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Super Poo: The Emerging Science of Stool Transplants and Designer Gut Bacteria

GPoo donors are so hard to find that they are sometimes referred to as “unicorns.” These elusive, healthy creatures serve a fecal transplant market that is growing rapidly as its benefits grow.

Emerging science shows that a human’s microbiome – their constellation of gut microbes – has a far greater effect on health than anyone previously thought. This huge ecosystem that we house in our bodies includes bacteria, fungi, viruses and more.

The collective genetic material in the microbiome performs myriad functions that affect our mood, immunity, and physical and mental health.

Crappy western diets and antibiotics are depleting our microbiota. And in some cases, one person’s microbiome is so dysregulated that it needs a little boost from someone else’s.

Getting them back to health has become a very serious scientific endeavor, as the diversity of our gut bacteria is linked to everything from depression to how we respond to cancer treatment.

Transferring healthy stools to the gastrointestinal tract from an unhealthy recipient has been proven to treat people with intestinal disorders, including the superbugs. Clostridium difficile colitis, or C diff — which can cause diarrhea, sepsis, and even death.

But as scientific understanding of the microbiome improves, the possibilities of fecal transplants are expanding.

Now researchers are working on a “super stool” – a poop pellet you can eat that mimics the special abilities of a so-called unicorn.

Replicating Unicorns

The BiomeBank office is located in a hub in the suburbs of Adelaide. Chief medical officer Sam Costello and chief executive Thomas Mitchell wear lanyards with images of bacteria — and Costello jokes that an organic-looking spill on him is probably a real experiment.

The biotech company has been on a unicorn hunt. This place is home to a stool bench – and it’s a place where designer poo transplants are performed.

Scott Costello of BiomeBank (left) and Thomas Mitchell. Photo: Andrew Beveridge/BiomeBank

There is a special donor area (a glorified toilet) where poo donations are received. There is a lab with an anaerobic workstation, where the strains of bacteria from donors are put in a ‘secret sauce’ to grow and then isolate strains. Those species have been categorized and cataloged for future reference.

BiomeBank’s chief of donor screening, Dr. Emily Tucker, says there is a long list of requirements for a stool donor. They must of course be healthy. They should be screened for infections. A detailed history is taken of their medical, travel and antibiotic history.

Those who pass all the assessments are enrolled in an eight-week program in which they must show up on time, fill out a questionnaire, and then (ahem) make a deposit in a special room.

So what happens if there aren’t enough unicorns? That question inspired BiomeBank’s latest effort – to replicate the contents of a unicorn’s guts.

The poo factory

People are building libraries of the very best that poop has to offer, and BiomeBank is part of the effort to categorize premium stool types.

Costello, a gastroenterologist, says people have historically had a much more diverse microbiota. We lived more closely with other people and with animals, and ate more unprocessed food.

There is evidence, he says, that this depletion is visible throughout society, especially in Western society.

A stool transfer syringe at BiomeBank.
The right stool for the job: a stool transfer syringe at BiomeBank. Photo: Andrew Beveridge/BiomeBank

He describes a “microbial extinction event” in the modern world. As on Earth, so it is in our gut – we live with the effects of an eroded ecosystem.

Mitchell explains that in BiomeBank’s first-generation microbial therapy, they extracted the right bacteria, freeze-dried them, and put them in a capsule.

Patients can take it orally to treat specific infections. This generation has already been rolled out in hospitals and, if approved by the Therapeutic Goods Administration, it will be the world’s first microbial therapy to be approved as biologic (it currently has preliminary approval).

Then there is the second generation – a replica. Think of the unicorns as Adam and Eve types, but their genomic sequences can be reproduced. You can grow them. Isolate them. Identify them, name them, put them in a library and gradually build knowledge about what each part can do.

And when you hit a gold vein — a strain of bacteria that clears up a deficiency in a person’s microbiota — you scale it up. Then you put that custom bacteria recipe in a capsule that someone else swallows. “It’s a new way to treat disease,” Mitchell says. “It’s a small factory.”

Why is the microbiome so important?

From the moment we are born, and throughout our lives, our microbiota is shaped by our environmental and nutritional inputs.

Babies born by cesarean section have a different mix than those born vaginally, a large study finds. The babies having the cesarean section pick up more stress from the hospital, which could explain the higher rates of immune problems such as asthma and allergies in those babies.

Prof Felice Jacka, director of the Food and Mood Center at Deakin University, is a nutritional psychiatrist (and the author of There is a zoo in My Poo, with recipes for “better swamp burgers,” “farty toast,” and “animal shit stew”). The center examines the “staggeringly complex” links between diet, gut and brain health.

“You have all these organisms interacting with each other in ways that are impossible to map at this stage,” she says. “We’re still in the early stages of figuring out what microbiota can do.”

Prof Felice Jacka
Prof Felice Jacka wrote There’s a Zoo in My Poo to teach kids what’s going on in their guts. Photo: Pan MacMillan

And Jacka is a fan of the “super stool” plan, not least because “giving people other people’s shit” has a bit of the creeps about it.

“It’s definitely worth doing,” she says.

“It’s hard to find those super donors. Only about 3% of people qualify… Those superpoopers are kind of rare so you can distil that, if BiomeBank can come up with a stool equivalent it would be great.

Jacka, as one of the world’s top microbiome experts, says scientists are still figuring out exactly how the gut-brain axis works, how the microbiome affects health, and how it can be manipulated.

Dozens of studies are underway in Australia, but existing research has already shown that a poor diet – such as the standard american diet – leads to increased inflammation in the body, which means a higher risk of cancer.

A team from Imperial College London and the University of Pittsburgh compared African Americans to rural South Africans. The volunteers were tested, then switched diets and were retested.

After just two weeks on the fiber-rich rural diet, Americans had significantly less bowel inflammation and a lower risk of cancer. Unfortunately, the rural group went the other way.

Cancer and the intestines

The Food and Mood Center studies nutrition and its effect on depression, on muscle and heart health, on psychotic disorders, on post-traumatic stress disorder, eating disorders, and a host of other health problems.

Jacka nominates cancer research as one of the most exciting fields in microbiome research. Show data: better responses to treatment, especially immunotherapy, in people with more diverse gut microbes.

But she warns that much research is still in its infancy, and industries looking to make money are taking advantage too quickly by selling products with vague promises to promote “gut health.”

“Note, keep an open mind, but not so open that your brain falls out. Or your wallet, more to the point,” she advises.

Fecal bacteria under the microscope.  Scientists are still discovering exactly how the microbiome affects our health and how it can be manipulated.
Fecal bacteria under the microscope. Scientists are still discovering exactly how the microbiome affects our health and how it can be manipulated. Photo: Steve Gschmeissner/SCIENCE PHOTO LIBRARY/Getty Images/Science Photo Library RF

The University of Sydney Microbiome Research Center studies the effect of the microbiome on cancer, women’s and children’s health, infection, immunity, inflammation, critical care and mental health and neuroscience.

The center’s director, Prof. Emad El-Omar, says there is advanced research showing the benefit of a more diverse microbiome (and thus fecal transplants) in dealing with C diff, in other conditions researchers are still investigating what works. and how .

He says that the number of genes in these microorganisms is smaller than that of the human genome.

“It’s a very exciting field, but some work still needs to be done to maximize the benefit to all of humanity.”

And he agrees with Jacka that the “wellness” industry sometimes jumps the gun on “gut health”.

How can you help your gut?

At this stage, poo transplants are only recommended or helpful in very specific cases. But anyone can improve their microbiome — and you don’t need supplements.

Jacka says that for most people, changing their diet is enough to change their bacteria.

“To have what we understand as a healthy microbiota, where the microbes present are associated with healthy conditions and the non-existent ones are associated with unhealthy conditions, we already know what you need to do,” she says.

“Eat a lot of plants, different kinds of plants, plants with different colors and throw in some fermented food.”

Think kimchi, kombucha and sauerkraut. And think fiber.

Jacka says that in typical Western diets, your gut flora is so “weak, pale, pale, and deficient” that it just can’t handle fiber. If people then try to take in more roughage, they get gas or stomach pain. Some people mistakenly think they have irritable bowel syndrome or gluten intolerance and stop eating high-fiber foods.

You have to start carefully, she says. Gradually increase the amount and type of fiber.

“The answer to a problem with beans,” she says, “is actually more beans.”

Costello says BiomeBank hopes to be “part of the global effort to solve this major problem, which is this loss of microbial diversity associated with disease … on a large scale”.

“We see it as a modern pandemic,” Costello said.

And there is still plenty of work to be done. At BiomeBank, researchers are beginning to understand the microbiome strains in frozen storage. Then there are the many species that have yet to be understood – we don’t know yet what they might be capable of one day.

Costello and Mitchell call that library of the known and unknown, next to the unicorns’ toilet, the “cave of wonders.”