iNEWS
The UK is to launch a national clinical trial of a “poo transplant” that researchers believe could treat advanced liver disease and fight antimicrobial resistance.
It follows the success of an initial trial where patients were given a faecal transplant via an endoscopy, where a tube is inserted into the body, proving that the process can dramatically improve gut health.
The KCL team will present their results at the EASL 2023 Congress in Vienna, Austria, today showing for the first time that the bad bowel bacteria in patients with end-stage chronic liver disease, known as cirrhosis, can be replaced with healthy bacteria from healthy volunteers in a process known as Faecal Microbiota Transplant (FMT).
The researchers said their “significant findings bring a renewed sense of hope for patients grappling with advanced cirrhosis and offer a potential breakthrough in their treatment”.
The new Promise trial will recruit cirrhosis patients from across the country to test whether oral FMT capsules from healthy volunteers’ freeze-dried stool, or “crapsules” as the researchers call them, also work. The new method removes the need for invasive endoscopy procedures and therefore reduces the likelihood of getting an infection.
Professor Debbie Shawcross, chief investigator of the Promise trial from KCL, said: “This landmark trial provides evidence that a faecal transplant can improve gut health by modifying the gut microbiome and reduce ammonia levels in patients with cirrhosis.
Initial findings are promising news for patients with chronic liver disease who are in desperate need of alternative treatment options.
“We are now expanding this nationally to 300 patients across the UK in the Promise trial. Patients told us that they would prefer to take tablets rather than have an endoscopy.
The ‘crapsules’, which have none of the taste or smell as the name suggests, may offer new hope for patients with cirrhosis who are out of treatment options.”
Cirrhosis – irreversible scarring of the liver – is the third biggest cause of mortality and loss of working life in the UK. The human body contains trillions of bacteria, but people with cirrhosis have an increased number of “bad” bacteria in the bowel which makes them highly susceptible to a host of infections.
Over-prescribing antibiotics means they are becoming less effective to treat these infections, and the bowel can become infected with “super-bugs”. Infections in people with cirrhosis are often severe and can be fatal.
In many cases, the only definitive treatment option for cirrhosis patients is a liver transplant. However, this cannot be safely performed if the patient has an antimicrobial resistant infection.
Patients with cirrhosis are at particularly high risk for antimicrobial resistance because of their disproportionate exposure to antibiotics – 25 per cent of patients are on long-term antibiotics.
