During my last trip to Bangladesh, a friend with innovative ideas mentioned of a unique initiative. To decrease pollution and ‘go green’, he contacted some scientists to come up with a method of drying and packaging cow dung. I said YACK! But I had more surprises waiting. Last month I read in the Scientific American magazine that scientists are making human feces, in the laboratory! Making human feces, in the lab? Why, are the seven billion people on this planet producing less feces than before? Even if the answer is yes, should not we be happier to have less of that obnoxious material around us? Then why make it in the laboratory?
This reminded me of another news several years ago of a physician curing her patient’s diarrhea and abdominal cramps with the latter’s son’s feces! The patient had a chronic infection of Chlostridium deficile (C. diff) that was cured by antibiotic treatment initially but eventually no antibiotic was effective. I knew of the bacterium of the genus Chlostridium from my MSc thesis advisor and mentor, the late Dr. Anwarul Azim Chowdhury, who taught us how to grow bacteria of this genus in the absence of oxygen.
C. diff is a normal member of millions of other harmless microorganisms (flora) in our digestive system. Although it produces a toxin (poison) in the oxygen-free environment in our gut (digestive tract), presence of other organisms renders the toxin harmless. After excessive antibiotic treatment killed most of the patient’s gut flora, some of the C. diff became antibiotic resistant, kept on growing profusely causing a persistent colitis diarrhea. As the last option for a potential cure that was never tried before, the physician proposed to transplant stool from a healthy individual in place of her C. diff-reach stool. Annually 15,000, mostly elderly Americans, die of C. diff infection! Two days after this human feces therapy, the patient was completely cured!
Gradually more and more gastroenterologists are applying this therapy on hundreds of patients, variously called as “Stool Transplant”, “Fecal Microbiota Transplantation”, “Fecal Bacteriotherapy”, because 90% of the patients are cured. Normally, the collected feces from a healthy individual is diluted with saline and its debris is filtered out on a coffee-filter paper. The resulting liquid is pumped by a tube through the nose, just like a hospital feeding tube does, to deposit at the base of the patient’s stomach. The colitis patients who were lying on bed for weeks or months, walk out of the hospital within hours to days after the procedure! Variations of the procedure include colonoscopic transplant and retention enema. This fast, safe, and less expensive treatment tremendously improves the quality of patient’s life. CAUTION: Please do not try it yourself!
In spite of such great benefits, the procedure cannot be approved by professional societies for lack of approved clinical study data. To approve a clinical study protocol, all of the study components must have a prior approval from the US Food and Drug Administration (FDA). By law FDA can approve only a food, drug, device, or a biologic such as insulin. Stool does not fall in any of these categories! Therefore physicians, and investigators have to wait until FDA figures out how to classify stool. Then FDA have to set a standard of the quality of the stool, such as its bacterial content and distribution, water content, etc.
Whatever the outcome of a future FDA deliberation, enthusiasts have “smelled” the potential benefit of human stool. They have engaged scientists at the University of Guelph in Canada to artificially make human stool, named it RePOOPulate, whose quality can be precisely regulated. Without a “Yack” factor, the patients would not feel repulsive to take it. People are also considering of establishing a “Stool Bank” from where one can buy healthy stool.
The author, a former Dhaka University teacher, is a biomedical scientist working in the USA.