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By Robert G. Bell

Robert BellCan we talk? I mean really talk? Let’s get down and dirty and talk about some good s**t. I’m talking about number two in all its glory. I’m talking about giving you the straight poop on poop—not just the bad poop but the good poop. One of the many side effects of conventional chemotherapy is gastrointestinal (GI) disturbances such as loss of appetite, nausea, vomiting, mouth and throat sores, taste loss, stomach pain, and diarrhea. Conventional chemotherapy, such as the alkalating agent dacarbazine, or the anthracyclines such as doxorubicin and mitoxantrone, or the antimetabolite methotrexate, target cells such as cancer that are actively growing and dividing. Unfortunately, that usually includes damage to the normal cells in the blood, mouth, intestines, GI, flora, and hair. The gastrointestinal flora is comprised mostly of bacteria with hundreds of different species coexisting in the gut that function in nutrition, digestion, immunity, and endocrine function in the human system. A compromised GI tract can lead to Clostridium difficile infections which are unfortunately common in many cancer patients. C. difficle is a gram-positive, spore-forming anaerobic bacillus linked to a pathogenic fecal toxin in patients with pseudomembranous colitis. C. difficile is difficult to treat (it is becoming antibiotic resistant) and can lead to serious medical complications and death.

An interesting therapy that is so old it is new again is stirring up a stink in a good way. I am talking about fecal microbiota transplants (FMT) or in elementary school terms, a poop transplant. In essence, FMT is an attempt to repopulate the intestinal tract of a patient whose microflora was killed off by cancer treatments and antibiotics with the native flora from a healthy subject. The human intestines contain about 100 trillion microorganisms, which is about 10 times greater than the total number of human cells in the body and has 100 times as many genes in aggregate as the human genome. We often overlook how critical the microflora of GI system is in healthy and diseased states, but it is one of our best sentinels in disease prevention and overall health. Nothing like good poop, so keep that flora happy and healthy throughout your lifetime.

poop emojiPoop transplants are nothing new—in the 4th century, Ge Hong treated patients with gastric distress with a fecal suspension called “solution of stool.” It was later described as a herbal remedy in the 16th century Chinese Compendium of Materia Medica (Ben Cao Gang Mu) as “fermented solution of stool,” “yellow soup,” and “golden juice” (from the tasting notes, the fermented stool beverage had a pungent nose with a lingering nutty aftertaste—a treat sure to be at your local juice bar soon). Today’s FMT is usually prepared by having a healthy donor collect a fist sized amount of stool that is mixed with saline, homogenized, filtered, and packaged/refrigerated. The stool mixture is then placed in the recipient’s colon where they should hold in the stool mixture in for at least two hours or more. This procedure has been shown to cure C. difficle infections and help cancer patients that have developed antibiotic resistant C. difficle infections.

So immunotherapy is an exciting possibility when it comes to cancer treatment options. From the previous posts, immunotherapy comes in multiple sizes and shapes, from maintaining lifelong healthy habits, to preventative and treatment vaccines, protein therapy, checkpoint inhibitors, MAbs, cytokines, and gene therapy, all which pave the way for personalized precision therapies for cancer patients. Immunotherapy, alone or in combination with other cancer treatment therapies, is making a difference in patients’ lives now, and will continue to do so in the future. The development of safe and effective cancer therapies is ongoing and full of promise…not to mention hope.

Robert G. Bell, Ph.D., is president and owner of Drug and Biotechnology Development LLC, a consultancy to the pharmaceutical industry and academia for biological, drug, and device development.