant to resort to FMT due to legal uncertainties. The FDA has said it regards the treatment as a biologic drug and is developing industry guidelines, but the agency is not going after doctors who perform transplants. Fecal transplant researcher Dr. Alexander Khoruts says regulatory clarity is needed to help develop more advanced treatments. The New York Times (tiered subscription model)

[bxcall1]

From  the Therap Adv Gastroenterol. Nov 2012; 5(6): 403–420.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491681/

 

 

Clostridium difficile infection rates are Climbing in frequency and severity, and the spectrum of susceptible patients is expanding beyond the traditional scope of hospitalized patients receiving antibiotics. Fecal microbiota transplantation is becoming increasingly accepted as an effective and safe intervention in patients with recurrent disease, likely due to the restoration of a disrupted microbiome. Cure rates of > 90% are being consistently reported from multiple centers. Transplantation can be provided through a variety of methodologies, either to the lower proximal, lower distal, or upper gastrointestinal tract. This review summarizes reported results, factors in donor selection, appropriate patient criteria, and the various preparations and mechanisms of fecal microbiota transplant delivery available to clinicians and patients.