fecal transplant

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To Ease Fecal Treatment, Stool Bank Starts Producing Long-Awaited ‘Poop Pill’

Introducing: the poop pill  (Courtesy of OpenBiome)

Introducing: the poop pill (Courtesy of OpenBiome)

By Gabrielle Emanuel

Fecal transplants may have just gotten a lot easier to swallow.

OpenBiome, the nation’s first stool bank, is beginning large-scale production of a poop pill. This week marks the first time such a pill will be commercially available to hospitals and clinics.

Early tests suggest the pill is highly effective and comparable to traditional, more invasive delivery methods — for instance via colonoscopy, enema or a plastic tube through the nose and into the stomach or intestines.

“Fecal transplants came from what used to be this dark art — where you needed a donor and a blender,” says Mark Smith, research director at OpenBiome and one of its founders. “And now you basically take something out of the freezer and can treat the patient immediately. I’m very, very excited about this.”

Try not to get grossed out because this is an upbeat story. It’s about a very effective medical treatment for a really nasty infection.

Earlier, we reported on fecal transplants and OpenBiome’s struggle to survive.

Founded by MIT students and based in Medford, OpenBiome is just like a blood bank but for poop.

“Fecal transplants came from what used to be this dark art — where you needed a donor and a blender. Now you basically take something out of the freezer and can treat the patient immediately.”

– Mark Smith, OpenBiome research director

It collects healthy poop and then gives it to doctors so they can perform fecal transplants. This procedure is used for patients with recurrent Clostridium difficile or C.diff infections. The bacterium is in the gut and can cause bad — sometimes debilitating — diarrhea.

C.diff sickens hundreds of thousands each year and kills nearly 30,000 people annually in the U.S.

But fecal transplants have proven to be remarkably effective when it comes to C.diff. Technically called Fecal Microbiota Transplantation (FMT), the procedure has been shown to be nearly 90 percent effective in treating C.diff. That’s compared to standard antibiotics, which cure less than 40 percent of recurrent C.diff patients, according to OpenBiome.

This procedure involves collecting stool from a healthy donor and infusing it in the gut of a sick individual. But the catch is that the delivery method is both unpleasant and invasive. Continue reading

‘Vladimir Pootin’ To Poop Pills: Saga Of First Stool Bank Goes On

Bottles of frozen human stool for fecal transplants at the nation's first stool bank, OpenBiome, in this file photo (Gabrielle Emanuel/WBUR)

Bottles of frozen human stool for fecal transplants at the nation’s first stool bank, OpenBiome, in this file photo (Gabrielle Emanuel/WBUR)

Coming up in the next issue of The New Yorker: “The Excrement Experiment,” a sweeping disquisition on the history of fecal transplants for treating intestinal ills. It includes the delightful tidbit that at the nation’s first stool bank, begun in an MIT lab and now located in Medford, donors are given nicknames like “Winnie the Poo” and “Vladimir Pootin.”

We posted the back-story of the stool bank, by Gabrielle Emanuel, here in April: “MIT Lab Hosts Nation’s First Stool Bank, But Will It Survive?

The existential threat to the stool bank loomed from the FDA, which said it considered stool to be a drug, and thus potentially subject to regulations rigorous enough to send the costs of fecal transplants soaring and probably kill the bank. More recently, the agency has seemed to signal that it will allow some fecal transplants — at least for now.

The New Yorker story reports that orders for OpenBiome’s stool supplies have been growing at 18 percent a month for the last year, spurring complaints from companies that are working on competing products — pills and enemas.

The prospects for poop pill prospects are looking promising, The New Yorker reports, and the stool bank is involved in those efforts as well:

Even if OpenBiome were to stop shipping stool to hospitals, it could presumably continue to operate as a resource for researchers. When I visited in October, there was a tray of shiny white capsules on [co-founder Mark] Smith’s desk—“poop pills that we’ve been working on,” he explained. Doctors at Massachusetts General Hospital had just announced the results of a study showing that capsules were as effective as colonoscopes for treating C. difficile, and the field was abuzz with the news, since, as Smith pointed out, “everyone would rather swallow a pill.” He had hit on a way to improve on the doctors’ methods: lining capsules with cocoa butter, which is solid at room temperature, thus insuring that they won’t disintegrate prematurely—on the shelf or in someone’s mouth.

Meanwhile, for Boston-area residents interested in becoming the next Vladimir Pootin, boston.com reported last month that the bank, which now ships to fecal samples to 122 hospitals, is paying $40 “per dump:”

Are you under 50 years old, willing to make daily trips to Medford, and have regular bowel movements? You, my friend, could be earning $40 a day—just for pooping.

And for the more altruistically motivated:

“These donors may seem very mild-mannered and think going to the bathroom is a humble thing,” said Smith, “but each sample they bring in can treat four or five patients.”

A (Frozen) Boost For Fecal Transplants To Treat Nasty Bacterium

Bottles of frozen human stool for fecal transplants at the nation's first stool bank, OpenBiome (Gabrielle Emanuel for WBUR)

Bottles of frozen human stool for fecal transplants at the nation’s first stool bank, OpenBiome (Gabrielle Emanuel for WBUR)

By Gabrielle Emanuel

Last month, we reported on the first national stool bank and its struggle to survive. This week, a pilot study, published online in Clinical Infectious Diseases, gives the stool bank a helpful boost.

The study found frozen stool from an unrelated donor to be as effective in treating patients as fresh feces taken from the patient’s family member. It also found that the transplant can be successfully administered through the nose.

Before you stop reading, here’s some background: A stool bank is just like a blood bank, but instead of collecting, testing and distributing blood, it works with fecal matter. The main beneficiaries are patients with recurrent Clostridium difficile (C. diff). C. diff is a nasty bacterium that causes such bad diarrhea it can completely disrupt a person’s life. Over the course of a year, it sickens half a million people and kills about 14,000 people in the U.S.

Luckily, there is a very effective treatment: fecal transplants. This is when you take stool from a healthy donor and put it into the gut of a sick patient; the good bacteria then outfights the C. diff. Studies involving animals and fresh fecal material show that this procedure works 90 percent of the time.

“It’s been remarkably successful and gratifying,” said Dr. Elizabeth Hohmann, an associate professor of medicine and infectious diseases at Massachusetts General Hospital and Harvard Medical School, and the study’s senior author. “There aren’t that many things we do in medicine that are over 90 percent effective.”

Despite such a success rate, many doctors are unwilling to do the procedure. One of the main reasons is that finding and screening donors takes a lot of time and can be expensive.

When Mark Smith, a PhD student at MIT, heard about this he decided to partner with some friends and start a stool bank. The thought was that if they provide prescreened, frozen stool, the procedure would be way easier and, thus, boost its availability. Their stool bank has been fully operational since early October.

But the FDA was more cautious. Continue reading