Researchers propose widespread banking of stool samples for fecal transplants later in life

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Changes in the way humans live and eat have led to enormous alterations in the gut microbiome, especially in recent decades. These changes have been linked to increased rates of asthma, allergies, digestive system diseases, type 2 diabetes and other conditions. In an opinion piece published June 30 in the journal Trends in Molecular Medicinea team from Harvard Medical School and Brigham and Women’s Hospital (BWH) proposes that we can combat these trends by asking individuals to bank samples of their own gut microbiota when they are young and healthy for a potential use later in life in autologous fecal microbiota (FMT) transplantation.

“The idea of ​​’rewilding’ the human microbiome has taken off in recent years and has been hotly debated from a medical, ethical, and evolutionary perspective,” says corresponding author Yang-Yu Liu, associate professor of medicine at Harvard and research associate. in the Channing Division of Network Medicine at BWH. “It remains unclear whether people in industrialized societies can achieve health benefits by restoring their microbiome to an ancestral state. In this article, we have proposed a way to rejuvenate the human gut microbiome.”

FMTs using donor stool have shown benefits for the treatment of certain conditions, primarily infections with Clostridioides difficile (C difference.), which affect about half a million people and kill about 29,000 in the United States each year. However, a limitation of using donor stool is variability in host response, likely due to genetic and environmental differences between donor and host.

Yang’s lab efforts focus on understanding the ecological dynamics and organizing principles of the human microbiome to inform the design of microbiome-based therapies. OpenBiome, a non-profit stool bank based in Somerville, Massachusetts, is the first stool bank to offer individuals the ability to store their own stool for future treatment of C difference. infection. Yang and his colleagues examined whether this approach could be feasible on a large scale for many other diseases.

“Conceptually, the idea of ​​stool banking for autologous FMT is similar to where parents bank their baby’s cord blood for possible future use,” says Yang. “However, there is greater potential for stool banking, and we expect the likelihood of using stool samples to be much higher than for cord blood.”

“But there are a lot of practical problems with implementing this idea,” Yang says. The article takes a closer look at some of these issues, including optimal storage methods, how much stool to keep, and possible costs.

“Autologous transplants would naturally avoid or at least mitigate donor-recipient compatibility issues, but a major drawback of autologous transplants is the need for long-term cryopreservation of stool specimens, usually requiring liquid nitrogen storage,” explains co-author Shanlin Ke, a postdoctoral researcher in Yang’s lab. “The safe long-term storage and subsequent resuscitation and culture of stool specimens is a matter of basic research in itself. “

Yang acknowledges that generalized banking could lead to a system in which those with more financial resources are more likely to have stools in the bank for future use. “We do not anticipate that all individuals in our society will be willing or able to pay the cost associated with the service of ‘rejuvenating’ their gut microbiome, in the same way that not all parents pay the cost of the blood bank. of cord for their newborns,” he says. “But as scientists, our job is to provide a science-based solution that could potentially benefit human well-being. Developing a reasonable business model and pricing strategy so that the solution is affordable for everyone would require the joint strength of entrepreneurs, scientists and perhaps governments.

“Autologous FMTs have the potential to treat autoimmune diseases such as asthma, multiple sclerosis, inflammatory bowel disease, diabetes, obesity, and even heart disease and aging,” says co-author Scott T. Weiss, Harvard medical professor and associate director. of the Channing Division of Network Medicine at BWH. “We hope this article will spur long-term trials of autologous FMT to prevent disease.”

This work is supported by grants from the National Institutes of Health (R01AI141529, R01HD093761, RF1AG067744, UH3OD023268, U19AI095219, and U01HL089856).

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