Liggins Institute researchers have formulated these capsules containing healthy donors' gut microbes for clinical trials.
Liggins Institute researchers have formulated these capsules containing healthy donors' gut microbes for clinical trials.
Would you accept another person’s faeces if it changed your health? Health researchers who just quizzed thousands of Kiwis - in the largest survey of its kind anywhere - were pleasantly surprised to hear most would. Jamie Morton reports.
It might sound like a hard pill to swallow.
A capsulecontaining a healthy donor’s stool - albeit treated, tasteless and securely enclosed so it doesn’t dissolve until it reaches the gut - that’s taken as a clinical treatment.
Get past the squeamishness, though, and there’s a world of incredible things gut microbiome transfers - or “poo transplants”, as they’re crudely called - might do for our bodies.
We each carry some 1.5kg of these microbes, yet much about the microbiome they make up - and the intricate ways they interact - remains an enigma.
However, it’s clear having too many unhelpful bugs and not enough beneficial ones can tip the microbiome off balance.
“Changes in the gut microbiome are associated with a large number of conditions,” explained Professor Justin O’Sullivan, director of the University of Auckland’s Liggins Institute.
“But the cool thing is that the gut microbiome can be manipulated - or restored.”
It’s thought implanting a healthier, more diverse range of microbes might treat a remarkably wider range of conditions, from diabetes and liver disease to food allergies, depression and anxiety.
Liggins researchers have already found giving capsules containing bacteria from healthy, lean donors to overweight teens can bring life-changing results.
They’re now investigating whether the same treatment might help ease stomach upsets thought to affect nearly half of New Zealand’s 90,000 autistic people - and are still seeking teenage and adult participants.
It's becoming very obvious our microbiome - the microorganisms in the gut - plays a vital role in our overall health. Photo / 123RF
For West Auckland man Eli Dobson, recently diagnosed with autism spectrum disorder, the latest trial offered a potential solution to stomach problems he’s suffered his whole life.
It also piqued the 46-year-old’s curiosity about science.
“I’d only just recently exposed to the idea of the stomach being like a second brain, where a lot of the things that are generated can affect your wellbeing.”
He said the trial had been straightforward and unintrusive.
“We were given capsules but weren’t told if they were placebos, and since then, it’s just involved completing a survey every few weeks to see if there’s been any changes, along with other tests every few months.”
Another participant, who declined to be named, said he’d similarly faced life-long stomach issues and was excited to be part of frontier research.
“It’s a really interesting space and it’s cool to be involved in it,” the 21-year-old Auckland student said.
Neither participant had any queasiness about the treatment themselves - but figured others might have some misconceptions about it.
“I’ve kind of avoided going into too much detail,” Dobson said of telling people about the trial, “just because you expect that kind of response”.
What do Kiwis think?
As such, when Liggins researchers recently surveyed nearly 2500 Kiwis, they were surprised at how many Kiwis weren’t just aware of the treatment, but would undergo it themselves.
More than three-quarters knew about the transfers and nearly all indicated they’d take them, provided they’d been proven safe for a condition they had.
Most were more comfortable taking the pills than more invasive approaches like endoscopy.
Still, the just-published survey findings highlighted a degree of apprehension when it came to the diet, health and screening of stool donors.
Respondents wanted to ensure donors ate healthy diets, with low amounts of processed food, and some - particularly vegetarians and vegans - said they’d prefer donors with similar diets to their own.
“We thought there might be more squeamish naysayers, but not so,” said study author Wayne Cutfield, a Liggins-based professor of paediatric endocrinology.
Professors Wayne Cutfield (left) and Justin O'Sullivan of the University of Auckland-based Liggins Institute.
“Neither the sex nor the ethnicity of the donor mattered: what was important was that the best possible donors were used.”
All too often, he said, clinicians thought of what was medically best, while overlooking how patients would feel - particularly when it came to unconventional treatments like gut microbiome transfers.
“If patients were put off by these transfers, then there’d be little benefit in offering it in future, even if it was shown to be of benefit,” he added.
“The good news is that the vast majority of those surveyed would have one if it was medically proven to help.”
A treatment of tomorrow?
O’Sullivan said the public had become increasingly fascinated by gut health, as shown by a run of best-selling books, along with documentaries like Netflix’s Hack Your Health and the 2018 Liggins-focused series The Good Sh*t.
“People really want to know how to change their gut microbiome.”
Liggins researchers were setting their sights on C. difficile diarrhoea for their next transfer trial.
“It’s a horrible form of diarrhoea that’s hard to treat and can prove to be fatal,” Cutfield said.
“We think gut microbiome transfers have the potential to become the new standard treatment for this condition in New Zealand in the future.”
Right now, though, gut microbiome transfers weren’t something patients could ask their GPs for.
They’re largely limited to the research space, as studies continue to address clinicians’ unanswered concerns about their efficacy and long-term safety.
“It’s also difficult to implement as a generally available solution due to the costs of screening and identifying ‘safe’ material to transfer,” O’Sullivan said.
“The real future lies in purpose-made communities that you can buy over the shelf.”
That meant finding out just which bugs were best to isolate - something the new trials were doing.
“We are already developing the skills to identify key bacteria of interest and then culture them so that they can be mass-produced,” Cutfield said.
“It could eventually become like a super form of probiotics - and one that doesn’t need to rely on human donors.”
Jamie Morton is a specialist in science and environmental reporting. He joined the Herald in 2011 and writes about everything from conservation and climate change to natural hazards and new technology.
