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Good germs to fight bad germs.
Penn Medicine researchers have singled out a bacterial enzyme behind an imbalance in the gut microbiome linked to Crohn's disease. The new study, published online this week in Science Translational Medicine, suggests that wiping out a significant portion of the bacteria in the gut microbiome, and then re-introducing a certain type of "good" bacteria that lacks this enzyme, known as urease, may be an effective approach to better treat these diseases.
"Because it's a single enzyme that is involved in this process, it might be a targetable solution," said the study's senior author, Gary D. Wu, MD, associate chief for research in the division of Gastroenterology at the Perelman School of Medicine at the University of Pennsylvania. "The idea would be that we could 'engineer' the composition of the microbiota in some way that lacks this particular one."
[...] In a series of human and mouse studies, the researchers discovered that a type of "bad" bacteria known as Proteobacteria feeding on urea, a waste product that can end up back in the colon, played an important role in the development of dysbiosis.
The "bad" bacteria, which harbor the urease enzyme, convert urea into ammonia (nitrogen metabolism), which is then reabsorbed by bacteria to make amino acids that are associated with dysbiosis in Crohn's disease. "Good" bacteria may not respond in a similar manner, and thus may serve as a potential therapeutic approach to engineer the microbiome into a healthier state and treat disease.
If the technique works, it could open the door to treating other conditions like obesity.
Josephine Ni, et al A role for bacterial urease in gut dysbiosis and Crohn's disease. Science Translational Medicine, 2017; 9 (416): eaah6888 DOI: 10.1126/scitranslmed.aah6888
(Score: 3, Interesting) by JoeMerchant on Friday November 17 2017, @12:45AM (12 children)
10 years ago this might have been news.... have they gone any further than simply transplanting from a healthy subject?
By the way, suppositories are preferred to oral ingestion.
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(Score: 2, Disagree) by Snotnose on Friday November 17 2017, @01:06AM (6 children)
So.... someone makes a steaming pile, you lay on your back legs spread, and use an ice cream scoop to transfer the steaming pile into your colon.
Yeah, I know this is a serious subject and has serious science behind it, but the giggle factor can't be denied.
When the dust settled America realized it was saved by a porn star.
(Score: 3, Insightful) by JoeMerchant on Friday November 17 2017, @02:06AM (4 children)
The real problem is the reimbursement factor: how much can you really charge for an injection of someone else's feces?
Back around 2001 we had an acquaintance with severe Crohn's, woman otherwise vibrant and healthy in her mid 20s. The recommended line of treatment was removal of the colon and lifelong use of a colostomy bag. That's a reimbursable surgery, lots of profit there. The poop injection was still deep in giggle-land at the time and poo-poohed by any MD you suggested it to. Think about that for a minute: they weren't even willing to try putting "healthy poop" into the diseased colon, but they were willing to give a woman a colostomy bag to carry for the next 60 years. h pylori had been established as the root cause of ulcers a decade earlier, but they were still scratching their heads over whether or not Crohn's might have a bacterial factor.
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(Score: 0) by Anonymous Coward on Friday November 17 2017, @03:17AM (3 children)
This is ignorant right here. Doing a fecal matter transplant involves risks that still haven't been fully identified. Not only do you have the risk of communicable diseases, but you also have the unknowns associated with the new bacteria and what they're going to do in somebody elses colon. Not to mention that the bacteria in a persons colon evolved for the specific diet and lifestyle of the person who has that colon. Just assuming that doing a transplant is going to go well is rather naive. I'm sure we'll get there, but we're not there yet.
By contrast removing the colon while drastic, is something that's relatively well understood in terms of procedure and consequences.
(Score: 2) by mhajicek on Friday November 17 2017, @04:43AM (2 children)
Yes, well understood to cause permanent irreversable harm.
The spacelike surfaces of time foliations can have a cusp at the surface of discontinuity. - P. Hajicek
(Score: 0) by Anonymous Coward on Friday November 17 2017, @05:11AM (1 child)
And precisely what is your point? We know what the results are going to be from that, but a fecal matter transplant can cause other problems which are much more significant than that and we're still not sure what bacteria should be present and in what concentrations.
The whole thing sucks, but let's not pretend like we know more about this than we really do. In the long run, I'm sure that fecal transplants will be more widely utilized, but considering the number of connections back to the brain, as well as the possibility of bacteria slipping into the blood stream, it's rather arrogant to suggest that we know that the result wouldn't be as bad.
It sucks to lose a body part, but it also sucks to get experimental surgery that goes wrong.
(Score: 3, Informative) by Kawumpa on Friday November 17 2017, @08:49AM
You're not completely wrong in that the long term effects of FMT need further research, but it has been proven successful in the treatment of recurring C.diff. infection (see https://www.ncbi.nlm.nih.gov/pubmed/24440934 [nih.gov] for example).
(Score: 2) by Snotnose on Saturday November 18 2017, @03:35AM
Of course you disagree, I was going for funny you humorless moderator. Jeez, some people's kids.
When the dust settled America realized it was saved by a porn star.
(Score: 2) by Spamalope on Friday November 17 2017, @01:47AM (2 children)
This appears to work for people with compromised protein handling in the gut, whereas the transplant helps with a gut population problem in an otherwise healthy person (or possibly a person who can function as normal if they've got a bacteria strain they're not getting naturally where they live). It's cheating to engineer replacements that don't make the problem protein but otherwise perform the gut function we need.
I know someone who suffered lots of painful health consequences from the auto-immune side effects of crohns before finally having to have their colon removed. A really tragic situation. Something like this could be profoundly life altering in an awesome way.
(Score: 4, Interesting) by JoeMerchant on Friday November 17 2017, @02:17AM (1 child)
We also knew someone who was on the verge of a colostomy for Crohn's shortly before I got involved with the world of epilepsy. There the great travesty of medicine is the ketogenic diet - doctors will literally let families rot in epileptic hell, offering damaging lobotomies and not even suggest trying the ketogenic diet first. The ketogenic diet isn't a 100% cure, nothing is (though, if you don't mind the side effects, you can usually improve epilepsy with the lobotomy...) but it _is_ a 100% cure for some people, and it's a significant improvement in symptoms for at least 1/3, about the same as most epilepsy meds.
The world of medicine is seriously warped by the money factor. Something without a focused profit center, like a diet change, or a poop transplant, just doesn't get respect or adoption that a pharmaceutical or surgical procedure does.
This thing for Crohn's has been kicking around since 2004-ish, about the same time the gluten-free diet started really gaining mind-share. Any MD who offers a colostomy to a young person without at least trying both (gluten-free and flora transplant) first, multiple times, really should have their license stripped. "First, do no harm" seems to have fallen out of practice, and it needs to come back.
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(Score: 0) by Anonymous Coward on Friday November 17 2017, @05:15AM
This kind of paranoia is ridiculous. The medical system has a lot of issues, but you don't think that health insurers would rather pay for a diet to solve things like this than the surgery? Precisely whose crack are you smoking?
Dietary changes are virtually always preferred by insurance when the medical evidence backs the treatment up. It's not something they have to pay for and even providing a few sessions to give the patient the necessary information is significantly cheaper than performing those surgeries that may or may not actually work and result in the risk of serious harm.
As far as doing no harm goes, doctors are supposed to make their recommendations on the basis of medical research. Just because you hear stories of something that people did and were successful does not mean that the treatment works, the people you hear from tend to be the ones for whom the effect was the most profound. For every one of them, there's other people who may not have been so lucky and without conducting proper medical testing, you don't have any way of knowing if it works and if it does work, whom it works best on.
(Score: 4, Informative) by frojack on Friday November 17 2017, @02:49AM (1 child)
It was news to me 30 years ago while in College. The guy from Australia had these pills he would take before flying home thereby avoiding the three days of gut aches upon arrival because there was just enough difference in the food that his fauna (or was it flora) could no longer deal with Australian grain after a year in the US.
His doctor (over there) gave him the opposite pills when first came th the US.
He told me it was somehow grown from poo, and was known in Australia since world war 1.
Prior to world wide shipments of grain, even British wheat was substantially different and required different yeast varieties. And US soldiers arriving by the boat load took a while to be able to digest it.
No, you are mistaken. I've always had this sig.
(Score: 3, Interesting) by frojack on Friday November 17 2017, @02:51AM
https://recipes.howstuffworks.com/is-american-wheat-different-than-european-wheat.htm [howstuffworks.com]
No, you are mistaken. I've always had this sig.