A recent publication in the journal Inflammatory Bowel Diseases titled, “Fecal Microbial Transplant Effect on Clinical Outcomes and Fecal Microbiome in Active Crohn’s Disease,” reports seven of nine patients with Crohn’s disease were effectively treated using FMT in a Seattle Children’s research study.
“This research could change the way Crohn’s disease is treated and help unravel the mystery of what causes it,” said Dr. David Suskind, the study’s lead investigator, who is a member of Seattle Children’s Research Institute’s Center for Clinical and Translational Research and a gastroenterologist at Seattle Children’s Hospital.
Rethinking the cause of Crohn’s disease
Crohn’s disease is one of the most common forms of inflammatory bowel disease (IBD). It is a chronic condition causing swelling and redness in the wall of the digestive tract. Over time, Crohn’s disease can damage the tissue and lead to sores, or ulcers.
Experts believe Crohn’s disease occurs because something goes wrong between a child’s genetic makeup, their immune system and their microbiome – the trillions of bacteria living in their digestive tract. The disease is most commonly treated with immune suppressants, but these medications can lead to unwanted side effects and aren’t always affective. Suskind wondered if the condition could be treated by improving the balance of microbes in the patient. His suggested method: Fecal microbiota transplant.
“Instead of treating the immune system’s reaction with powerful anti-inflammatory medications, I decided to try altering the bacteria in a patient’s digestive tract to treat the primary culprit causing IBD,” Suskind said.
Testing a new treatment
FMT is a common, low-risk treatment for recurrent bouts of Clostridium difficile infection (C. diff), a debilitating intestinal bacteria. The therapy involves taking a sample of microbes from the intestine of a healthy person (i.e stool) and putting it into the intestine of someone with a digestive problem. The donor can be anyone, but often in pediatrics is a close family member, usually a parent.
Suskind and Dr. Ghassan Wahbeh, director of the Inflammatory Bowel Disease Center at Seattle Children’s, were treating a patient with C. diff when they stumbled across a potential role for fecal microbiota transplant – not only did the patient’s C. diff infection improve, so did her IBD symptoms and inflammatory markers.
“Fecal transplant has been used to treat C. diff in patients from 2 to 90 years old with no overt side effects,” Suskind said. “While there’s a hypothetical risk of transferring an infection, our screening procedures significantly reduce that risk.”
To test the effectiveness of treating IBD with fecal microbiota transplant, Suskind designed a study that included patients with Crohn’s disease as well as patients with ulcerative colitis, all of whom were experiencing flare-ups of their symptoms. Each patient received a single treatment of stool (donated by their parent) mixed with saline, via a nasogastric tube.
While patients with ulcerative colitis did not improve significantly, the majority of those with Crohn’s did – and some have continued to experience no symptoms of the disease more than six months after treatment.
“At this stage, it does not appear to be a cure-all, but these results are promising,” Suskind said. “This is just the beginning. As time goes on, as we learn more and adjust protocols to determine what works for patients, this will bring significant improvements. I am thrilled to see that patients are already benefiting from FMT and I am completely committed to seeing it through.”
Seattle Children’s is the only institution in the country conducting this type of Crohn’s research in pediatric patients. Since sharing his research publicly in 2013, Suskind has been contacted by patient families from around the world. He is now leading a larger, double-blind, placebo-controlled trial of FMT which will include 32 patients with Crohn’s disease.
“This is the golden age of research for inflammatory bowel disease,” Suskind said. “It’s an exciting time to be working in this field because we’re so close to finding answers to some of our most important questions – and it’s possible that cures are right around the corner.”
If you would like a referral to the Inflammatory Bowel Disease Center, talk with your primary care provider or current gastrointestinal specialist.
Update: Seattle Children’s is no longer doing this study. The results are being analyzed and will be reported on in the future.