The UK is set to begin a clinical trial to fight advanced liver disease with a new tablet – made of poo. The ‘crapsules’ contain the good bacteria from the dried and powdered faeces of healthy volunteers. Apparently, they do not taste or smell of poo.
“There is an urgent and unmet need to tackle infection and antimicrobial resistance in chronic liver disease,” said Dr Lindsey Edwards, senior lecturer in inflammation biology at King’s College London. “If we can boost liver patients' own immunity to reduce infections by modifying the microbiome, we can reduce the need for the prescription of antibiotics.”
The trial aims to establish whether poo transplants – otherwise known as faecal microbiota transplants (FMT) – can reduce the likelihood of infection in liver disease patients. The scientists also hope the trial will confirm initial findings that FMT can dramatically improve gut health in the microbiome.
The advanced stage of liver disease known as cirrhosis is irreversible. It is the third most common cause of death in the UK, as well as the third most common reason that people have to stop working.
People with cirrhosis have ‘bad’ bacteria in their bowels which makes them more vulnerable to infections, which are more severe and can even be fatal in cirrhosis patients. Scientists hope that this ‘bad’ bacteria could be replaced with the good bacteria in the pills.
The trial, led by King’s College London, will involve 300 participants from across the UK. Over the course of two years, they will be given either an FMT tablet or a placebo to take every three months.
The UK trial follows the end of a wider European trial with a smaller pool of 32 patients, which established the safety and feasibility of FMT. However, the FMT in this trial took the form of an endoscopy – an invasive procedure where a long tube is inserted into the body – rather than a tablet.
This initial trial also showed the success of the poo transplant in modifying gut bacteria and enhancing immunity.
The news of the UK trial brings hope to cirrhosis sufferers, whose only option currently is a liver transplant. Liver transplants, however, are not possible if the patient also has an antimicrobial-resistant infection – which is common in cirrhosis patients given their high exposure to antibiotics.
According to Pamela Healy, CEO of the British Liver Trust, in the future this tablet could help to tackle the antimicrobial infections themselves: “Finding new, effective ways to treat resistant bacteria is one of the most important challenges in global medicine and this could provide a solution that could save healthcare systems across the world millions of pounds.”
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