Best Microbiology: Truth on Transpoosions

23 April 2019

Interview with 

Luke McNally, University of Edinburgh

STOMACH-ACHE

A man gripping his stomach in pain

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Getting back to the battle of the "Bests" Luke McNally, from Edinburgh University, makes the case of "transpoosions"; using good guts bugs to defend against bad bugs.

Luke - I think one of the big changes we've had as a result of the crisis we've faced with antibiotic resistance is starting to think differently about how we treat bacterial infections, as it is two ways that that happens. So one is with transpoosions where we give good bugs to fight the bad bugs. Right. And and trying to harness the good bugs in our microbiome as a way to stop infections but also many other disorders, metabolic disorders, can be affected by the microbiome. And so this approach of using good bugs is one of our major advances.

Adam - Who... And how... did we figure out it was a good idea in the first place?

Luke - It sounds as if a 3 year old could have come up put it you know, if you have a problem with your gut let's take poo from a healthy person and give it to you, maybe it'll make you better. And the reality is that a lot of our treatments at the moment, they are kind of crude to some extent because it is as simple as that.

It was really only when we started to discover the complexity of the communities of microbes that live in our guts that we started to think that this was even an option. But at the moment most of the treatments just take poo from a healthy person and grow the bacteria up from them and then use basically a nasoduodenal tube, so a tube up through the nose and down into the small intestine to infuse the full community of bacteria in. But now there's a lot more refinement. So we're starting to figure out which individual microbes are actually having these effects. Clostridium difficile infection, C. diff, a lot of you will have heard of. It’s a very important hospital acquired infection, kills a lot of people who go in for treatment with cancer because their microbiome gets depleted by antibiotics and then they get infected. We now know the bug in good poo that helps protect against that. It's another closely related species Clostridium scindens, that modifies our bile acids into secondary bile acids and those kill C. diff. It kind of works like a beaver dam, Clostridium scindens lives very high up in our digestive system and converts our bile acids and then lower down that suppresses C. diff.

Adam - And very briefly is there anything else we can do to protect our gut bugs other than transpoosions.

Luke - Yes we can. We can try to eat a healthy varied diet. One of the best things we can do to maintain our microbiome is varying our diet. You know if we eat the same things all the time the same bugs are going to grow more and more and it'll be less diverse than otherwise. Yeah. And that's one of the biggest things we can do. There's more and more probiotics that are useful but you need to do your research on them. A lot of them are kind of pseudo-scientific and there's not much evidence behind. But there are some good probiotics out there as well.

Adam - And I think it's probably the ultimate case of don't try this at home.

Luke - Yes. Yes. Do not try. Do not try faecal transplantation yourself at home.

There's been people who've ended up with infections as a result. There are people who tried to do this. I do not recommend it. There's banks of healthy faeces available to be used for this problem.

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