Clostridium difficile is a vicious bug. In the past decade, infection rates for the gut bacteria have doubled in hospitals, and today it kills 14,000 Americans a year. But researchers say they might have found a new kind of treatment for recurringC. diff infections, one of the most notoriously difficult and painful sicknesses to treat.
It’s a pill. A poop pill, rather. A pill full of gut microbes donated by family members—from their poop.
If that sounds terrifically weird, consider the science behind fecal transplants. When antibiotics enter the system, they take the collateral damage approach to warring your body’s bad bacteria. In addition to wiping out the infection, recent evidence shows that they knock out the good bacteria too, and sometimes it’s permanent.
That’s when the opportunistic C. diff strikes, but new research shows that restoring healthy microbes to the gut can fight off the infection successfully. Because babies get the majority of their gut bacteria from their mothers as they leave the womb, recreating the microbiomes of family members’ fecal matter made the most sense.
Fecal transplants can get tricky and expensive, however, when they’re administered by enema or by nasal tube. A patient’s failure to respond to either of those methods led University of Calgary researcher Thomas Louie to develop a pill.
Last week, Louie and his team presented their work at a conference in San Francisco. In a trial with people who suffered from recurring C. diff infections at least four times, poop pills cured all 27 patients.
"They came in for lunch on an empty stomach ... and took 24 to 30 pills on average," Louie said during his presentation.
"The pill is a great idea," Dr. Ravi Kamepalli, a gut doctor at the Regional Infectious Disease-Infusion Center in Lima, Ohio, told Co.Exist. Kamepalli, who also presented his work next to Louie in San Francisco, found a 98% success rate with the 40 recurring C. diff patients he treated with fecal transplants fed through a nasal tube into the gut. In his own practice, Kamepalli says his patients described the treatment as "life-altering" and demanded to know why no one had done it sooner.
Still, Kamepalli acknowledges that even with the pill and other fecal transplantation success, scaling up something for mass distribution would be enormously difficult. One of the problems is that no one quite knows how the microbiome really works, though the National Institutes of Health are currently working on a $115 million project to map our gut’s ecosystem. If someone wanted to commercialize the pill, he says, researchers might have to find a universal donor, and our understanding of why certain people respond to bacterial therapy and others don’t is still limited. Efforts like RePOOPulate, a synthetic microbiome of 33 different types of bacteria, are expensive, as Nature notes, and still working out the kinks.
But the poop pill is just one innovation on a wave of microbiome research and fecal transplant development. "There is a lot that’s going to happen down the road," Kamepalli said. As an example, Kamepalli imagines—and wants to develop—the equivalent of a bone marrow bank, except for healthy feces. "This is a crazy idea, but I think is the idea of the future," he said.