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Probiotics kicked up a notch
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engineerguy posted:
Hi folks,

This is an FYI. Any thoughts are greatly appreciated.

A recent article in Scientific American American Dec 2011, p. 34 The Science of Health, "Swapping Germs" describes fecal transplant. Here are exerpts:

"Marion Browning of North Providence, RI was at her wit's end. The 79-year-old retired nurse had suffered from chronic diarrhea for almost a year. It began after doctors prescribed antibiotics to treat her diverticulitis... The regimen also killed friendly bacteria that lived in Browning's intestines, allowing a toxin-producing organism known as Clostridium difficile to take over and begin eating away at the entire lining of her gut.

... After 4 rounds of antibiotics, her gastroenterologist told her that he had done all that he could think of. He recommneded that she see Colleen Kelly, a clinical faculty memeber at Brown University's medical school, who was trying something new.

Kelly proposed a treatment. ... [Kelly> could replace Browning's bacteria completely, by inserting into her colon a diluted sample of stool from someone whose intestinal health was good. If the good bacteria in the donated stool took hold and recolonzed her intestine, the C. Difficule would be coowded out, and she would be cured.
Browning had never heard of such a procedure--variously called fecal transplant, fecal bacteriotherapy or fecal flora reconstitution--but she was willing to try anything. Kelly asked her to recruit a healthy donor. Browning chose her 49-year-old son. In the fall of 2009 Browning performed the bowel-cleansing routine that preceeds a colonoscopy, while her son took an overnight laxative. Kelly diluted the donation, then used colonoscopy instruments to squirt the solution high up in Browning's large intestine. The diarrhea resolved in two days and has never recurred.

...

A Growing Threat

Browning is not alone in being a success story. In medical journals, about a dozen clinicians in the U.S., Europe and Australia have dscribed performing fecal transplants on about 800 C. difficile patients so far. Over 90 percent of those patients recovered completely, an unheard-of proportion. "There is no drug, for anything, that gets to 95 percent," Kelly says. Plus, "it is cheap and it is safe." says Lawrence Brandt, a professor of medicine and surgery at the Albert Einstein College of Medicine, who has been performing the procedure since 1999.

[Several paragraphs follow, about the difficulty of getting the procedure recognized and approved by FDA, partly because it does not fit into any existing categories of treatment, as well as the ick factor.>

...

C. Difficile has also become harder to cure. Thanks to increasing antibiotic resistance, standard treatment now relies on two drugs: metronidazole (Flagyl) and vancomycin. Both medications are so-called broad-spectrum antibiotics, meaning that they work against a wide variety of bacteria. Thus, when they are given to kill C. difficile infection, they kill most of the gut's friendly bacteria as well. ...[recurrence of bouts are high>... Some victims with no other options must have their colon removed. (A new drub, fidaxomicin, which was approved for C. diff infection by the FDA in late May, may lead to fewer relapses because it is a narrow-spectrum antibiotic).

...
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engineerguy responded:
A Simple Procedure
... I 2010 [Khoruts> analyzed the genetic makeup of the gut flora of a 61-year-old woman so disabled by the recurrent C. Diff that she was wearing diapers and was confined to a wheelchair. His results showed that before the procedcure, in which the woman received a fecal sample from her husband, she harbored none of the bacteria whose presence would signal a healthy intestinal environment. After the transplant--and her complete recovery--the bacterial contents of her gut were not only normal but were identical to that of her husband.
...
To ensure safety, the physicians performing the procedure require that donors have no digestive diseases and put them throught the same level of screening that blood donation would require. ...
Proponenets have come up with work-around for those possible barriers. Khoruts no longer uses related donors--which requires finding a different individual for every case--but instead has recruited a cadre of "universal donors" from among local health care workers. (He has seen no change in how often the transplants "take.") Last year Michael Silverman of the University of Toronto boldly proposed a yet more streamlined solution: having patients perform the transplants at home with a drug-store enema kit. A drawback, e cautioned in Clinical Gastroenterology and Hepatology, is that too much of the stool solution might leak out for the transplant to take. Nevertheless, seven patients with recurrent C. diff have safely performed the home version, he wrote, with a 100 percent recovery rate.
Next Steps
Even without large-scale rigorous investigations of fecal transplants, the medical community appears to be coming around to the practive. The Journal fo Clinical Gastroenterology deitorialized in September 2010 the "it is clear from all of these reports that fecal bacteriotherapy using donor stool has arrived as a successful therapy"(1). Albert Einstein's Brandt recently suggested in the same journal that fecal transplants should be the first treatment tried for serious C. diff infection rather than the last resort. Increasing research interest in the influence of gut flora on the rest of the body--and on conditions as varied as obesity, anxiety and depression--will likely will likely bring pressure for transplants to be adopted more widely.
Currently three clinical trials of fecal transplants have begun in Canada. In the U.S. however, the research logjam persists. An FDA spokesperson said in an interview that there is no way to determine how the agency might rule on an investigational application until the application is brought. ...
[End of exerpts from Scientific American>

Exerpts from editorial in Joural of Endroconology Sep 2010(1)
...They then [after fecal transplant> carefully analyzed the flora at 4, 8, and 24 weeks following the infusions using sophisticated bacteriologic studies. They showed that the donor flora was relatively stable in the microbiota of the feces. This is a landmark study and suggests that the manipulation of the colonic microbiota is effective and holds promise for new therapies in the treatment of colonic or metabolic disease. This study comes after the report recently by Khoruts et al2 who treated Clostridium difficile diarrhea by fecal transplantation and found that 14 days after the transplantation the fecal bacterial flora was similar to that of their donor. As a clear bonus, the C. difficile appeared to be cured.

In the final paper from northern California and the University of Washington, 19 patients were treated with fecal bacteriotherapy delivered through colonoscopes.11 All 19 patients were successfully treated. C. difficile was eradicated in a follow up of 6 months to 4 years.
...
The group from Australia has attempted its use in inflammatory bowel disease.12
[end of exerpts from(1)>
 
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engineerguy replied to engineerguy's response:
[ continued again >

(1) Editorial in Journal of Clinical Gastroenterology: September 2010 - Volume 44 - Issue 8 - pp 529-530
http://journals.lww.com/jcge/Fulltext/2010/09000/Fecal_Bacteriotherapy,_Fecal_Transplant,_and_the.8.aspx

Comment from EngineerGuy:

We see that sometimes probiotics take a year to fully recover a person, after antibiotics. Please note that fecal transplant does have some risk, in that you want to be sure that the donor is not a hepatitus carrier, or other disease. But with some care in donor selection, this seems promising for those with serious conditions.

Does this suggest a simple and more effective way to administer probiotics, from an enema bottle? There is a wide range of bacteria used for probiotics. Are all probiotics safe to administer in such a way? Perhaps, if considering administering a probiotic pill dissolved in water, in such a way, start very very small, and gradually increase the amount over several weeks.

Best regards, EngineerGuy
 
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DoloresTeresa replied to engineerguy's response:
Obviously, the best thing you can do for your health is to stay away from doctors. Instead of recommending a healthful diet they will prescribe antibiotics and then tell you that you need a fecal transplant. There is no limit to what doctors will try on patients and no limit to the trust some people have in their doctors.

Dolores


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