Serious bowel diseases that blight the lives of thousands could be cured with a ‘faecal transplant’, research suggests.
For the first time, the nauseating procedure resolved severe colitis in patients who developed the disease following cancer treatment, a study found today.
In as little as one transplant, the patients’ symptoms – including bloody diarrhoea, abdominal pain and an urgent need to use the toilet – completely disappeared.
Serious bowel diseases could be cured with a ‘faecal transplant’, research suggests (stock)
The researchers analysed a 50-year-old woman and a 78-year-old man who developed colitis as a result of treatment with immune checkpoint inhibitors (ICIs) for bladder and prostate cancer, respectively.
ICIs block proteins that prevent the immune system from killing cancer cells and are effective at treating several types of tumours.
However, they cause gastrointestinal side effects, including colitis, in up to 40 per cent of patients, according to lead author Dr Yinghong Wang, from The University of Texas MD Anderson Cancer Center.
The two patients were treated for colitis between June 2017 and January this year at the Anderson Center via steroids or immunosuppressive drugs.
However, their diseases did not respond to these traditional therapies.
Under ‘compassionate use’ care, the patients then received bacteria from the faeces of healthy volunteers.
This was mixed with saline and strained before being injected into their digestive tracts.
After undergoing just one fecal microbiota transplant (FMT), the woman’s symptoms completely disappeared within just two weeks.
The man experienced partial recovery after one treatment and complete resolution after a second.
‘The resolution of colitis in these patients can be confirmed clinically and endoscopically after FMT treatment,’ Dr Wang said.
Endoscopy results suggested the patients had significantly less inflammation and ulceration in their bowels.
Stool samples later revealed the patients’ microbiomes were most similar to the donors’ immediately after treatment.
Although the similarities faded over time, their post-transplant microbiomes still mirrored those of the donors’ by 75 per cent.
Their post-treatment gut bacteria also contained anti-inflammatory bugs that were not present before.
The study was published in the journal Nature Medicine.
‘In the second patient, there was a notable increase in the abundance of Blautia and Bifidobacterium species after FMT – which have been associated with reduced intestinal inflammation,’ Dr Wang said.
‘In addition to this, he had a decrease in the abundance of potentially pathogenic Escherichia and an increase in potentially beneficial Bacteroides after his first FMT.’
Speaking of the female patient, she added: ‘Immediately following FMT in the first patient, donor-derived bacteria had effectively colonised the intestinal tract.’
‘Together, these cases provide provocative and novel evidence that modulation of the gut microbiome via FMT can be associated with significant and rapid improvement of ICI-associated colitis – with early insights into potential mechanisms.
‘Given the widespread application of ICI with expanding indications across cancer types, it’s anticipated there will be an increased incidence in colitis and other immune-related adverse events.
‘Based on these results, this should be evaluated even as a first-line therapy for ICI-associated colitis because it’s safe, quick, and the effect is durable – from one treatment.’
Treating colitis with steroids has been linked to insomnia, irritability and indigestion, while immunosuppressant drugs put a person at risk of infections.
In severe ICI-induced colitis cases, patients may even be forced to stop their cancer treatment until they are in remission.
‘If the patient is a good responder to immunotherapy, that means you’ve taken their effective treatment away,’ Dr Wang said.
‘We have a limited amount of time to fix the problem so they can resume ICI treatment, but I feel that we’ve made great progress in this area.’
The researchers acknowledge, however, their study only included two patients.
Future studies should compare the effectiveness of faceal transplants versus traditional colitis treatments, they add.
Colitis is a long-term condition where the colon and rectum become inflamed. Small ulcers can also develop on the colon’s lining that bleed and produce pus.
It is the most common form of inflammatory bowel disease in the UK, affecting around 240 in every 100,000 people. In the US, approximately 907,000 people suffer.
FMTs involve the transfer of a fecal sample from a healthy donor to a recipient to help restore the bacteria balance in their gut so they can fight an infection.
They are approved for recurrent C. difficile infections when standard antibiotic treatment is unsuccessful.
Such infections recur up to 25 per cent of the time, with antibiotics becoming less effective with continued use.