Poop Transplant for Treatment of COVID-19

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Poop transplant
University of Minnesota post doctorate fellow Matt Hamilton displays a sample of fecal bacteria at the St. Paul, Minn. campus Nov. 14, 2012. The fecal matter is donated and used to treat patients with Clostridium difficile, an intestinal disease that is caused when a person's gut flora is eliminated by antibiotics.

Two people in Poland, suffering from a gut infection and COVID-19, received a poop transplant that ended up clearing their COVID-19 symptoms.

Poop transplant, also called Fecal Microbiota Transplantation (FMT), has recently gained attention for its ability to treat a wide range of diseases. Although it’s first-line therapy for Clostridioides difficile infection, it has also shown promising results for patients with advanced melanoma and Auto-Brewery Syndrome (ABS). However, according to a letter published in the journal Gut, a poop transplant may also help treat COVID-19 infections.

The procedure involves the selection of a closely related, healthy donor. Faecal matter from the donor’s colon is then taken and turned into a liquid mixture. The suspension is then transferred into the patient’s colon via nasogastric and nasoduodenal tubes, or as a retention enema. The aim of the transplant is to restore the gut microbiome and in turn boost the body’s immune system. 

In the online letter, the authors describe the case of two patients with COVID-19 who received a poop transplant primarily to treat C difficile infection.

The first case was of an 80-year-old man with recurrent C difficile infection. He was also suffering from COVID-19 symptoms as well as pneumonia and sepsis. A positive swab test confirmed him to be suffering from COVID-19. Doctors then started him on remdesivir and plasma. They also performed FMT for his recurrent C difficile. However, two days after the procedure, the man’s fever disappeared, and his pneumonia did not worsen any further.

The second case was a 19-year-old male with ulcerative colitis and on immunosuppressants. He underwent hospitalization because of a relapse of C difficile infection. Doctors started him on antibiotics and performed a colonoscopic FMT. 15 hours later, he developed a fever and tested positive for COVID-19. However, despite no treatment, the fever subsided and did not progress to severe disease.

No Progression Despite Risk Factors

Since the donor stool was tested for SARS-CoV-2 and the patients also tested negative upon admission, doctors ruled out that the transplant caused the infection. Post-transplant stool samples had tested positive in both patients.

Our main conclusion from these cases is that [stool transplant] appears safe and of comparable efficacy in treating recurrent [C difficile infection] in patients with coexisting COVID-19

study authors

Although both patients had risk factors of severe disease, they only had a mild course of infection. The study authors hypothesize that the transplant likely aided recovery by restoring the gut bacteria and boosting the immune response. However, the case study only represents two cases; thus, one cannot draw a conclusion on FMT’s role in treating COVID-19. The study authors hope to conduct a clinical trial to investigate whether poop transplant can become a standard COVID-19 treatment.

Reference:

Biliński J, Winter K, Jasiński M, et al. Rapid resolution of COVID-19 after faecal microbiota transplantation.Gut. Published Online First: 06 July 2021. doi: 10.1136/gutjnl-2021-325010

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