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 is resolved.
In as little as one transplant, the patients' symptoms – including bloody diarrhea, abdominal pain and urgent need to use the toilet – completely disappeared.
Serious bowel diseases could be cured with a faecal transplant, research suggests (stock)
The researchers analyzed 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.
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 faecal microbiota transplant (FMT), the woman's symptoms disappear completely within just two weeks.
The man has partial recovery after a treatment and complete resolution after a second.
The resolution of colitis in these patients can be clinically and endoscopically after FMT treatment, Dr Wang said.
WHAT IS A FAECAL MICROBIOTA TRANSPLANTATION?
Faecal microbiota transplantation (FMT) is used when standard antibiotic therapy fails to treat recurrent C. difficile.
It involves the transfer of healthy bacteria from a donor into the intestines of the recipient.
The idea is to restore the balance of bacteria in the recipient's intestine so they can fight infections.
After one C. difficile infection, there is a 25 per cent opportunity it will come back.
Antibiotic treatment becomes less effective each time.
Extensive screening of the donor's faecal sample means complications are rare.
Endoscopy damage occurs in less than one in 1,000 cases. This may include infection, bleeding or tearing.
Discomfort, loose bowels and bloating are expected initially.
Source: Guy's and St Thomas' NHS Trust
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 good bacteria thus contained anti-inflammatory bugs that were not present before.
The study 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 has been associated with reduced intestinal inflammation," Dr Wang said.
In addition to this, he had a decrease in the abundance of potentially pathogenic Bacteroides after his first FMT. '
Speaking of the female patient, she added: Immediately following FMT in the first patient, donor-derived bacteria had effectively colonized the intestinal tract.
ICG-associated colitis – with early insights into potential mechanisms.
'Given the widespread application of ICI with increasing indications across cancer types, it is anticipated there will be increased incidence in colitis and other immune-related adverse events.
ICI-associated colitis due to 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 are used 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.
ICI treatment, but I feel like 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 facial transplants versus traditional colitis treatments, they add.
Colitis is a long-term condition where the colon and rectum become inflamed. Small ulcers can therefore 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 140,000 people. In the US, approximately 907,000 people suffer.
FMTs involve the transfer of a faecal sample from a healthy donor to a recipient to help restore the bacteria balance in their well so they can fight an infection.
They are approved for recurrent C. difficile infections when standard antibiotic treatment is unsuccessful.
Search infections recur up to 25 per cent of the time, with antibiotics becoming less effective with continued use.