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Science Photo Library; Eye of Science
Cynthia Morgan-Robson always prided herself on her independence. She raised four kids (her husband died of cancer 45 years ago), including a daughter with Downs syndrome. She lived on her own in Port Hope, Ont., well into her senior years, and every Sunday night, shed drop into daughter Linda Harnesss house for dinner. In 2009, following a string of hospital visits related to knee-replacement surgery, Morgan-Robson acquired a vicious Clostridium difcile (C. diff) infection. Laid low by crippling diarrhea, she could no longer care for herself. At times, she was incoherent. Vancomycin, a powerful antibiotic prescribed for C. diff, seemed to help, but as soon as she went off the drug, her symptoms returned.
Harness moved her mother, now 75, into a nursing home in early 2012. Her cognition was completely gone, says Harness, a nurse. She couldnt eat, couldnt use the toilet, couldnt walk. A doctor at the nursing home referred her to infectious diseases specialist Dr. Elaine Petrof, who works with C. diff patients at the Kingston General Hospital. Petrof suggested a fecal transplanttransferring a donors stool, by colonoscopy or enema, into the patients colon.
Harness, who was tapped to supply her mothers dose, was initially horried. Dr. Petrof said, Go buy a Magic Bullet [blender]. Youre only going to use it once, and its not going to be for a drink, she says. The idea of fecal transplant is that good bacteria from healthy stool move in and take up residence, crowding out bad bacteria such as C. diff. The donor (typically a patients family member) is screened for conditions that could disqualify her, including hidden disease or parasites. Shes instructed to produce a sample at home, put it on ice and take it to hospital for the procedure. I almost broke into hysterics, Harness continues. Even as a nurse, Id never heard of this.
The Magic Bullet was spared. Instead of calling for Harnesss sample, Petrof recruited Morgan-Robson into a clinical study using synthetic fecesthe rst of its kindproduced with the help of the robo-gut at the University of Guelph, a bioreactor that approximates the human colon. Elaine contacted me because she knew I could culture a lot of the bugs found in the human gut, says Guelph microbiologist Emma Allen-Vercoe. They found a donor whod rarely taken antibiotics and was thought to have a healthy, diverse communty of gut bacteria, then seeded the robo-gut with the donors fecal sample. The scientists chose 33 strains of bacteria they knew could be knocked out with antibiotics (so there would be an antidote if anything went wrong), and added them to a saline solution. The synthetic stool, called Repoopulate, is way less gross than the real thing, says Allen-Vercoe, who adds that it looks a bit like a vanilla milkshake.
Amazingly, it seems to have cured Morgan-Robson and the other C. diff patient who was treated as part of the study. Both received Repoopulate by colonoscopy at Kingston General in May 2012; since then, their symptoms have disappeared. Morgan-Robson, who remains in the nursing home, has returned to her former self. After the treatment, she was able to recognize Harnesss three daughters again. We were amazed, Harness says. Shes back.
Canada has become a hotbed for C. difcile infection, which can be fatal: Between 1997 and 2005, hospitals saw an almost fourfold increase in associated deaths, according to the Public Health Agency of Canada, partly due to the spread of a more dangerous strain of the bug. Those at risk arent just the elderly and hospital-bound. Increasingly, community-acquired cases are being reported among young and otherwise healthy people, Petrof says, such as women whove received antibiotics prior to Caesarean sections, or patients who get antibiotics from their family doctors for sinus infections. I have Queens University students in my clinic, says Petrof, who is also an associate professor there. I see people in their twenties. Ive been contacted about children [with C. diff].
Fecal transplant appears to be a powerful way to treat them, maybe even more effective than antibiotics. Emerging evidence suggests many of the illnesses that plague us today, including asthma, heart disease, diabetes, allergies and even autism, could be related to the billions of bacteria in, on, and around usand the success of fecal transplant in combatting C. diff hints at potential xes for a range of conditions.
In a study published in January in the New England Journal of Medicine, a Dutch team found that these transplants (using the real stuff, not synthetic) cured 15 of 16 people with recurring C. diff. Antibiotics cured three of 13, and four of 13, in two separate groups. Fecal transplant was signicantly more effective than the use of vancomycin, the study concluded. Its a proof of principle that restoring a normal intestinal ecosystem can cure an important disease, says Dr. Martin Blaser, an infectious diseases specialist at New York Universitys Langone Medical Center, who was not involved in that study. It suggests that if the microbial ecosystem is disturbed, and you can [x] it, you could cure various diseases. In other words, not just C. difcile.
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A miracle cure, not for the squeamish