“It sounds disgusting at first, but if you look at the therapeutic effectiveness and consider that some patients are life-threateningly ill, then it is a very sensible treatment,” says Andreas Stallmach, Director of the Clinic for Internal Medicine IV at the Jena University Hospital. He talks about Fecal Microbiota Transplantation (FMT). In this therapy, the stool of a healthy donor is extensively examined, processed and then transferred to a sick person – either swallowed in a capsule or rectally as an enema. The aim is to establish the viruses, archaea, fungi and bacteria contained therein as well as their genes and metabolic products – the intestinal microbiome – in the patient. In the best case, this leads to a new colonization of the intestinal tract.
Therapeutic successes through transplantation of the “golden syrup”
Stool transplantation is not an invention of modern medicine. There is one historical source that describes the medicinal administration of stool – or the “golden syrup”, as it was called in the 16th century – as early as the fourth century. Nowadays, the treatment is mainly for recurring dangerous intestinal infections with the bacterium Clostridioides difficiles asked. The success rate is more than 80 percent. “This is remarkable when the cure rates after taking modern antibiotics are only 30 to 40 percent,” says Stallmach. However, FMT is also being used more and more successfully in the chronic inflammatory bowel disease ulcerative colitis. Scientists in Israel and the USA achieved an equally promising success. FMT was used here for the first time to prepare skin cancer patients for immunotherapy. In their studies, which were published in Science last year, they showed that for patients in whom checkpoint inhibitor immunotherapy initially did not work, it was sometimes successful after FMT. More and more studies are appearing worldwide that share this success and investigate further in order to further improve cancer therapies. In June of this year, the Viennese company “Biome Diagnostics” launched the first and only prediction test based on the intestinal microbiome. With the help of an algorithm, this can determine the composition of the microbiome and thus predict with 80 percent accuracy how high the chances of success for an immunotherapy are. In this way, patients could be spared severe side effects if the chances of recovery were low.