Thursday, March 28

Super Poop: The Emerging Science of Stool Transplants and Designer Gut Bacteria | Health


GRAMPoop donors are so hard to find that they are sometimes called “unicorns.” These healthy and elusive creatures serve a rapidly growing market for fecal transplants as evidence of their benefits grows.

Emerging science shows that a human’s microbiome, its constellation of gut microbes, has a far greater effect on health than anyone previously imagined. This huge ecosystem that we house in our bodies includes bacteria, fungi, viruses, and more.

The collective genetic material in the microbiome performs a myriad of functions that affect our mood, our immunity, and our physical and mental health.

Bad western diets and antibiotics are depleting our microbiota. And in some cases, one person’s microbiome is messy enough that it needs a little boost from someone else’s.

Restoring your health has become a very serious scientific endeavor, as the diversity of our gut bacteria is linked to everything from depression to how we respond to cancer treatment.

Transferring healthy stool to the gastrointestinal tract from an unhealthy recipient has been shown to treat people with intestinal conditions, including superbug. Clostridium difficile colitis, or C diff, which can cause diarrhea, sepsis, and even death.

But as scientific understanding of the microbiome improves, the possibilities for fecal transplants expand.

Now researchers are working on a “super stool”: a pellet of poop you can eat that mimics the special abilities of a so-called unicorn.

Replicating unicorns

The BiomeBank office is located downtown in the Adelaide suburbs. Medical director Sam Costello and CEO Thomas Mitchell wear laces patterned with depictions of bacteria, and Costello jokes that an organic-looking spill on his is likely a real-life experiment.

The biotech company has been on the hunt for unicorns. This place is home to a stool bank, and it is a place where designer poop transplants are performed.

BiomeBank's Scott Costello (left) and Thomas Mitchell.
BiomeBank’s Scott Costello (left) and Thomas Mitchell. Photograph: Andrew Beveridge / BiomeBank

There is a special donor room (a glorified bathroom) where poop donations are received. There is a laboratory with an anaerobic workstation, where the donor strains of bacteria are put into a “secret sauce” to grow and then isolate the strains. Those strains are classified and cataloged for future use.

BiomeBank’s director of donor screening, Dr. Emily Tucker, says there is a long list of requirements for a stool donor. They have to be healthy, obviously. They have to be tested for infections. A detailed history of your medical, travel and antibiotic history is taken.

Those who pass all the assessments sign up for an eight-week program in which they must show up on time, fill out a questionnaire, and then (ahem) make a deposit inside a special room.

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So what if there aren’t enough unicorns? That question inspired BiomeBank’s latest effort: replicating the contents of a unicorn’s innards.

The poop factory

People are creating libraries of the best poop has to offer, and BiomeBank is part of the effort to categorize premium stool strains.

Costello, a gastroenterologist, says that humans historically had a much more diverse microbiota. We lived more closely with other people and animals, and ate more raw food.

There is evidence, he says, that this exhaustion is evident throughout society, particularly Western society.

A syringe for stool transfer in BiomeBank.
The right stool for the job: a stool transfer syringe at BiomeBank. Photograph: Andrew Beveridge / BiomeBank

Describe a “microbial extinction event” in the modern world. As on Earth, so it is in our intestinal system: we live with the consequences of an empty ecosystem.

Mitchell explains that in BiomeBank’s first generation microbial therapy they removed the right bacteria, lyophilized them, and put them in a capsule.

Patients can take it orally to treat specific infections. This generation has already been implemented in hospitals and, if approved by the Therapeutic Products Administration, it will be the first microbial therapy in the world approved as biological (currently it has provisional approval).

Then there is the second generation, a replica. Think of unicorns as types of Adam and Eve, but their genomic sequences can be reproduced. You can cultivate them. Isolate them. Identify them, name them, put them in a library, and gradually accumulate knowledge about what each branch can do.

And when you find a streak of gold, a bacterial strain that fixes a deficiency in someone’s microbiota, you scale it. Then you put that custom bacterial recipe into a capsule that someone else swallows. “It’s a new way of treating disease,” Mitchell says. “It is a small factory.”

Why is the microbiome so important?

From the moment we are born and throughout our lives, our microbiota is determined by our environmental and dietary contributions.

Babies delivered by cesarean section have a different mix than those delivered vaginally, a major study found. C-section babies pick up more strains from the hospital, which could explain higher rates of immune problems like asthma and allergies in those babies.

Professor Felice Jacka, Director of the Food and Mood Center at Deakin University, is a nutritional psychiatrist (and author of There is a zoo in My Poo, featuring recipes for “best swamp burgers,” “fart toast,” and “zoo poop stew”). The center examines the “incredibly complex” links between diet, gut health and the brain.

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“You have all these organisms that interact with each other in a way that is impossible to map at this stage,” he says. “We are still really in the beginning of figuring out what the microbiota can do.”

Prof. Felice Jacka
Professor Felice Jacka wrote There is a Zoo in My Poo to teach children what is going on in their guts. Photography: Pan MacMillan

And Jacka is a fan of the “super stool” plan, not least because “giving people other people’s shit” has some rough edges about it.

“It’s worth doing,” he says.

“Finding those super donors is difficult. Only about 3% of people qualify … Those super spoilers are kind of rare so you can distill that, if BiomeBank can find a stool equivalent that would be awesome. “

Jacka, as one of the world’s leading microbiome experts, says scientists are still figuring out exactly how the gut-brain axis works, how the microbiome affects health, and how it can be manipulated.

There are dozens of ongoing studies in Australia, but existing research has already shown that a poor diet, such as standard american diet – leads to increased inflammation in the body, which means an increased risk of cancer.

A team from Imperial College London and the University of Pittsburgh compared African Americans to rural South Africans. The volunteers were tested, then exchanged diets and were tested again.

After just two weeks on the high-fiber rural diet, Americans had significantly less colon inflammation and a lower risk of cancer. Unfortunately, the rural group went the other way around.

Cancer and the intestine

The Food and Mood Center is studying nutrition and its effect on depression, heart and muscle health, psychotic disorders, post-traumatic stress disorder, eating disorders, and a host of other health problems.

Jacka names cancer research as one of the most exciting fields in microbiome studies. Data sample better responses to treatment, particularly immunotherapy, in people with more diverse gut microbes.

But he cautions that much research is still in its infancy and that industries looking to make money are capitalizing on it too quickly, selling products with vague promises to promote “gut health.”

“Be careful, keep an open mind, but not so open that your brain falls out. Or your wallet, more specifically, “he advises.

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Fecal bacteria under the microscope.  Scientists are still discovering exactly how the microbiome affects our health and how it can be manipulated.
Fecal bacteria under the microscope. Scientists are still discovering exactly how the microbiome affects our health and how it can be manipulated. Photograph: Steve Gschmeissner / SCIENCE PHOTO LIBRARY / Getty Images / RF Science Photo Library

The University of Sydney Microbiome Research Center is studying the effect of the microbiome on cancer, women’s and children’s health, infections, immunity, inflammation, critical care, and mental health and neuroscience.

The center’s director, Professor Emad El-Omar, says that while there is advanced research showing the benefit of a more diverse microbiome (and thus fecal transplants) when it comes to C diff, in other disorders Researchers are still looking at what works and how.

He says that the number of genes in these microorganisms dwarfs that of the human genome.

“It is a very exciting field, but there is still a bit of work to be done to maximize the benefit to all of humanity.”

And he agrees with Jacka that the “wellness” industry sometimes jumps into “gut health.”

How can you help your gut?

At this stage, poop transplants are only recommended, or useful, in very specific cases. But everyone can improve their microbiome and you don’t need supplements.

Jacka says that for most people, changing their diet is enough to change their bacteria.

“To have what we understand to be a healthy microbiota, where microbes present are associated with healthy conditions and those that are not present are associated with unhealthy conditions, we already know what to do,” she says.

“Eat lots of plants, different kinds of plants, different colored plants, and add some fermented foods.”

Think kimchi, kombucha, and sauerkraut. And think fiber.

Jacka says that with typical Western diets your gut microbiota is so “weak, pale, pale and deficient” that it just can’t cope with fiber. Then when people try to add more fiber, they get gas or have a stomach ache. Some people mistakenly think that they have irritable bowel syndrome or gluten intolerance and reject fibrous foods.

You have to start out soft, she says. Increase the amount and type of fiber gradually.

“The answer to a problem with beans,” he says, “is actually more beans.”

Costello says BiomeBank hopes to be “part of the global effort to solve this huge problem, which is this disease-associated loss of microbial diversity … on a massive scale.”

“We see it as a modern pandemic,” says Costello.

And there is still a lot of work to do. At BiomeBank, researchers are beginning to understand microbiome strains in frozen storage. Then there are the many strains that are yet to be understood; We still don’t know what they might one day be capable of.

Costello and Mitchell call this library of the known and the unknown, next to the unicorn bath, the “cave of wonders.”


www.theguardian.com

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