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ZOOM – Feces are synonymous with dirt, evoke disgust, repugnance. Yet, the bacteria fauna they contain is of great interest to medicine. Fecal transplantation, the act of implanting the stool of a donor into the intestine of a recipient, already able to cure a disease, could do the same with many others and allow the development of drugs new generation.
– Charlotte Anglade
The case made a big splash last week. The Saint-Antoine hospital in Paris has announced that it will have to stop a study on faecal transplantation because of the human tide of volunteer donors. The poster, which appealed to them and promised compensation of 50 euros per stool donation, which had only been stuck in the hospital and the medical school, had finally circulated on social networks, attracting crowds. If the operation ended in a fiasco, LCI wanted to know what the fecal transplantation was. Harry Sokol, hepatogastroenterologist at St. Antoine Hospital, answers us.
Implant good bacteria to heal
"The concept is very simple: it is about replacing the microbiota (set of bacteria, yeasts and viruses, ed) that we think abnormal of a patient with a disease by the microbiota of a subject healthy, "explains the specialist. The fecal matter, a real breeding ground for bacteria, is therefore taken from a healthy donor to be transplanted to the patient.
The administration, which is practiced only in a few centers in France, is done by natural means, preferably by the anus, during a colonoscopy or an enema. This can also be done through the nose, thanks to a probe that goes down to the stomach. "We use a sufficient amount, about 50 grams of faeces," says Harry Sokol. From the donor to the recipient, it is very little transformed. The stool is first suspended in saline and then cryopreservant, a substance that preserves bacteria even if they are frozen. The whole is then kept at a very low temperature (-80 ° C) until transplantation.
From the 4th century to today
"In itself, it's not new at all, says the gastroenterologist.There are traces of use of this type of process in Chinese medicine of the fourth century.In the wild, by the way, this is There's a lot to do, just look at the dogs on a leash, and they eat the poop of their peers fairly regularly. "
Currently, fecal transplantation is used only to treat Chlostridium difficile infection, an infection with the bacterium of the same name that may be triggered by antibiotics. "If it proliferates, it's because the microbiota has been disrupted, the disease is almost entirely related to this disturbance," says Harry Sokol. This treatment, described as "extremely effective" by the specialist, is practiced almost every week in his service at the Saint Antoine Hospital. "Unfortunately we do not have a stool bank like we have a blood bank, so we call on the patients themselves to find donors around them."
There are even ongoing studies on neurological diseases such as multiple sclerosis or autism.Harry Sokol, gastroenterologist at Saint-Antoine Hospital
Studies are ongoing on other diseases, such as irritable bowel syndrome and metabolic syndrome. The results are mixed for the moment. Acute rectocolitis, an object of study that had to be abandoned for some time, had already been the subject of studies suggesting that fecal transplantation may be of some effectiveness. "There are even ongoing studies on neurological diseases such as multiple sclerosis or autism," says the doctor.
These studies, he says, must be done in a strict framework, because it is not an insignificant treatment. If the health status of the donor and the quality of his stool are not properly controlled, there is a risk of transmitting a disease or having negative effects. "There are people who have had fecal transplants because they have transit problems, for example, and their situation has worsened rather than improved."
The idea is to identify microbiota bacteria that have positive effects in a particular situation and try to make drugs.Harry Sokol, gastroenterologist at Saint-Antoine Hospital
Beyond the application of fecal transplantation to certain diseases, the research also focuses on how to use the microbiota more precisely. "The idea," explains Harry Sokol, "is to identify the microbiota bacteria that have positive effects in a particular situation and to try to make drugs, which is the principle of the new generation probiotic. " The results of this research could be applied in the coming years.
Fecal transplantation, no matter how effective it may be in treating difficult chlostridium and perhaps other diseases in the future, is surely only a transitional technique, waiting for a better understanding of the role of bacteria.
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