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Fecal Transplants Now Come in Pill Form

A new study put frozen fecal matter in pills to treat Clostridium difficile infections.

by Fruzsina Eordogh
Oct 13 2014, 6:00pm

Image: Wikimedia Commons/CDC

Clostridium difficile colitis, a type of infectious diarrhea, is so painful and debilitating that people often need to go to hospital to treat it. The CDC estimates that 14,000 Americans die of causes linked to the infection every year.

Standard treatment involves antibiotics, but various strains of C. difficile are now antibiotic-resistant. For cases that don't respond to antibiotics, a new treatment known as a fecal microbiota transplantation (FMT) has gained popularity in recent years. The procedure, however, is unpleasant: Current FMTs require a tube to be stuck down your nose or in your rectum for a doctor to pump in liquid fecal matter. Enter the poop pill.

A team of doctors at the Massachusetts General Hospital in Boston, led by Elizabeth Hohmann in the Infectious Diseases Division, have made a pill version of the FMT treatment. In a recent study, they gave 20 people infected with C. difficile bacteria a pill capsule containing frozen feces from a healthy person.

The donor fecal matter was gathered and combined with saline "using a commercial blender," wrote the researchers in their study. The mixed material was then sieved with a strainer to remove the larger pieces, put through a centrifuge, and mixed again with saline along with glycerol, to protect the biological material from becoming damaged when frozen.The fecal matter solution was put into capsules, which were then put into another, slightly larger capsule. The completed pills were stored at −80°C (−112°F).

The pills cured 90 percent of the patients in the study, making it as effective as reports from studies involving a colonoscopic FMT. Fourteen of the 20 patients saw their symptoms clear up after one course of 15 pills taken each day for two days; the other four responded after they did the treatment a second time.

The use of capsules obviates the need for invasive procedures.

"[T]hese results may help make FMT accessible to a wider population of patients, in addition to potentially making the procedure safer," the authors of the study wrote in a statement. They published their results in the Journal of the American Medical Association on Saturday.

"The use of capsules obviates the need for invasive procedures for administration, further increasing the safety of FMT by avoiding procedure-associated complications and significantly reducing cost," the doctors added. In short, a pill could relieve the need for C. difficile sufferers getting an FMT to have an invasive procedure. Further tests with the frozen pill will have to be done, however, given the small sample size of this study.

Why are we putting someone else's fecal matter in our guts, exactly? Sometimes it's the only way, given the various new strains of C. difficile bacteria that are resistant to antibiotics. In fact, antibiotics can make these virulent C. difficile strains worse, because they can kill the good gut flora in your intestines that helps prevent C. difficile bacteria from gaining a stronghold. This is why C. difficile is known as an antibiotic-associated bacteria.

However, the high cost of getting FMTs with the surgical procedure, which numbers in the thousands of dollars, has even led some people to start doing their own fecal transplants at home DIY-style, which can be dangerous.

As a field, fecal bacteriotherapy is relatively new, as is our study of our own microbiota (the US launched the Human Microbiome Project in 2008). But so far, results from various studies using FMTs are encouraging for more than just C. difficile. In 2012, one review suggested the procedure could help cure a variety of diseases and ailments, including type 2 Diabetes, Multiple Sclerosis, Crohn's disease, and even allergies. 

Here's to hoping the frozen pill created by this study, and the team's work at Massachusetts General Hospital, takes off. 

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