The "ick factor" - which is pretty much reduced to a minimum if the donor stool is processed appropriately anyway - may not be long for the world. There has been at least one small scale study using synthetically derived donor samples - essentially taking someone's stool, figuring out what the hell is in it, and culturing accordingly.
That may also solve one of the big burdens behind using fecal transplant as a common technique - while the procedure itself isn't too expensive (though its not trivial, getting microbes past your stomach acid in quantity is no small thing), testing donor stool is, because of the amount of things we could accidentally give you. Synthetic donor culture would have less of a problem with that.
1. Fecal transplants are pseudoscience, because we don't know if they work.
2. We should assume they work, and identify specific microbes within them that are relevant or dangerous.
That's contradictory. Further, without data from examining #1, #2 is almost impossible - there are at least 1,000 species in our gut at all times. The only identification process I know of that could be reasonably affordable is 16S RNA sequencing, which is still expensive and would be nearly impossible to do properly on the 0.5 - 1.0 kg sample of gut bacteria (yes, that's the weight of just bacteria) from the average human. Not to mention that evidence suggests that gut bacteria act in concert, that is, we'd have to examine combinatorially many combinations of these 1,000+ species to get any real data.
Two things, you aren't necessarily trying to achieve the identical balance. Most of the research in this area is finding the particular bacteria that are important to repopulate the ill gut. The aim is to eventually transplant only the important bugs or just grow the important ones and skip the fecal donors all together.
The other issue is that it would be very hard to get a fecal sample that hasn't been exposed to O2.
There is an excellent New Yorker article on fecal transplants and gut flora.
The article spends considerable time talking about the donors, and the rigorous screening process to make sure the donated bacteria are good ones. Obviously, that procedure wasn't followed in this particular incident.
Fecal microbiota transplants are more pseudoscience than science. Research should be done to identify the most relevant microbes within fecal transplants, which could then be isolated and manufactured via industrial fermentation; such standardized products would be more scalable, would reduce the risk of infections from unwanted microbes, and would improve the scientific study of the approach, since the same substance would be administered each time. https://en.wikipedia.org/wiki/Fecal_microbiota_transplant#Re... This would remove many unnecessary and correlated variables associated with feces transfer, especially when it is being transferred "with the liquid injected through people's noses"! This could benefit from either a medical ethics review or an editorial review of the article.
This is why the doctors/scientists in the article recommended that donors be screened first.
But the more I discover about medicine and biology, the more I realize how much we still don't know. Hundreds of types of bacteria in a typical stool sample? This is amazing! Whole biomes await study... from internal gut bacteria (very small scale), to microbial colonies (regional or national scale) that we use for fermentation. Exciting!
I wonder if it would be worth finding out about the donor's diet, and trying to replicate it after the transplant in an effort to maintain the gut flora.
I wonder if prebiotics are a better choice, with fecal transplants done for when you have a real issue.
For what it’s worth, and doctors obviously don’t suggest this, you can easily do a fecal transplant at home. By “easily” I mean that the process is simple, not that it isn’t super gross.
Wouldn't this be a great case for fecal transplant? I have to wonder how effective oral probiotics can really be, give that the oral route includes an acid bath on the way to the intestines. Seems that a fecal transplant would get the desired results near-instantly.
In mice*. Fecal transplants and their benefits in different areas have come up for a fairly long while now, however I don't think I've seen much in the way of human research. Wouldn't something like this be fairly straightforward to try and replicate in humans so long as you find willing participants?
While I'm a huge proponent of patient autonomy and knowledge, it's really, really, really a bad idea to perform fecal microbiota transplantations at home, without medical equipment or training, and with an unvetted donor. I do hope that FMTs become an accepted part of medical practice -- the clinical results are more than encouraging -- but this kind of experimentation could go bad pretty fast.
Interestingly, nowadays fecal transplant is considered an effective treatment for some conditions that can cause intestinal issues (eg antibiotic resistant C. diff)
That may also solve one of the big burdens behind using fecal transplant as a common technique - while the procedure itself isn't too expensive (though its not trivial, getting microbes past your stomach acid in quantity is no small thing), testing donor stool is, because of the amount of things we could accidentally give you. Synthetic donor culture would have less of a problem with that.
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