FMT Research

Should We Bank Our Own Stool?

"Why, I wondered, didn’t doctors work harder to prevent this collateral damage, not with store-bought probiotics, but with “microbial restoration”? Why didn’t we re-infuse patients with their own microbes after antibiotics?"

 

Find out about how to participate in OpenBiome's pilot launch of PersonalBiome here

Stool Bank May Be Answer to Recurrent Gut Infections

"It’s a landscape that Openbiome needs to navigate, says Edelstein, but she sees advantages in going the repository route. 'In addition to being selective about the stool that we use, we can monitor the use of stool and follow up with patients a lot more systematically on a much broader scale,' she says. 'Also, we can source donors and use them over multiple treatments, so we can spread the cost of finding donors.'" 

 

 

Poop Transplants and Microbiome Makeovers

"When I talk to Smith, he seems relieved that I don’t want to talk about how he is paying people for their poop (that story’s been done, and done, and done.) I wanted to talk about where the poop was going. Because OpenBiome isn’t just sending raw material for C. diff patients: For investigators who have applied for and received the FDA’s approval, it’s also assisting in a growing number of clinical trials for many other kinds of diseases. A U.S. government database of current clinical trials around the world lists 82 results for "fecal matter transplant" related to conditions as diverse as liver diseasemetabolic syndrome and obesityHIVCrohn’s diseasepancreatitis, and Type 2 diabetes.

'I think there’s a lot of hype in this space. A lot of people look at the success that we have had for C. difficile, and think it will work 90% of the time for more complicated conditions. But if even a fraction of the hype is true—and I think it probably will be—then that’s going to have a huge impact,' says Smith."

Two Men Behind Fecal Transplants

Interview with OpenBiome co-founders James Burgess and Mark Smith:  

NE: Is the future of good health really in the form of poop pills?
JB & MS: When it comes to personalized medicine, this is about as personal as it gets, right? It’s definitely the beginning of engineering the microbiome; a lot of the excitement is there are so many conditions—from gastrointestinal issues to obesity to depression—that are associated with the microbiome. It's a crude way of doing it, taking everything you’ve got and putting it in someone else. We're just really scratching the surface on how to do this type of engineering and ultimately this will have broad reaching effects on how we improve everyday health, treat infectious diseases, or more complex conditions.

 

Mark Smith named to The Verge Top 50

OpenBiome co-founder Dr. Mark Smith has been named one of The Verge's Top 50 most important people at the intersection of technology, art, science, and culture.  Here is an excerpt from the piece: 

"His efforts have made the [fecal transplant] procedure — one that's surprisingly effective — far more accessible than ever before. Prior to 2013, when OpenBiome started the project, people suffering from a C. diffinfection had to try to find their own donors, and the stool sample had to be fresh. But Smith and his colleagues changed all that. He calls OpenBiome "Red Cross, but for poop," and it has the potential to turn poop into something truly life-saving."

Mark's profile can be found here and the full collection can be viewed here

The Excrement Experiment

"The inspiration for OpenBiome was a friend of Smith’s, an otherwise healthy man in his twenties who, in 2011, acquired C. difficile following gallbladder surgery. 'He ended up on seven rounds of vancomycin over a year and half,' Smith told me. 'He was very sick.' 

The man found a doctor who was open to the idea of performing a fecal transplant and waited six months while the doctor researched the procedure. Finally, unable to wait any longer, he gave himself a transplant using his roommate’s stool. 'It worked for him,' Smith, who was then completing his Ph.D., said. 'But the whole thing seemed very bizarre to me: why is it so hard to get a treatment that is very effective?'" 

Read the full story here

When feces is the best medicine

"[FMT] is about as close to a miracle cure as medicine offers. Yet access to fecal transplants has proven challenging. As recently as 2013, Amy Barto, a gastroenterologist at the Lahey Clinic in Massachusetts, said her patients had to find their own stool donors, whom the clinic would screen individually. On the day of the procedure, the donor had to provide a fresh stool sample, which Barto said she personally mixed using a blender from Target and transplanted into the patient’s colon. 'It was embarrassing and stressful for patients to find their own donors, and expensive to have them screened,' she said. 'I did about 100 procedures with the blender, and it was not efficient.'

'When OpenBiome was established, my quality of life went through the roof,' Barto said. More importantly, access to the procedure 'just blossomed.' More doctors were willing to get involved and patients were able to able to get the procedure more quickly, with fewer barriers and less expense."

Medicine's Dirty Secret

"This is how far a mother will go.

Your daughter has been sick for more than four years with a severe autoimmune disease that has left her colon raw with bloody ulcers. After multiple doctors and drugs have failed, you are frantic for her to get better. Then you send her disease into remission, virtually overnight, with a single act of love. “Who wouldn’t do that for their daughter?” you say. It’s like a miracle, you say. “An overnight magic wand.”

You’ve agreed to do it again – twice – for strangers. You’ve seen first-hand how effective it can be and you felt so badly for the patients and their families. Had you donated blood or plasma, no one would blink. But this? You can’t tell anyone else about this because of how they might react.

There are more like you, men and women who have given their loved ones a remarkable reprieve from a group of chronic conditions known as inflammatory bowel disease. There are many more who have cured patients of a potentially fatal bacterium known as Clostridium difficile. This microbe can persist in a cocoon-like spore for up to five months, impervious to nearly everything except bleach. It is fast becoming resistant to every antibiotic thrown at it."

Read the full story here

MIT Lab Hosts Nation's First Stool Bank, But Will It Survive?

"You walk through a labyrinth of MIT buildings and into what looks like a typical laboratory: white walls and clean counters, the constant buzz of machines, the clutter of pipettes. In the corner, you open the door to a hulking freezer. When the puff of frosty air clears, you see stacks of plastic bottles filled with what looks a little like smoothies — in tawny, rusty colors Odwalla would never market. That’s your first hint of this lab’s unique purpose. Then there’s the giveaway: on the sterile countertop, you see a trophy of a squatting muscleman, labeled “Most Generous Donation.” Welcome to the first national stool bank. It’s like a blood bank, but for fecal matter. And that brown smoothie is actually very healthy stool, parasite-free and loaded with happy bacteria."

Here's the full piece. 

Fecal transplant safety is goal of stool bank

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"The excitement about the successful use of fecal transplants to treat the gastrointestinal infection C. difficile has also led to a premature interest among the general public suffering from ailments for which it is completely unproven and untested. “I have pretty serious concerns about this,” said Mark Smith, a graduate student in microbiology at MIT who co-wrote the paper published in Nature. “It’s an exciting area of research, but it’s not ready for every patient to get their hands on.”

Here's the full piece. 

Alternatives needed to do-it-yourself feces swaps

"Already, instructions for home transplants are available online, with YouTube videos promoting the use of feces from friends and family. “Some have even approached us for advice about using their pets as donors,”  write microbiologist Mark Smith and bioengineer Eric Alm, both at MIT, and gastroenterologist Colleen Kelly of Brown University. Dog poop probably isn’t going to cure you of much, since dogs carry different bacteria than people do, and home procedures with pet or human stool can be dangerous, as I discussed previously. Not to mention that a home enema may not even get the microbes far enough into the digestive tract to be useful in many cases.

On the other hand, people are legitimately eager to treat their serious conditions with a method that has shown success rates of 90 percent and better in published trials treating C. difficile, a bacterium that causes severe diarrhea."

Here's the full piece.

A New Kind of Transplant Bank

"Around noon on a recent Friday, Donor Five, a healthy 31-year-old, walked across M.I.T.’s frigid, wind-swept campus to a third-floor restroom to make a contribution to public health.

Less than two hours later, a technician blended the donor’s stool into preparations that looked like chocolate milk. The material was separated and stored in freezers at an M.I.T. microbiology lab, awaiting shipment to hospitals around the country. Each container was carefully labeled: Fecal Microbiota Preparation."

Read the full piece here

Need a fecal transplant? There's a poop bank for that

"As we increasingly realize the role of the microbiota in just about every aspect of human health, the idea of banking healthy gut microbiota through poop doesn't seem very outlandish. (Note: While there are many associations between differences in the gut microbiota and certain diseases such as obesity and asthma, there's less evidence, at least for the time being, that a fecal transplant can cure diseases aside from C. difficile.) The "Brown Cross" could become part of our public health infrastructure."

Read the full post here

Introducing the first bank of feces

Erika Engelhaupt, an editor at Science News and writer for the magazine's Gory Details blog, provides a synopsis of OpenBiome in a post on February 12.  The following line captures the piece:

"A new nonprofit called OpenBiome is hoping to do for fecal transplants what blood banks have done for transfusions. It’s a kind of Brown Cross."

We loved the new moniker!  In her piece, Erika also suggests that stool banks could provide an important alternative to the risky practice of at-home treatments. The full post is here

The Chronicle of Higher Education covers OpenBiome

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David Glenn from The Chronicle of Higher Education featured OpenBiome in the story, "Student-Led Project Banks on Promise of Fecal Transplants" on February 3rd.  The full article is behind a paywall, but here is an excerpt:

"By the end of the weekend, the two graduate students [Carolyn Edelstein and Mark Smith] and James Burgess—another friend from their Princeton days—had hatched a plan. They would open the world’s first public stool bank, offering prescreened, frozen fecal specimens to hospitals around the country. What the Red Cross has done for blood, their project—known as OpenBiome—would do for feces."

The full text is available here to Chronicle subscribers.

A Q&A with OpenBiome, from the Power of Poop

Our team spoke with Tracy Mac, editor of The Power of Poop, a website that provides resources about fecal transplants "for patients, by patients."  We discussed the origins of OpenBiome, our progress to date, and questions of regulation, safety, efficacy, and research, among others. Here is an excerpt:

US hospitals can now purchase pre-screened frozen fecal microbiota to treat patients with Clostridium difficile. While others have been ignoring the C diff problem, complaining about bureaucracy or lamenting the fact that there’s not enough money in fecal transplants, OpenBiome have been quietly going about fixing the problem.

Q: You mention on your site that one of your family members went through the C diff ordeal. What made you take action – as opposed to just sitting around complaining about it?

A: We couldn’t believe how hard it was for our friend to get treatment given the simplicity of the procedure and the strong clinical evidence supporting its efficacy. He suffered for many months while waiting for a treatment that should have been easy for any gastroenterologist to provide. Thousands are dying and many more are suffering needlessly because this treatment is not yet available for them. So we started off with a feeling that there was a huge problem that needed to be solved. We think everyone who has been involved in FMT has seen that.

In our case we also have had the good fortune of having access to a lot of resources and support at MIT. It’s really an extraordinary place with tremendous resources for biotechnology entrepreneurship. One of our team, Mark Smith, has been deeply involved in microbiome research for many years as a PhD student at MIT. As a result, he was familiar with the technical requirements for implementing our vision and was well positioned to bring together the necessary resources. 

Read the full Q&A here.

Dr. Mike Edmond: "Great news for patients with C. Difficile"

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Dr. Edmond is the Richard P. Wenzel Professor of Internal Medicine in the Division of Infectious Diseases at Virginia Commonwealth University. He also holds a faculty appointment in the Department of Epidemiology and Community Health and serves as the Hospital Epidemiologist for the VCU Health System. He posted about OpenBiome on the blog, Controversies in Hospital Prevention. Here is an excerpt:  

Yesterday I stumbled on OpenBiome's website and as I explored it I was nearly euphoric. [...] The company provides processed, frozen human stool from donors that have been carefully selected and screened for multiple infectious diseases at least twice, at a cost that's 1/6 the price of me testing one donor, and 5 to 14-fold cheaper than the drugs that these patients have taken without success. 

Read the full post here.

Dr. Paul Levy: "Will OpenBiome be #1 in the #2 business?"

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Dr. Paul Levy is the former President and CEO of Beth Israel Deaconess Medical Center (BIDMC) and author of the blog, Not Running a Hospital. Below is an excerpt from Dr. Levy's post about OpenBiome: 

The folks at OpenBiome will face some interesting and challenging business development issues over the coming months, but their concept is sound and has the potential to bring great value to society.  Keep an eye on this one!

Read the full post here