How the stool transplant works – 07/13/2023 – Equilíbrio

For ten months, a severe intestinal imbalance caused by a bacteria caused retired Sônia Maria Vitor Oliveira, 67, to have uncontrollable and persistent diarrhea.

“I suffered night and day, without any control over my body. I had to wear diapers and lost 45 kilos”, she says.

the bacteria Clostridioides Difficilewhich caused Sonia’s health problem, is present in anyone’s body.

However, when there is prolonged or careless use of antibiotics, the bacteria can move, causing the condition called pseudomembranous colitis, experts point out.

It is an inflammation of the colon, the central region of the large intestine, which causes fever, abdominal pain and diarrhea.

Sonia, for example, has needed to use many different medications in recent years due to high blood pressure and diabetes, underwent a kidney transplant and had a severe Covid-19 infection during the pandemic.

Prolonged use of different medications, according to physician Felipe Tuon, who accompanied Sônia, contributed to dysbiosis – the imbalance of bacteria in the intestinal flora.

With no appetite and continually losing weight, she was admitted to the Hospital Universitário Cajuru, in Curitiba, Paraná – one of the university hospitals currently researching stool transplants in Brazil.

“I spent 63 days in the hospital, it was a very difficult period. The doctors found several ulcers [feridas] in my gut. When they described this, I was afraid I had cancer. But after some tests, they found that it was this bacteria that was causing the damage.”

When the doctor recommended a stool transplant, Sonia thought it was a joke.

“I laughed, but he immediately told me he was serious, and then added in a good-natured way: ‘It really is a poop transplant. Are you up for it?’ And I didn’t think twice. I said that if it was for my own good, yes, I would.”

How does a stool transplant work?

Also called fecal microbiota transplantation, the procedure is simple and aims to transfer intestinal bacteria from a healthy donor to a person who has damaged flora.

The first work describing this procedure was done in 1958, but, in Brazil, the feces transplant happened for the first time only in 2013.

Despite the suggestive name, it is not literally feces that are placed on the sick patient.

The fecal cake undergoes a procedure to separate the “good” bacteria, which are the microorganisms present in the human body that play positive roles, such as helping with digestion, strengthening the immune system, producing essential vitamins, competing with harmful bacteria and maintaining balance. of the microbiome.

Afterwards, the content can be injected as powder, after going through a dehydration process, or liquid, the most used form, which needs to be stored in an ultrafreezer (-80°C), which guarantees its viability for about four months .

The procedure is similar to a colonoscopy, which examines the large intestine.

After taking a diarrhea medicine and being sedated, the patient is given an injection of the transplanted fecal sample into the colon through a colonoscopy tube.

“The medicine against diarrhea keeps the healthy bacteria in the body, which increases the chances of them proliferating and helping with the treatment”, explains infectologist Felipe Tuon, responsible for the project at the University Hospital Cajuru.

For Sonia, the transplant was a success. “In ten days I had no more diarrhea, I was able to stop using diapers and go out again”, she says.

According to Tuon, among the 30 patients who have already been treated free of charge by the project, 27 were successful in curing their conditions.

“As a researcher, although I am excited about bringing benefits, I am sometimes quite skeptical”, says the doctor. “And that’s also why the transplant is so surprising: the patients really have a wonderful response, many stop diarrhea within 24 hours. In addition, the procedure avoids the need for surgery, prolonged hospitalization and infections by multiresistant bacteria.”

At the Federal University of Minas Gerais (UFMG), another that offers stool transplants within a research protocol carried out at the university hospital, the success rate is also high: 11 of the 12 patients who underwent the procedure had satisfactory results, according to the report. institution to BBC News Brasil.

Anvisa studies to regulate the technique

In 2022, places like the United Kingdom, United States and Australia received approval from local health regulatory bodies to perform fecal transplantation as an official treatment option for recurrent superbug infections.

“In the United States, even, they are already more advanced: the FDA [órgão regulador equivalente à Agência Nacional de Vigilância Sanitária no Brasil, a Anvisa] approved two different pills that work as an oral microbiota transplant”, explains Eduardo Vilela, gastroenterologist and coordinator of the UFMG Center.

In Brazil, the technique has not yet been approved and regulated by Anvisa and, therefore, cannot be widely offered in hospitals.

The universities that offer the procedure are within a research protocol approved by the National Commission for Ethics in Research – and must follow the rules stipulated in the authorized project.

Anvisa told BBC News Brasil that it recently received a request for a “regulatory framework” for this type of treatment.

“The ‘regulatory framework’ defines which regulatory path is necessary for a new technology,” the agency said.

“At the moment, technicians are studying the subject and seeking information from international reference agencies.”

Infectologist Felipe Tuon considers that the history of stool transplantation is “just beginning” in Brazil.

“It is still a challenge without specific legislation, but we are working in this direction, so that the procedure is regulated and that it can be inspected by the inspection bodies, guaranteeing safety for patients”, he says.

stool bank

Within their research projects, both the Hospital Universitário Cajuru and the UFMG, which serves through the Hospital das Clínicas, try to build stool banks – places to store fecal material from healthy donors.

“It is a way of facilitating the offer for the patients we serve, and our idea is to expand to offer material not only for our institution, but also abroad”, says Tuon.

Currently, research groups face the challenge of finding donors.

“The screening is extremely rigorous, more demanding than an organ transplant. An interview and a series of blood and stool tests are performed to ensure that there is no transmission of viral, bacterial, fungal or parasitic infection”, details the doctor from the Cajuru University Hospital.

Eduardo Vilela, coordinator of the UFMG project, adds that the clinical criteria include not having a chronic or ongoing disease and not using medication, not having suffered a gastrointestinal infection in the last six months and having good cardiovascular health.

The candidate undergoes a complete battery of tests, with several blood tests to detect possible transmissible infections, in addition to clinical and laboratory evaluation.

Finally, your fecal material undergoes molecular tests that aim to detect pathogens that are not causing any symptoms in that person, but may cause the recipient.

“We have already evaluated more than 170 donors, and only 6 met all the necessary requirements”, says Vilela.

“Getting a perfect biological material is a very big concern, since safety is essential for those who are going to undergo the transplant.”

In Brazil, few centers have similar initiatives, and donations end up being made according to demand.

Because it is a technique not yet regulated, if there is someone with an indication for a stool transplant admitted to a hospital, the procedure can be performed with the consent of the patient, who signs a term.

“Since there is no stool bank in the hospitals, they call a family member who goes through the entire triage”, explains Tuon. “It’s a complicated process to do this individually, because the person has to immediately collect and analyze this material, and the other patient has to be prepared to undergo the transplant. And there are still chances of it not being an ideal biological material.”

This text was published here