Saturday, August 25, 2012

Could Multiple Sclerosis Be Caused By Bacteria?

TITLE: Fecal Microbiota Transplantation (FMT) in Multiple Sclerosis (MS)


T.J. Borody, S.M. Leis, J.L. Campbell, M. Torres, A. Nowak, , Centre for
Digestive Diseases, Five Dock, New South Wales, AUSTRALIA;

Recent evidence implicates the GI microbiota in the progression of neurological diseases such as Parkinsons Disease 1, Multiple Sclerosis and Myasthenia Gravis 2. We report three patients with MS diagnoses who achieved durable symptom reversal with FMT for constipation.

Case study observations on three MS cases

Case 1: A 30 yr old male with constipation, vertigo and impaired concentration and a concomitant history of MS and trigeminal neuralgia. Neurological symptoms included severe leg weakness and he required a wheelchair and an indwelling urinary catheter. Previous failed treatments included Mexiletine,
Tryptanol and 9-interferon. The patient underwent 5 FMT infusions for his constipation, with its complete resolution. Interestingly his MS also progressively improved, regaining the ability to walk and facilitating the removal of his catheter. Initially seen as a ‘remission’, the patient remains well 15 yrs post-FMT without relapse.
Case 2: A 29 yr old wheelchair-bound male with ‘atypical MS’ diagnosis and severe, chronic constipation. He reported parasthesia and leg muscle weakness. The patient received 10 days of FMT infusions which resolved his constipation. He also noted progressive improvement in neurological symptoms, regaining the
ability to walk following slow resolution of leg parasthesia. Three years on the patient maintains normal motor, urinary and GI function.
Case 3: An 80 yr old female presented with severe chronic constipation, proctalgia fugax and severe muscular weakness resulting in difficulty walking, diagnosed as ‘atypical’ MS. She received 5 FMT infusions with rapid improvement of constipation and increased energy levels. At eight months she reported completere solution of bowel symptoms and neurological improvement, now walking long distances unassisted. Two years post-FMT, the patient was asymptomatic.

We report reversal of major neurological symptoms in three patients after FMT for their underlying GI symptoms. As MS can follow a relapsing-remitting course, this unexpected discovery was not reported until considerable time had passed to confirm prolonged remission. It is tempting to speculate that
FMT achieved eradication of an occult GI pathogen driving MS symptoms.
Our finding that FMT can reverse MS-like symptoms suggests a GI infection underpinning these disorders. It is hoped that such serendipitous findings may encourage a new direction in neurological research.
CONTROL ID: 1147679


1. Borody et al Am J Gast 2009;104:S367

2. Gower-Rousseau et al Am J Gast 1993;88;1136

reversal of multiple sclerosis symptoms after fecal microbiota transplantation

Wednesday, August 22, 2012

Ulcerative Colitis, Fecal Microbiota Transplant, and Fecal Flora - Medical Literature - Possible Cure?

Treatment of Ulcerative Colitis Using Fecal Bacteriotherapy

Borody TJ, Warren EF, Leis S, Surace R, Ashman O.
Centre for Digestive Diseases, 144 Great North Rd, Five Dock NSW 2046, Australia.
Although the etiology of idiopathic ulcerative colitis (UC) remains poorly understood, the intestinal flora is suspected to play an important role. Specific, consistent abnormalities in flora composition peculiar to UC have not yet been described, however Clostridium difficile colitis has been cured by the infusion of human fecal flora into the colon. This approach may also be applicable to the treatment of UC on the basis of restoration of flora imbalances.
To observe the clinical, colonoscopic and histologic effects of human probiotic infusions (HPI) in 6 selected patients with UC.
Case Reports
Six patients (3 men and 3 women aged 25-53 years) with UC for less than 5 years were treated with HPI. All patients had suffered severe, recurrent symptoms and UC had been confirmed on colonoscopy and histology. Fecal flora donors were healthy adults who were extensively screened for parasites and bacterial pathogens. Patients were prepared with antibiotics and oral polyethylene glycol lavage. Fecal suspensions were administered as retention enemas within 10 minutes of preparation and the process repeated daily for 5 days. By 1 week post-HPI some symptoms of UC had improved. Complete reversal of symptoms was achieved in all patients by 4 months post-HPI, by which time all other UC medications had been ceased. At 1 to 13 years post-HPI and without any UC medication, there was no clinical, colonoscopic, or histologic evidence of UC in any patient.
Colonic infusion of donor human intestinal flora can reverse UC in selected patients. These anecdotal results support the concept of abnormal bowel flora or even a specific, albeit unidentified, bacterial pathogen causing UC.
2003 Jul;37(1):42-7.
[PubMed - indexed for MEDLINE]

Reduced Diversity and Imbalance of Fecal Microbiota in Patients with Ulcerative Colitis.

Hideyuki Nemoto, Keiko Kataoka, Hideki Ishikawa, Kazue Ikata, Hideki Arimochi, Teruaki Iwasaki, Yoshinari Ohnishi, Tomomi Kuwahara and Koji Yasutomo
Department of Immunology and Parasitology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, 770-8503, Japan
Clinical observations and experimental colitis models have indicated the importance of intestinal bacteria in the etiology of ulcerative colitis (UC), but a causative bacterial agent has not been identified.
To determine how intestinal bacteria are associated with UC, fecal microbiota and other components were compared for UC patients and healthy adults.
Fresh feces were collected from 48 UC patients. Fecal microbiota were analyzed by use of terminal-restriction fragment length polymorphism (T-RFLP), real-time PCR, and culture. The concentrations of organic acids, indole, and ammonia, and pH and moisture, which are indicators of the intestinal environment, were measured and compared with healthy control data.
T-RFLP data divided the UC patients into four clusters; one cluster was obtained for healthy subjects. The diversity of fecal microbiota was significantly lower in UC patients. There were significantly fewer Bacteroides and Clostridium subcluster XIVab, and the amount of Enterococcus was higher in UC patients than in healthy subjects. The fecal concentration of organic acids was significantly lower in UC patients who were in remission.
UC patients have imbalances in the intestinal environment-less diversity of fecal microbiota, lower levels of major anaerobic bacteria (Bacteroides and Clostridium subcluster XIVab), and a lower concentration of organic acids.
[PubMed - as supplied by publisher]
2012 May 24. [Epub ahead of print]


Tuesday, August 21, 2012

Dr Tom Borody Video Fecal Microbiota Transplant for Clostridium Difficle

Professor Tom Borody, on ABC TV Australia, Catalyst,

Fecal Microbiota Transplant - From Trash To Treasure!

In order to understand why a person would have a Fecal Microbiota Transplant, we first need to understand the incredible history of Fecal Microbiota Transplants.

In 1958, Chief of Surgery at Denver General Hospital, Dr Ben Eiseman, reported in the Journal of Clinical Gastroenterology of four patients who were cured of pseudomembraneous colitis.  Enemas containing feces from healthy colons successfully replenished good digestive bacteria.  Pseudomenbranous is a painful, extremely debilitating and potentially fatal inflammation of the colon associated with a bacterium called Clostridium difficile. 

In the mid 1980s, Australian gastroenterologist, Professor Thomas Borody, who invented the triple antibiotic therapy for helicobacter pylori bacterium (the cause of stomach ulcers), was faced with one of the most difficult cases he had seen at that time.  His patient was a woman who had developed an incurable colitis through an unidentifiable pathogen after holidaying in Fiji.

He searched medical literature for alternative treatments and came across the paper which was published in 1958 by Dr Eiseman.  "So I looked at the method and I kind of made up the rest of it," Borody said.

The woman's brother donated stool which was screened for known pathogens.  Using a blender, and mixed with some brine (nowdays he uses normal saline) Professor Borody made a slush which he filtered to remove any solids.

He administered it to his patient by enema on two consecutive days.  The results were incredible and her colitis was gone within days! It never returned!

This was the beginning of an amazing medical story - one that is still evolving - one that has helped countless people regain normal lives after the ravages of clostridium difficile.  Both Dr Ben Eiseman and Professor Thomas Borody have something special as doctors.  The ability to "think outside the box".  Fortunately others have followed these pioneers into the new fronteer.

Fecal Microbiota Transplants are now being used across the USA with increasing frequency.  The cure rate for clostridium difficile has been quoted at between 90 and 95% success rate.  But it doesn't stop there - there are reports of reversal of symptoms and disease of ulcerative colitis, crohn's disease, parkinson's disease, multiple sclerosis, acne, autism and even obesity!  How could FMT possibly help with these diverse diseases and disorders?  Look for my next post and find out. :-)