Fecal microbiota transplantation can be a solution when antibiotics are not enough to combat infections in the intestinal tract. This procedure is performed using endoscopy or colonoscopy, and transfers intestinal bacteria from a healthy donor to a sick person.
The first report of this procedure was made in 1958, but in Brazil, fecal transplantation was only performed for the first time in 2013. Since then, the technique has reached the SUS and has achieved promising results, with an effectiveness that can be as high as 90 % among transplant patients.
To overcome drug resistance while offering adequate treatment, the Hospital Universitário Cajuru, in Curitiba (PR), performs fecal transplants in patients suffering from inflammation in the large intestine, that is, Clostridioides Difficile colitis. With 100% service via SUS, the hospital has achieved good results, with patients improving quickly and being discharged from hospital.
The practice, which began in 2018, has now gained a new research front for the development of a product based on fecal microbiota by the PUCPR Infectious Diseases Laboratory. “Currently, on the international market, we only have two products similar to ours, one in the United States and the other in Switzerland”, reports the responsible infectious disease specialist, Felipe Tuon.
The treatment is also an ally against superbugs, which, according to the World Health Organization (WHO), could kill 10 million people per year from 2050 onwards. To compare fecal microbiota transplantation with traditional treatment, the group led by infectologist and researcher Felipe Tuon began a controlled clinical study with 48 patients who will be treated with the product in hospitals in Curitiba, including the Hospital Universitário Cajuru. “Our expectation is to verify that fecal microbiota transplantation is more effective than treatment with antibiotics”, he explains.
And the treatment possibilities only increase as studies advance. Research from Harvard Medical School in the United States has shown that fecal transplantation could be the key to treating several other diseases, such as asthma, multiple sclerosis and diabetes. This occurs because human feces act in a similar way to a probiotic food, with the presence of bacteria that are beneficial for the functioning of the human body. “The microbiota is an important part of our body, representing up to 90% of all the cells we have, and is formed since our birth. This partnership between the human body and the microbiota is natural, as it forms our intestine’s first line of defense and helps us to better digest foods that we might otherwise be unable to take advantage of”, explains the gastroenterologist at Hospital Universitário Cajuru, Jean Tafarel.
The fight for donors
One of the great challenges of fecal microbiota transplantation is finding a donor, as Brazilian society does not yet have a culture of donating feces and faces distrust, lack of information and compatibility difficulties. To facilitate the process, a stool bank was implemented at PUCPR, in partnership with the Cajuru University Hospital. In Brazil, few centers have similar initiatives, and donations are made according to demand.
To be a donor, the candidate undergoes tests such as blood count, as well as assessments on lifestyle, eating habits, physical exercise, absence of gastrointestinal symptoms and infections, and the non-use of antibiotics in the four months prior to collection. “The screening is extremely rigorous, more demanding than an organ transplant. An interview and a series of blood and stool tests are carried out to ensure that no transmission of viral, bacterial, fungal or parasitic infections occurs”, details the infectious disease specialist.
The procedure
Fecal transplant transfers the microbiota of an individual who has beneficial bacteria to the patient who has damaged microbiota. The procedure is similar to colonoscopy, an exam that uses endoscopy techniques to analyze the large intestine. After taking anti-diarrhea medication and being sedated, the patient receives an injection of the fecal sample transplant into the colon through a colonoscopy tube. When you wake up, the diarrhea medicine keeps the bacteria healthy in the body, thus increasing the chances of proliferation and helping with treatment.
The history of fecal transplantation in Brazil is just beginning. It is a simple and low-cost technique that, when performed by trained professionals and with appropriate biological precautions, can bring numerous benefits to the population. “It is still a challenge without specific legislation, as happens in other countries. Therefore, the study we are developing on our product is extremely important, which will make it possible to request its release and registration with Anvisa. From this, our intention is that this fecal microbiota can be widely distributed in the national market, ensuring adequate treatment and safety for patients”, concludes Felipe Tuon.