4 May 2016
Faecal transplants as a treatment for rheumatoid arthritis (RA) may be closer than you think.
So says Tim Spector, professor of genetic epidemiology at King’s College London, who is visiting Darwin to speak at the scientific meeting of the Australian Rheumatology Association.
Prof Spector, a rheumatologist, says the microbes in our gut are key to the development of our immune systems and are clearly involved in autoimmune disease.
“It looks like you can predict if someone has rheumatoid arthritis just as well by taking a poo sample and looking at their microbes as you can with autoantibody tests.”
He says new studies are showing that how people respond to disease-modifying arthritis drugs very much depends on the type of microbes they have.
“This is an extremely new area that’s very exciting, and we’re just starting some research looking at whether we can we predict whether people will do well on their biologic drugs for their arthritis by the microbes they have. And if not, can we improve the treatment by replacing their gut microbes.”
This could be done by adding probiotics or making other changes to the diet, or through faecal transplants, he says.
“Faecal transplants are emerging from just being a joke subject to reality, and they’ve been approved for Clostridium difficile infections with a 90% success rates,” he says.
There are 160 studies faecal transplant studies currently registered, with some planned for rheumatoid arthritis.
Prof Spector says trials in inflammatory bowel disease may point the way to efficacy in RA.
“The latest one is showing a significant effect for ulcerative colitis and Crohn’s disease, which is going to be published soon. There’s a good chance that what works in colitis is also going to work in rheumatoid arthritis.”
He says faecal transplants may be effective for people with RA who are failing biologic therapy, as it seems changing the makeup of the microbiome affects how well immunotherapy works.
“We’re still at the early stages of how it’s done. Obviously faecal transplant is a very crude therapy because we don’t know what’s in it. It’s a blunderbuss approach and it goes against all conventional wisdom of doctors, and that’s probably why it’s had some resistance. But it does seem to work.”
He says it’s a question of understanding who it’s going to work for. There may be a genetic component, and donors may also have to be genetically matched.
“But I think in 5 years this is going to be fairly commonplace.”