Each year in the US, around half a million people get sick from the bacterium Clostridioides
difficile--better known as C. diff.
When you have too much C. diff in your gut, at best you get diarrhea; at worst your colon
swells, your kidneys fail, and you die.
Here’s the crazy part: antibiotics might actually help C diff kill you, and the thing
that could save you is… someone else’s poop.
Chances are, you’ve got some C diff in your gut right now.
And you probably got it from… eating poop with C diff spores in it, likely from contaminated
food.
But you don’t have a full blown C diff infection, with diarrhea, fever, abdominal cramping,
the whole nine yards, because other bacteria in your gut -- the good bacteria -- keep C
diff from growing out of control, both by stealing its lunch and by producing chemicals
that inhibit the toxins it produces.
But we’ll get back to that in a second.
Let’s say you take a bunch of antibiotics -- maybe for a strep throat infection -- more
than likely, those antibiotics won’t kill the C diff.
But they will kill the good bacteria, leaving a nice warm wet place for C diff to take over.
So how does it do that?
With two toxic enzymes, toxin A and toxin B. These two molecules transfer glucose, or
sugar groups, onto enzymes called GTPases that your cells use to do things like signal,
or divide, or make protein.
The essentials really.
This causes a protein called actin, which gives your cells structure and allows them
to move, to condense.
When that happens your cells become rounded--as opposed to their normal spread out, elongated
shape--and this triggers cell death, destroying the lining of your intestines.
All this leads to THESE GREAT SYMPTOMS and if left unchecked, maybe also sepsis--a scary,
often deadly, immune response to an infection that has spread through your bloodstream.
If your body can’t handle C. diff on its own, you might be given these molecules -- C.
diff-specific antibiotics like vancomycin and fidaxomicin.
Vancomycin blocks C. diff cell wall creation and fidaxomicin blocks the bacteria’s transcription
of DNA to RNA.
So these molecules can help control C. diff in your system, but even after treatment you’ll
sometimes still have a bit of it hanging around, juuuuust waiting.
So, even when you receive treatment it doesn’t mean you’re in the clear.
You may need to take those antibiotics again, and again, and again, which is the cycle that
breeds antibiotic resistance, and that is absolutely terrifying.
One solution is to introduce more good bacteria to your gut.
There are a lot of different products out there, like kombucha or probiotics, that are
being marketed to do just that.
Unfortunately, there isn’t any conclusive data showing that these will do the trick.
Right now, we’re discovering that your best option is probably... someone else’s poop.
In more scientific terms, a fecal microbiota transplant.
A fecal transplant is exactly what it sounds like--someone else’s poop--which has been
screened for dangerous bacteria, viruses, you name it-- is put into another person.
The goal is to try to get those “good” bacteria reintroduced into a sick person’s
gut, to get it back to normal so it can fight off dangerous bacteria like C. diff.
Doctors can do this in a few ways.
First, oral fecal capsules.
This is the newest and often more preferred method.
Second is the poop enema, where a healthy person’s poop is put into an enema bag or
bottle and infused into your rectum over the course of a week or so.
Last, and almost certainly least, is the poop feeding tube option, where healthy poop makes
its way, in a tube, down your throat, and right to the intestine.
Some clinical trials suggest that fecal transplants could be the superhero that cures C. diff.
Perhaps a pooperhero.
One study found that patients with recurrent C. diff infection following treatment with
vancomycin or fidaxomycin had a much higher cure rate after receiving a fecal transplant
compared to patients treated with only with those antibiotics.
And that’s really exciting--not only because these patients were cured but because it means
we’re reducing the need for antibiotics and that decreases the chances of antibiotic
resistance.
With all that said, fecal transplants have not yet been approved by the FDA and there
are still some concerns.
In June, 2019, the FDA issued a safety alert following the death of an immunocompromised
clinical trial patient who developed an E. coli infection following a fecal transplant.
So although promising, there’s still work to be done.
Have you ever had a fecal transplant?
And, if so, did it help?
Let us know in the comments and we’ll see you next week.