OpenBiome will pay for poo

If you think your better half buys a lot of crap, then you might want to consider OpenBiome before starting on the criticism. The American non-profit is paying donors dollars for their doo-doo in an effort to gather more materials for fecal microbiota transplants (FMTs), a relatively new, but 90 percent effective, treatment for the debilitating Clostridium difficile infection (CDI).

Clostridium difficile (C.difficile) are a bacteria found in the soil, air, water, and human and animal feces. Although many can carry the bacteria and suffer no ill effects, others will experience severe diarrhea, abdominal pain and fever. More extreme cases can require hospitalization and perhaps even lead to death. OpenBiome claims that between 14,000 and 30,000 deaths are estimated to be caused by CDI each year in the US alone.

While healthy people are unlikely to develop CDI, those taking antibiotics are at higher risk of picking up cases of C.difficile from infected surfaces. This is because antibiotics kill good as well as bad bacteria in the gastrointestinal tract, providing a site for the bacteria to gain a foothold. According to the Mayo Clinic, the number of cases have increased rapidly over the past two decades, with the elderly who take antibiotics being particularly prone.

Though ceasing the antibiotic used to treat the primary infection will generally be effective on treating mild CDI cases, more targeted antibiotic treatment is the standard procedure for more serious cases. However, the Centers for Disease Control now says that fecal transplants appear to be the most effective method for helping patients with repeat C. difficile infections.

The US Food and Drug Administration has also classified FTM as an "investigational drug" and since the middle of 2013 it has allowed doctors to treat patients with C.difficile without their having to make the usual Investigational New Drug application. The problem, however, is that even as acceptance for fecal transplants grows – the Mayo Clinic began performing them in 2011 – the amount of fecal matter available does not. Typically it is close relations who provide the material.

The OpenBiome team says they founded their non-profit, "after watching a friend and family member suffer through 18 months of C. difficile and 7 rounds of vancomycin before finally receiving a successful, life-changing Fecal Microbiota Transplantation (FMT)." After seeing the difficulty of securing the treatment first hand, they realized that expanded access was key.

We have written about less-traditional uses of FMT before, though in the case of Dr Jeff Leach he was researching gut bacteria and the hunter-gatherer diet, rather than treating a stubborn case of C.difficile.

But why does this work?

The importance lies in gut flora and healthy gut bacteria. Scientists and medical professionals are beginning to understand that the key to many diseases and even allergies may lie in what lives in people's guts. In fact, "hereditary gut bacteria" may play a role even in obesity, with researchers at Kings College London and Cornell University examining the potential of probiotic treatments for the obese.

FMT involves introducing the stool containing microbes that include bacteria, fungi and viruses from a healthy donor into the gut of the person suffering a C. difficile infection. This is performed more or less in the way one would (or try not to) imagine: via colonoscopic or nasogastric administration – the latter refers to a tube inserted into the nose or mouth and down the throat.

OpenBiome is seeking healthy donors who will be are financially remunerated at US$40 per sample, with those donating five times each week pocketing an extra $50. However, all donations must be done on-site at their Massachusetts suite and all donors go through a lengthy screening process and are rescreened each 60 days. Donors can also win prizes for the "biggest single donation of the month" or the most donations. According to the non-profit, less than 20 percent of people screened go on to become donors. For those on the receiving end, as a non-profit, the company charges $250 per treatment to cover its costs.

Synthetic stool

For those worried about what Scientific American termed the "ick factor" surrounding FMT, a synthetic stool sample, called "rePOOPulate," was developed last year for the treatment of C. difficile with the results published in the journal Microbiome in 2013.

"Patient concerns" is the way both the rePOOPulate developers and those at OpenBiome describe said "ick" factor inherent in discussions of FMT. OpenBiome is also working to develop a synthetic alternative, partnering with Assembly Biosciences in researching and product supply. "[We] believe that supporting these research efforts will be critical to improving treatment options," says the company.

Source: OpenBiome