Catalyst: Human Probiotic Infusion - ABC TV Science

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1 Catalyst: Human Probiotic Infusion - ABC TV Science 8-10 minutes download segment mp4 (average size 10 MB) Quite simply, HPI involves infusing a patient with someone else's faeces. It's a confronting treatment, but one which patients suffering from the tummy superbug, Clostridium difficile, are prepared to undertake in order to get their lives back to normal. Maryanne Demasi follows one patient through the treatment process which has a remarkably high success rate. Yeah, I want to break free of these chains. A chronic illness, you really feel like there's no light at the end of the tunnel. Well it started off with bleeding from my bowel, which is pretty scary. And that's been kind of an ongoing thing. Extreme abdominal pain, sweats, fevers. Along with that, also a lot of depression as well, and anxiety. It's unclear how, but caught a tummy bug called Clostridium difficile, or C.difficile. It's a super-bug that can be virtually impossible to treat. There is a percentage of patients with C.difficile infection, who will go into the relapsing stage where you cannot get rid of the bug, because it makes spores.

2 But has been using a radical treatment to cure this condition. I'd been reading literature and I came across this paper from 1958, where an inflammatory condition responded to restoration of the bowel flora. It's called human probiotic infusion. Put simply, will be infused with someone else's faeces. We have a bank of donors who we know and we test every few weeks. Donors have to be healthy people who have been screened for any known possible disease and their stools are tested. With some saline, homogenised in a blender, filtered through a simple, kitchen-type filter until it's able to be injected through a channel inside the colonoscope. It's hard to believe that this faeces could be a medical therapy. Bowel flora is made up of huge numbers of bacteria. So poo is a zoo. It contains living animals, you can call it bacteria. So it's a living organ that lives inside our colon. It has a few jobs, including destroying the waste. It itself is not waste. And so the transplantation procedure brings in bacteria which were removed, and they implant. I'm about to follow as she undergoes this confronting treatment, which she hopes will change her life. Big day for you today? Yes it is, and I'm just so excited.

3 Yeah? Yeah. So you don't feel too icky having some donor faecal material being transplanted in? I know that it does sound a bit gross, and a bit undignified and not very ladylike. But at the end of the day, I just want to be restored and have my life back. Yeah, exactly. C.difficile releases a toxin that destroys the bowel lining and causes ulcers. The symptoms are similar to severe food poisoning, and in extreme cases can lead to death. The worst strain that we know of started in Canada, around the year 2000, where it is thought it mutated, and produced the super-strain. It's now moved into North America, and the first strains have arrived, but they're in very low numbers in Australia. Should we be concerned about this? I think we should be. There are measures that have been put in place to try and prevent the spread of it. But once a hospital is infected, it's very difficult to disinfect the hospital.

4 Dr Borody is not being an alarmist. He says this infection has become an epidemic in the US, killing around 300 Americans every day. He believes antibiotics are one of the major causes. Over-use of antibiotics can certainly damage your bowel flora. Or the microbiome, as we call it. And so for the last fifty years, we have been hitting our bowel flora with antibiotics. So now we're trying to repair it. Seven years ago, was struck down by a strain of C.difficile after taking a course of antibiotics for a simple dental procedure. I couldn't believe I was in so much pain that, I, I well, I really thought that my life was over. So changed everything. The antibiotics she took were toxic to the good bacteria in her bowel, allowing resistant ones like C.difficile to thrive. I never ate anything. Because the severity of the pain I was unable to walk. So it was not good. You still seem really affected by it. Yeah.

5 was one of the first patients to have a faecal infusion. She wasn't very happy going ahead, but because she was so ill, she agreed to have an implant. After a single infusion, noticed a dramatic improvement. For the first week after, there wasn't one case of severe symptoms. So you were already seeing improvements, a week after the procedure? Definitely, definitely. Right, and then what happened? By the fourth week, I was symptom-free. Dr Borody boasts a ninety-five per cent success rate. The theory is that donor faeces acts like a probiotic, to restore the balance of good and bad bacteria in the gut. is now being sedated, ready for her infusion of donor faeces.

6 A routine colonoscopy reveals the extent of damage in her bowel. Certainly does look quite ulcerated, doesn't it? That's a colitis, quite bad. A lot of cobblestoning and pseudo-polyps. Puss. She didn't go well. It's time for the faecal slurry to be infused in 's colon. These bacteria have been through a blender, so they're kind of dizzy. And after a few hours, they find an environment there which is warm, dark, and it becomes their new home. The last syringe going in now, and just going to flush it through with some saline. Sixty to eighty per cent of the donor stool bacteria remains in the recipient. And I believe they make molecules which kill off not just the bugs, but also the spores. Are you happy with the procedure? Yes, I'm happy with what we did. So what do you expect in the next couple of weeks? Well she should reduce having frequency of diarrhoea, and if you look inside

7 there again, it'll be more healed. She will have less urgency and possibly less blood being passed. Dr Borody says our attitude towards faeces needs to change. It's made up mostly of bacterial cells, and the number of bacteria is a fascinating statistics. There's about nine times more living bacterial cells in our stool than there are living cells in our body. So that in effect we are ten per cent human, and ninety per cent poo. The big question now is whether this rather rudimentary science will move beyond the need for using human faeces. Ultimately there will be a non-faecal method of doing it, but I think that might take some years. So how are you feeling? Um, I'm feeling good, considering. Yeah, still just a little bit uncomfortable, but you know I feel really, just mentally at peace. What are you looking forward to the most? Just regaining those natural pleasures of life. Because this condition as left me completely spent.

8 Yeah. And so just to have the energy to enjoy life, live life and live it to the full. So, that to me is just going to be the best. Three weeks later, is free of stomach pain, and she's hopeful she'll stay that way. Reporter: Producer: Paul Schneller Researcher: Roslyn Lawrence Camera: Kevin May Sound: Steve Ravich Editor: Lile Judickas Prof. Thomas Borody Gastroenterologist Medical Director, The Centre for Digestive Diseases