Australia is poised to undertake its first clinical trial using fecal transplantation to treat blood cancer patients who’ve developed serious complications following bone marrow transplantation.
In graft-versus-host-disease (GVHD), the immune cells in a donor’s bone marrow (the graft) attack the organs and tissues of the person who received the transplant (the host). GVHD can be particularly devastating for people who’ve received a bone marrow transplant to treat cancer.
“A bone marrow transplant can be a double-edged sword,” said Dr Andrea Henden, a clinician-scientist at QIMR Berghofer Medical Research Institute and doctor at the Royal Brisbane and Women's Hospital. “It saves the lives of people with aggressive blood cancers but then can take their lives by causing GVHD, which is heartbreaking.”
For patients that develop GVHD in their gut, traditional treatments fail to work.
“GVHD is particularly hard to treat in the gut with patients often hospitalized for long periods of time where they are dependent on hospital care and intensive immune suppressing medications,” Henden said. “Conventional immune-suppressing steroid medication fails to work in half of all GVHD patients.”
Research has shown that the gut’s microbiome, or microbiota, is crucial to maintaining good health. A collection of trillions of microorganisms that coexist in a healthy gut, the microbiome stimulates the immune system, protects against invading pathogens, breaks down potentially toxic foods, and creates certain vitamins and amino acids.
Enter fecal microbiota transplant (FMT) or, as it is known colloquially, “poo transplant," which is designed to restore the gut to health by repopulating the microbiome of an unhealthy person using the fecal bacteria and other microbes from a healthy individual.
As with blood donors, microbiota donors are rigorously screened. Fecal donations are processed and tested at a Therapeutic Goods Administration (TGA) approved facility before use. FMT has already proven to be a great success in treating gut infections.
“Emerging science shows that the microbiome has a far greater effect on health than anyone previously imagined,” Henden said. “We already know that FMT can be life-changing, with a 90% success rate in the treatment of another gut infection, recurrent Clostridioides difficile.”
Now, for the first time in Australia, FMT will be trialed in blood cancer survivors diagnosed with GVHD. The trial, led by Henden, will involve 10 patients over the next year before progressing to a larger trial.
It’s hoped that the groundbreaking clinical trial will lead to the discovery of a specific microbe responsible for improving GVHD, with the goal of offering patients a simpler, targeted treatment in future.
“FMT is a really exciting new approach that could save lives," Henden said. "If we can restore a healthy gut microbiome in these patients we can potentially influence immune function in the gut and treat the GVHD in a safer way that preserves the patient’s immunity."
The trial also has the potential to reveal more effective treatments for conditions such as Crohn’s disease and ulcerative colitis, which share similar traits to GVHD.
The below video explains the trial and the impact of GVHD on patients.
