便：命を救う便のリスクとメリットのバランス
コンテンツにスキップ
腸内細菌叢の健康ロゴ
便：命を救う便のリスクとメリットのバランス
バルセロナの 2 つの病院、クリニクとベルビチェは、スペイン初の糞便微生物バンクを立ち上げました。彼らの目標は、健康な個人から糞便の提供を受け、クロストリジウム・ディフィシル感染症として知られる、致命的となる可能性のある細菌感染症に苦しむ患者に微生物移植を行うことです。私たちは、両病院の糞便微生物移植ユニットを訪れ、その運営方法を学び、提供者の何人かに会いました。
フェイスブックツイッターリンクトインワッツアップEメール
「私の一番好きな会話です。実際、家族の集まりや友人との外出の際、私のうんちの話をしない日はありません」とアデラ・ガレさんは言います。「私が4年間もうんちを寄付していると言うと、人々の反応がとても好きです。たいてい驚かれます」とバルセロナ在住の32歳の女性は説明します。
アデラさんは、スペインで糞便微生物移植（FMT）の先駆的実施センターの一つであるバルセロナ病院の定期ドナーグループの一員です。彼らはベリビチェ大学病院（バルセロナ）と共同で、スペイン初、そしてヨーロッパでも数少ないカタルーニャ微生物バンクを設立しました。
「私たちは、糞便の寄付を当院での治療に使用したり、糞便微生物移植の対象となる患者がいる他の病院に提供したりしています」と、微生物バンクの技術ディレクター、アンドレア・アイラ氏は説明する。
この治療法では、健康なドナーの便サンプルから腸内細菌叢を採取し、腸内細菌叢のバランスが崩れた患者の体内に注入します。ほとんどの場合、これは大腸内視鏡検査によって行われますが、経鼻胃管、浣腸、または経口凍結乾燥カプセルによって行うこともできます。
ドナーから採取したサンプルは凍結され、2 か月間隔離されます。バルセロナ クリニック病院。
スペインでは、現在、糞便微生物移植は、入院患者の下痢の原因となる日和見細菌であるクロストリディオイデス・ディフィシルによる再発性感染症に対してのみ承認されています。つまり、通常は健康な人には感染しませんが、腸内微生物叢が変化した人や免疫力が弱っている人には感染を引き起こす可能性があります。
この細菌は、特に最近の長期入院、高齢（65歳以上）、免疫反応の低下（化学療法中など）、抗生物質の長期使用などの特定のケースで、結腸に重篤で生命を脅かす損傷を引き起こす可能性があります。これらの感染症は通常、最初に抗生物質で治療されますが、患者の20～30％は再発し、再び抗生物質を服用する必要があります。これらの再発性感染症の場合、糞便微生物叢の移行の方がはるかに効果的であることが証明されています。
“When we have patients who have relapsed once or twice, before treating them again with antibiotics, we offer them the possibility of undergoing an FMT, which has a very high success rate, and they all accept,” explains Aira. At Hospital Clínic, FMTs are performed via colonoscopy, which “is effective in 9 out of 10 cases,” notes Begoña González, gastroenterologist at this hospital who performs the fecal transfer procedure. “Lyophilized capsules are slightly less effective, around 75-80%, because the capsule formation process itself causes some bacteria to not survive,” comments this specialist, although she points out that “the difference in success rate between procedures is small, and capsules save you from the invasive colonoscopy.”
Currently, research in FMT focuses on designing increasingly efficient capsules, not only lyophilized ones. For example, Aira, from Hospital Clínic, in her doctoral thesis, created a new formulation of patented and licensed capsules, now being exploited by a Scottish company conducting clinical trials with patients with hepatic encephalopathy and bone marrow transplants that reject.
The most common procedure for performing a microbiota transplant is colonoscopy, but capsules are increasingly being researched. Although they are slightly less effective, they are less invasive. Bellvitge Hospital.
“It’s like a pellet (small droppings of feces) of intestinal microbiota to which we add excipients that remove moisture from the sample to maintain stable microbiota,” says this microbiologist, adding that this procedure to obtain microbiota capsules “is easier and cheaper than lyophilization.”
Both at Clínic and Bellvitge, they began researching FMT in 2018 to treat C. difficile patients, but they already have various studies underway to apply it to other pathologies, such as treating recurrent urinary tract infections in women or to decolonize the intestinal tract of patients from multiresistant bacteria before surgery. In other centers, this procedure is also being researched for pathologies such as obesity, type 2 diabetes, Alzheimer’s, and other neurodegenerative diseases.
And although it seems new, this treatment was already used in China in the 4th century to treat severe food poisoning and diarrhea, using a stool suspension known as “yellow soup.”
Donors, the key to success
The donor selection process is one of the keys to the success of the Catalonia Fecal Microbiota Bank. To donate stool, individuals must be between 18 and 50 years old and pass a series of controls, blood tests, and screenings. “We take maximum precautions because it is essential to guarantee the safety of the product we are transferring. Right now, the relationship between intestinal microbiota and countless pathologies is being studied. That’s why we reject many people and only keep between 4 and 5% of potential donors,” says Aira.
Donors send their stool in a kit designed for this purpose, to the hospital where it is prepared, frozen, and quarantined. Two months after donation, if the donor successfully passes all the tests again, the samples are thawed and prepared for use.
At Bellvitge, they process stool samples from donors and subject them to a lyophilization process. Bellvitge Hospital.
“During the week, I try to do my business in the sample collection kit they give us and notify them. Shortly after, they come to pick it up, and that’s it. It doesn’t require any effort on my part, and I know I’m helping other people,” says Adela.
Both at Clínic and Bellvitge, they obtain about 230 doses annually, respectively. Now, these two pioneering centers in FMT in Spain are working to try to create biomarkers that allow evaluating the quality of a donation.
“It’s very rewarding when the hospital sends us a message informing us of how many treatments have been possible with our stool,” acknowledges Adela, who undergoes rigorous health tests and checks periodically to ensure excellent health. “I’m hyper-controlled; I know I’m super healthy,” she jokes.
Leave it to the pros: don’t try it at home
The process of screening and monitoring stool donors is extremely strict to ensure that no pathogenic microorganisms are transplanted to the recipient. Therefore, it should always be done under medical supervision and never on one’s own initiative. “We have to be extremely cautious and prudent because we could transmit a predisposition to develop a disease, for example,” points out Jordi Guardiola, head of the digestive system service at Bellvitge University Hospital.
Guardiola emphasizes the importance of having a public Microbiota Bank, “because it guarantees the traceability of the samples.” He explains that “we have donors and recipients very well-identified, whom we follow for 30 years, so if any of them develops a disease at any time, we can compare their microbiotas and try to see if it’s involved.”
For Guardiola, moreover, this bank opens the door for local researchers to advance knowledge about the relationship between microbiota and various pathologies using the samples it holds. “In the near future, FMT will be approved to treat many other diseases and also to improve the effectiveness of treatments such as immunotherapies.” FMT is poised to be a true revolution in medicine.
Yet for all the excitement, scientists still know little about how FMT works. To complicate matters further, a gram of stool contains a staggering mix of microorganisms that varies enormously from one person to the next. Potential risks of undefined microbiota transplants include transmitting infectious microorganisms from the donor, increasing susceptibility to diseases associated with gut microbiota composition (e.g., obesity and even mental disorders), and transmitting antibiotic resistance genes present in apparently harmless gut microorganisms. These risks should be weighed in the context of the potential hea benefits of this treatment.
July 24th, 2024
By Cristina Sáez
Categories: Digestive Health, Fecal Microbiota Transplant, Gut Microbiota, Gut Microbiota Composition, Infections, News Watch
Tagged: Fecal microbiota, Fecal microbiota transfer, FMT, Gut microbiota, Stool bank
Cristina Sáez
Cristina Saez is a freelance science journalist. She works for several media, for instance the Spanish newspaper La Vang... uardia, where she coordinates the science section, Big Vang; as well as research centres and scientific societies. She has been awarded for her journalistic work, among others, with the Boehringer Ingelheim Award in Medical Journalism 2015. Follow Cristina on Twitter @saez_cristina Show more >
FacebookTwitterLinkedInWhatsAppEmail
Related articles
What if your gut microbiota is linked to respiratory health?
10 Jul 2024
by Manon Oliero
You are probably familiar with the gut-brain connection. But did you know that your gut and lungs are in constant conversation? Scientists call this connection the gut-lung axis. Both the gut and lungs are mucosal organs—while the gut absorbs nutrients from food, the lungs absorb gases like oxygen from the air.
World Microbiome Day 2024
27 Jun 2024
by GMFH Editing Team
The topic for World Microbiome Day 2024 is “Feed your microbes”. We have interviewed scientists about the knowns and unknowns of what is a healthy gut microbiome and the current level of application of microbiome-directed personalized nutrition to healthcare.
Navigating evidence-informed ways to improve gut health
19 Jun 2024
by Andreu Prados
While gut health and the microbiome have captured the attention of both researchers and the lay public, there is a gulf between popular media claims about gut health and the actual science. We spoke to Kristina Campbell, a microbiome science writer, about her new book on the subject called “Gut Health for Dummies”.
Stay tuned to our latest news
by subscribing to our newsletters
メールアドレスを入力
Check our latest issues
Awards今年の腸の健康に関するベストブログ
今年の腸の健康に関するベストブログ
今年の腸の健康に関するベストブログ
GMFH が Healthline の 2016 年ベスト腸の健康ブログの 1 つに選出されました
私たちの取り組みがスペインの賞を受賞
検索する：
検索 ...
によって編集欧州神経胃腸病学会
ゴールドスポンサーブロマテック
ルサッフル
プライバシーポリシー
法的言及
クッキーポリシー
お問い合わせ
当社では、お客様にウェブサイトで最高の体験をしていただくためにクッキーを使用しています。
当社が使用しているクッキーの詳細を確認したり、クッキーをオフにしたりすることができます。設定。
受け入れる