Transplantation of intestinal microflora - Causes, symptoms and treatment. MF.

Cases of unsuccessful attempts to restore normal bacterial flora of the intestine after using antibiotics, against the backdrop of the course of gastrointestinal tract diseases, are becoming more numerous and problems of stool disorders( constipation or diarrhea) become a disease of civilization. In the United States, over the past few years, the transplantation of normal intestinal flora from a healthy donor to a recipient suffering from stool disorders has been widely used and is rapidly growing. Accumulated in North America, a large positive clinical experience, the recommendations of the National Institute of Health USA( NIH, USA) gave grounds for the application of this innovative method of treatment in Russia.

In 2012, researchers from the Henry Ford Hospital conducted a study involving 49 patients suffering from severe recurrent diarrhea caused by Clostridium difficile. For the procedure, an endoscope was used, through which a homogenized and filtered solution was introduced into the colon of the patients, which included warm water and 30 to 50 grams of feces taken from healthy donors. In some cases, the solution was administered during the colonoscopy procedure.

As a result, 90% of patients had an appetite within two hours after the procedure, within a day they felt a significant improvement in their condition, and a week later they felt completely healthy. At the same time, within three months after therapy, they did not develop any complications or side effects of this method of treatment.

Another study conducted in 2013 by scientists from the University of Amsterdam showed that the transplantation of stool in the gastrointestinal tract was three to four times more effective than antibiotics. Initially, the researchers planned to recruit 120 patients to participate in the trials, but eventually decided to stop the tests because of the obvious difference in the health status of both groups of volunteers. Of the 16 members of the group receiving the stool transplant, 13 recovered completely after the first procedure, two more - after the second( 94%), while out of 26 patients receiving vancomycin, only seven( 27%) recovered. The remaining members of this group themselves asked the doctors to conduct the same procedure and recovered after one or two infusions.

Also in February 2014, the United States has the world's first fecal sample bank to treat patients suffering from a severe form of recurrent diarrhea caused by an antibiotic-resistant strain of Clostridium difficile.

In addition to treating intestinal infections, transplanting fecal bacteria from donors can help to reduce excess weight. Researchers hope in the course of further experiments to determine the mechanism of the influence of bacteria on the process of losing weight and, possibly, to offer a new, non-surgical way to lose weight.

A few years ago, Australian scientists suggested that patients suffering from Parkinson's disease and constipation should be treated with fecal transplantation. As the results of the study showed, due to experimental therapy, the symptoms of the underlying disease, including Parkinsonism, multiple sclerosis, rheumatoid arthritis and chronic fatigue syndrome, decreased in patients.

According to the hypothesis of scientists, if the composition of microflora is violated, various antigens enter the bloodstream. They cause an excessive reaction of immunity, which affects the development of parkinsonism and autoimmune diseases. These assumptions are confirmed by other studies. In particular, according to Dutch experts, stool transplantation increases insulin sensitivity in patients with metabolic syndrome.

In Russia, the first transplantation of cultures of normal intestinal microflora successfully took place in Novosibirsk in the Center for Scientific and Technical Information in Akademgorodok. Such a transplant is essentially the colonization of the patient's bowel with symptoms of diarrhea / constipation by a normal intestinal microflora obtained from a healthy donor. At the same time, the donor undergoes a thorough examination necessary to prevent transmission of infectious diseases and full confidence in the presence of normal healthy microflora. The survey uses the standards of the National Institute of Health USA( NIH, USA).

Indications for the transplantation of the microflora

Transplantations are carried out in chronic inflammatory bowel diseases( Crohn's disease, ulcerative colitis), irritable bowel syndrome( with constipation and diarrhea), obesity, as part of the treatment of C. difficile infections( pseudomembranous enterocolitis).

Microflora Transplant Procedure

Actually - this is the transfer of fecal donor masses, dissolved in water and containing beneficial bacteria, to the recipient. In order for the microflora to "catch on", bacterial cultures are placed precisely in the place where they must "live and work" - in the large intestine - with the help of a fibrocolonoscope - a flexible thin endovideososcopic instrument. This procedure( colonoscopy) is performed under general anesthesia( sedation) after consulting a gastroenterologist, undergoing a survey according to an individual plan and takes 1 day. In consequence, the patient receives detailed, not burdensome recommendations and is observed with the gastroenterologist for 2 weeks. According to animal studies, transplantation of fecal bacteria can restore normal intestinal microflora by 90%.

Side effects of the procedure

Despite the growing popularity, experienced information, in particular, in Russia, accumulated little. There is evidence that if the transplant is carried out from a patient with obesity, then the recipient is also at risk of obesity! There is reason to believe that the same mechanism is applicable to other diseases.

Scientific progress: feces in capsules

Existing methods of transplantation of fecal microbiota - transplantation of feces taken from healthy donors through a colonoscope, nasogastric tube or enema - have a potential risk of damage to the gastrointestinal tract and cause patients some discomfort.

Therefore, American scientists suggested an oral method of fecal transplantation( through the mouth) in the treatment of intestinal infections. The results of the study showed that the intake of frozen feces in capsules is just as effective and safe in the fight against the bacteria caused by Clostridium difficile diarrhea, as well as fecal infusion through a colonoscope or nasogastric tube.

The new approach is as follows: the feces of healthy donors are frozen, then the resulting mixture of intestinal bacteria and packed into acid-fast capsules intended for oral administration. Preliminary laboratory analysis of fecal samples for various infections and allergens is carried out.

A pilot study involved 20 people aged 11 to 84 years with an intestinal infection caused by C. difficile. For two days each subject took 15 capsules with fecal contents. In 14 patients, experimental therapy led to the complete disappearance of the symptoms of the disease after a single two-day course. The remaining six participants underwent a second course of treatment, after which the patient's condition also normalized. During the test, no side effects of the drug were noted.

As the authors of the study note, in patients who needed a second course of therapy, the initial state of health was worse than in the rest of the patients."The preliminary data obtained indicate the safety and effectiveness of the new approach," the researchers noted."Now we can conduct larger and larger studies to confirm these data and identify the most effective bacterial mixtures for oral administration."

The availability, safety and efficacy of this method of restoring normal microflora provide new opportunities for overcoming serious problems in chronic gastrointestinal diseases and metabolic disorders.