It's become well-known that something as simple as a cheek swab can give your care team information on the best ways to treat your medical conditions. Did you know that there's another small piece that can be just as important?

Recently, NorthShore doctor spoke at MATTER Chicago about microbiomes, and how researchers like himself are using them to detect and treat underlying conditions. He talks about this innovative research and its uses below:

Biomes and microbiomes aren’t uncommon topics of conversation in your field – at the same time, a lot of people don’t know what these are and how they impact our lives – can you explain how they relate to patients?
For many years, it has been believed that our gut’s organisms, or the “microbiome”, were somehow involved in chronic illnesses. We call this “dysbiosis,” which is the idea that the environment of organisms in the gut is imbalanced, and that perhaps fixing that imbalance might in fact treat or even cure a whole variety of diseases such as inflammatory bowel disease, which is my particular area of research interest.

What are some conditions patients are commonly diagnosed with that you’ve found could be affected by microbiomes? How are these microbiomes related to the conditions?
Almost every field of medicine has conditions where the microbiome is involved: fatty liver disease, inflammatory bowel disease, diabetes, depression, Parkinson’s, chronic fatigue syndrome, obesity, rheumatoid arthritis and food allergies to name a few.

One of the innovative procedures your team has been working on is the use of the Fecal Microbiota Transplantation. Can you tell us about how it works and what it’s being used for?
Fecal Microbiota Transplantation is the infusion of a liquid stool preparation obtained from a healthy donor into the GI tract of another recipient. This has been reported in many disease processes above, but currently, the best evidence and current practice is for the treatment of recurrent Clostridium difficile infection (“C. diff”), which is a common infection that causes diarrhea.

Where do you get the samples that you use for transplants? Can just anyone donate?
We previously asked our patients to have a family member donate stool, but it turned out to be a difficult task to find an optimal donor, as we require a lot of our stool donors, much like we would if you were going to donate one of your kidneys. You have to be in good health, cannot be on antibiotics and cannot have a list of diseases, including diabetes or other autoimmune disorders, as we want to make sure that this does not potentially get transferred from donor to recipient. Thus, at NorthShore, we have used universal donors, people who we test monthly and have reviewed their entire medical history. It also speeds up the process of fecal transplant, as we don’t have to wait and test potential donors that a patient provides until we find an adequate donor.

Yes, anyone can donate, and we are always looking for healthy donors!

Clostridium difficile, or “C. diff”, is a common cause of infection in the US. How has FMT been used to combat this?
C diff is a common infection, and the standard treatment has involved taking an antibiotic to treat this. However; in the past decade, we have seen C. diff become more resistant to antibiotics, and in some cases, more aggressive and difficult to treat. We believe that people who get C. diff repeatedly have a lack of diversity of bacteria in their colon, which predisposes them to recurrent infection. Thus, FMT has been shown to improve their biodiversity by introducing a donor’s bacteria. It has been very successful.

What kind of results have you seen in patients at NorthShore who have received fecal Microbiota transplants?
Thus far, we have done FMT over 170 patients with C. diff, and have a 96% cure rate. While this is phenomenal, these results are similar to my colleagues at other institutions that do FMT for C. diff. Keep in mind that these are for patients who have had at least 3 recurrences of C. diff, where your risk of next recurrence is over 70%.

What are some of the goals you and your team have for the use of donated samples?
We have started a new trial looking at sicker patients in the hospital with C. diff, to see if this is effective in the inpatient setting with a sicker population of patients. To date, we have cured a few cases of severe C. diff in the hospital, and saved patients from going to surgery for their C. diff with FMT. To our knowledge, we are the only institution in the country doing a trial in the inpatient setting for C. diff and FMT.

In addition, we are planning on analyzing samples of patients with C. diff who are the hardest to treat, to see if there is a composition of bacteria that predict a more severe course.