Life-changing C. difficile therapy on demand at stool donors, London, Ontario. Hospital Says – London


St Joseph’s Health Care London (SJHCL) is calling on local residents to throw in their poop in support of routine but life-changing medical treatment.

The treatment, oral capsule-based fecal microbiota transplantation, or FMT, has been shown to be curative for all C. difficile infections in patients, SJHCL officials say, citing a 96 percent success rate through their infectious disease treatment program.

A treatment bottleneck, however, has emerged in a lack of fecal donations from the public, due in part to the COVID-19 pandemic, which has led to a waiting list for patients, they say.

Clostridioides difficile infections are most commonly acquired after antibiotic treatments and sometimes during hospitalization.

Antibiotics will wipe out the healthy bacteria in the gut, allowing C. difficile bacteria to overgrow, leading to severe diarrhea and other health complications, Dr. Michael Silverman.

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“The diarrhea is often severe enough to hospitalize people, (it) can put people in intensive care units, and rarely people can die from it,” said Silverman, chair of infectious diseases at the Schulich School of Medicine and Dentistry and chief of Infectious Diseases at SJHCL and London Health Sciences Centre.

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Antibiotics are commonly used to treat such infections, says Silverman, but a problem arises because antibiotics kill C. difficile along with many healthy gut bacteria. When the patient stops taking the antibiotics, the C. difficile comes back.

“What people need are healthy bacteria that control C. difficile. And the way to get that is from a healthy person,” Silverman said.

How do you get healthy bacteria? poop.

According to Silverman, healthy, verified donors give a fecal donation in a container to St. Joseph, which is then processed and filtered. The gut bacteria from the donation are then placed in capsules and frozen and thawed and consumed by the patient on the day of treatment.

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A poop donation can be up to 40 capsules, which is considered a treatment dose, which the patient takes on an empty stomach with water over the course of about 30 to 40 minutes, Silverman says. The capsules are opaque and have no odor.

The bacteria from the capsules then go into the stomach, replacing C. difficile and becoming the new normal gut bacteria.

Capsule-based stool transplants are relatively new, and Silverman notes that they’ve been underway at St. Joseph’s for about four to five years.

The St. Joseph’s Infectious Diseases Care Program is one of only two programs in the country to implement the capsule treatment. Elsewhere, stool transplants are often done through enema or colonoscopy, methods that can take longer and have lower success rates, Silverman says.

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However, officials have encountered an unfortunate problem: a shortage of fecal donations to be encapsulated. The challenge in raising the donations lies in the rigorous processes put in place when selecting poop providers.

Candidates are screened for underlying medical conditions and to make sure they’re not taking medication, Silverman says. They will also be checked for known transmissible agents, such as bacteria or parasites, that could be harmful to the patient.

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“Many people have a bacterium or parasite that doesn’t actually harm them… However, if it gets into someone whose immune system is compromised… it can cause disease,” he said.

Since the start of the COVID-19 pandemic, donor candidates have also been screened to ensure they are not currently infected with COVID and have not been in the past three months, which has impacted the candidate pool, Silverman says.

“We have a lot of people in London who have had COVID in the last three months and they are young, healthy people… and so our supply of donors has gone down,” he said.

“The other thing is, people … they’ve been doing this for quite a while, but a lot of our donors are, say, undergraduates or graduate students, and then they graduate and move to work somewhere far away and then have to.” we can find a new donor to replace her.”

Given the costs associated with screening — none of which are borne by donors — Silverman says finding donors who donate regularly rather than just once is an ongoing challenge.

“We have to screen some people to find someone who passes the screen. They say it’s easier to get into Harvard than to become a stool transplant donor just because their acceptance rates are higher.”

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One person who managed to go through the process was John Chmiel, a graduate student at the Lawson Health Research Institute’s Canadian Center for Human Microbiome and Probiotics in St. Joseph’s.

Chmiel has been a donor to the program since 2018 and says he learned about successful trials of stool transplants for C. difficile while he was in college.

In graduate school, he jumped at the chance to participate in a study related to stool transplants that a lab colleague was recruiting for, he said.

“I was like, ‘Hey, I have to do this. That sounds great. It’s like cutting-edge medicine that I want to be a part of in any way I can,'” he said.

“I’m a Ph.D. Student, so we do a lot of research in this area. I found it fascinating how the FMT almost magically resolves the C. difficile infection. I think the research behind this is really cool because essentially we’re using ourselves to treat ourselves.”

Chmiel says he has been unable to donate to the program in recent months due to a COVID-19 infection, but will resume donating once permitted.

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He encourages others to check if they are eligible to donate. Chmiel not only helps the community, jokes that the initiative also makes for a great icebreaker for conversations.

“If you’re at all interested, go for it. Worst case scenario, you’re not eligible, but it’s super easy,” he says.

“I do this 1-3 times a month and it takes about 10 minutes. The team is really great and they’re really good at working with you to get these samples as needed…the more donors we have, the more people we can help and the more research we can do to advance this area.”

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According to St. Joseph’s, donors will receive $50 in cash per drop to help pay for parking and travel expenses. Those interested in becoming a donor can call extension 519-646-6100. 61726 or email Seema Nair Parvathy (PhD) at [email protected]

For more information on developments in FMT research, visit Lawson’s website.