Better screening needed for transpoosion

Fecal transplants are becoming a common treatment for infections of the gut, but better donor screening is needed to prevent complications
27 October 2015

Interview with 

Professor Tim Spector, Kings College London


Every year, more than 10,000 people in the UK suffer from a severe infection withMedical Record Clostridium difficile - known as C.diff for short. It leads to severe long-term diarrhoea and inflammation in the intestine and can be life-threatening. Recently, the idea of faecal transplants, or "transpoosions" has been gaining traction - but, according to an article in the British Medical Journal by Tim Spector, from King's College London, there are some risks, as he explained to Kat Arney.

Tim - It's been very hard to get figures, but the US is leading the world I think in this moment and there's one centre in Boston that has all these poo donors. It's supplying over 430 centres across the US on a regular basis and they're shipping something like 50 different treatments every single week.

Kat - What are the issues around having this relatively small pool of donors that is potentially treating so many people?

Tim - It's crucial that the donors that are being used both in the US and in the UK are properly screened because the obvious reasons like infections which is being pretty well dealt with. But the idea these people could transmit their microbes which stay with the other person for the rest of their lives is something a bit spooky and we haven't really thought about much. So, they could be transmitting microbes that are making them more tendency, to get fat. They could be transmitting microbes that make them more likely to be anxious or stressed or have some mental illness. And so, we really need to be screening these people very well to make sure that you don't replace one disease with another in a few years' time because we don't know the long term effects of these, and also realising that many people are - because they are relatively simple to do yourself - taking matters into their own hands.

Kat - Do we know whether there are any ill effects from poo transplants that have taken place either officially or DIY so to speak.

Tim - At least 6,000 or 7,000 recorded transplants that we know of have been done. Remarkably, few adverse events have been reported. There are a couple of anecdotal reports that two women gained weight after they had received some samples and they'd recovered from their infection. It turned out the donors were on the chubby side. Anecdotally, some people think they might have changed personality, but it's very subjective. So at the moment, it's a lifesaving operation that seems to have very few risks. But as people start to think about and we do trials for transplants in other less lifesaving conditions such as obesity, diabetes, colitis, irritable bowel syndrome then I think the balance of risk and benefits is going to be much more important.

Kat - So, how do we go forward from here? What is the future for poo transplantation?

Tim - Well hopefully, countries around the world are going to start setting up centres for this, invest some money with poo banks like they have in Boston. Regulations need to be changed because at the moment in the UK, we're not allowed to actually import the frozen poo from Boston although they've offered it, which is crazy because there's also people storing their own poo for when they get ill later because the best donor is going to be yourself. So, we need to start thinking about this and at the moment, we can store our own poo but it would break through any regulations to give it back to yourself.

Kat - How can we move forward with finding out more about how to use the power of the bugs in the gut?

Tim - I think one way is to start getting people used to testing their own microbes in the same way we currently test them for blood in the stool for colon cancer. Now, it's pretty simple. You can test it genetically, sending a sample via post on a cotton wool bud. No one is doing this on the NHS. I think we need some bigger organisations to start doing this and so, hospitals should have access to this. So donors or people thinking about it could actually look and see what their microbes really are before and after they have these transplants or they're thinking about them.


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