What is a fecal transplant?
Also called a fecal microbiota transplant or FMT, a fecal transplant is a therapy which shows promise for treating a number of conditions including chronic diarrhea and inflammatory bowel in humans and animals. The treatment uses the stool from a healthy donor, and transplants it into the patient, to restore microflora in the intestinal tract.
Fecal transplants may be an emerging therapy in modern medicine. It is first described by Chinese medical doctor Ge Hong in the fourth-century. In the 1600’s Chinese doctor, acupuncturist used yellow soup and golden juice to treat a number of gastrointestinal diseases.
The digestive tract contains a complex community of symbiotic and commensal bacteria (microbiota). Each individual (human or animal) has its own unique microbiota which consists of trillions of bacteria. These organisms play an important role in maintaining the overall health of the host including:
- Metabolism of nutrients
- Synthesis of vitamins B and K
- Regulation of immune response
- Protection against pathogens
In some cats, healthy microbiota become out of balance (called dysbiosis or leaky gut), most commonly due to the over-use of antibiotics which as we know are prescribed to treat bacterial infections. Unfortunately, antibiotics are not selective, and can kill helpful gut bacteria as well as pathogenic (disease causing) bacteria. When this occurs, pathogenic bacteria can take hold in the gut which leads to dysfunction, most often inflammation and/or diarrhea.
Why do cats need FMT?
While there is still little research on fecal microbiota transplants in cats (read here on the first FMT in cats), it has shown promise in both humans and dogs. FMT is used to treat Clostridium difficile colitis in people which is caused by an overgrowth of bacteria of the same name. This bacteria (shortened to C. difficile or C. diff.) release toxins which cause inflammation of the intestines leading to chronic diarrhea, abdominal cramps and fever. The success rate of fecal microbiota transplants in humans with C. diff is between 85-90% for the first treatment and up to 100% after a second treatment.
Veterinarians will try a number of methods to treat chronic diarrhea in cats. It is classified according to how it responds to a particular treatment, such as:
- Antibiotic responsive diarrhea
- Dietary responsive diarrhea
- Fibre responsive diarrhea
- In some cases, diarrhea fails to respond to conventional treatment
Inflammatory bowel disease:
Inflammatory bowel disease (IBD) is a frustrating group of disorders caused by the infiltration of inflammatory cells into the mucosa of the gastrointestinal tract and is a leading cause of vomiting and diarrhea in cats.
We still do not fully understand the cause of IBD. Likely causes include bacterial infection, dietary allergy or intolerance, genetic influence and parasites which cause cats to produce antibodies that attack their own digestive tract.
Increasing attention is being focused towards the role of gut microbiome which are a group of micro-organisms that live in the gut and has many roles such as inhibiting pathogens, metabolic function, assisting the immune system, regulating the production of antibodies.
Traditional treatment for IBD includes the following:
- Dietary changes (high fibre, highly digestible diet with a novel protein)
- Immunosuppressive drugs
As with chronic diarrhea, not all cats will respond to treatment. This is where fecal transplants may offer hope to restore a healthy microbiome.
How is a fecal transplant performed?
Obviously a fecal transplant requires two cats. The donor cat who will provide the stool sample and the recipient who will receive it. The donor cat must be healthy, have no history of gastrointestinal disease, have not had antibiotics for a set period of time (which can vary), and is free of disease and parasites.
The donor cat provides a stool sample, which is mixed with sterile saline and strained to produce a particle free slurry.
The recipient is fasted overnight, the following morning sedation and anesthetic are administered followed by an enema to clean the GI tract and the fecal transplant is introduced into the gastrointestinal tract of the recipient via enema, colonoscopy, endoscopy or sigmoidoscopy. The slurry is held in the colon for 45 minutes before anesthesia is reversed and the cat regains consciousness.
I hope in future there will be more research in cats for this promising if not unique therapy.