Healthy Choices

Sacramento nonprofit center’s collection helps patients with intestinal disease

Laura Hamilton, a registered nurse, holds up a bottle of processed fecal matter at AdvancingBio. The stool bank launched by the new non-profit just opened at Mather Commerce Center. It is one of only five such banks in California. It screens and processes stool from donors, whose fecal matter will be used in a fecal transplant to help patients suffering from a rare but severe gastrointestinal disorder called C. diff.
Laura Hamilton, a registered nurse, holds up a bottle of processed fecal matter at AdvancingBio. The stool bank launched by the new non-profit just opened at Mather Commerce Center. It is one of only five such banks in California. It screens and processes stool from donors, whose fecal matter will be used in a fecal transplant to help patients suffering from a rare but severe gastrointestinal disorder called C. diff. rpench@sacbee.com

Walking into the AdvancingBio building in Mather Commerce Center feels a lot like walking into a blood bank. There’s a table full of snacks and water bottles, a rack of magazines and a room for medical screening.

The difference is, donors aren’t ushered onto a cot to fill a blood bag. They’re just pointed toward the bathroom.

AdvancingBio, one of only two stool banks in the U.S., opened in mid-February with a mission to save lives by collecting excrement donations for people in need of fecal transplants.

The bank launched in response to the rising number of Americans suffering from Clostridium difficile, or C. diff, a life-threatening gastrointestinal infection that wipes out the affected person’s healthy gut bacteria and replaces it with harmful bacteria. A growing body of research suggests that Fecal Microbiata Transplant, or the transfer of fecal matter from a healthy person’s gastrointestinal tract to a sick person’s, may be the most effective way to re-establish a colony of good bacteria that can overcome the C. diff infection.

When staff at Northern California donation network BloodSource became aware of the high demand for healthy stool, they made a plan to open an affiliated stool bank nearby, drawing on BloodSource’s corporate and financial resources. That bank became AdvancingBio, a nonprofit that so far has collected 47 stool samples, which get processed into liquid form, tested for infectious diseases and frozen before being shipped to health providers performing fecal transplants.

“It’s gaining more and more,” said AdvancingBio’s Executive Vice President Nicole Anderson of the stool bank concept. “When you look at the number of patients suffering, it really seemed like something we needed to do.”

A study funded by the federal Centers for Disease Control and Prevention that was released in late February found that nearly 500,000 people became infected with C. diff in 2011, more than previously estimated. About 30,000 of those patients died from the illness, with more than half of deaths occurring in people over 65. Experts believe infection rates are growing due to a more aggressive strain of the bacteria that appeared around the year 2000.

C. diff infections occur mainly in older people who undergo multiple medical procedures or spend a significant amount of time in a medical facility. They often follow a round of strong antibiotics, which can inadvertently clear out healthy gut bacteria and allow for rampant C. diff growth.

The standard treatment for C. diff infection, which can cause abdominal pain, severe diarrhea, dehydration, nausea and kidney failure, is actually more antibiotics. That works about 75 percent of the time, said Mark Davis, a Portland naturopathic physician on the board of directors for the Fecal Transplant Foundation. Those who find antibiotics ineffective seek out more unconventional alternatives.

“What my patients tell me is that the ick factor of having this disease is so high, that the ick factor of having a fecal transplant just pales in comparison,” said Davis, who has been performing fecal transplants for about four years. “Well over 90 percent of the people I introduce it to are so sick that they’re eager to try this.”

Healthy fecal matter can be transplanted through endoscopy, enema, nasal tube, oral capsule or other methods. Case studies of fecal transplants show an average cure rate of 91 to 93 percent for C. diff patients. Experts estimate the procedure has been performed less than 500 times in the U.S.

The Food and Drug Administration formally defines Fecal Microbiota Transplant as an investigational drug, requiring physicians to discuss the experimental procedure with patients and acquire informed consent before moving forward. The FMT Foundation’s provider directory shows five facilities in California offering fecal transplants, which are only available for C. diff patients, though Davis said the procedure could be helpful for people with other gastrointestinal problems, such as Crohn’s disease and irritable bowel syndrome.

At AdvancingBio, Anderson and her staff have little say in what happens to the stool once it leaves their facility. Their main prerogative is to harvest as many healthy donations as possible and make them available to physicians, who pay a service fee for the product.

The 47 samples in the AdvancingBio freezer came from 22 local donors. The product from each donor is weighed and parted into 50g samples, which each get added to 250 milliliters of saline. The saline solution is blended and filtered, then transferred to a sterile, glycerol-lined bottle to await off-site testing and then shipment. Consolidating the collection and screening process reduces time and cost for individual facilities, Anderson said.

Unlike OpenBiome, a stool bank in Massachusetts that offers $40 per stool sample, AdvancingBio does not offer any financial incentive to donors, instead relying on their willingness to help those in need, much like a blood bank.

It was that sense of compassion that drove Kevin Spencer, a 35-year-old Rocklin resident and frequent blood donor, to visit the Mather facility two weeks ago. Spencer does not believe he knows anyone suffering from C. diff but as a firefighter he felt compelled to give when he heard about the need.

The process was very clean and convenient, he said, and the staff made him feel comfortable with what could have been an awkward situation.

“It’s something that you’re going to do anyway,” he said. “It’s going to happen. So if you have the opportunity to help someone else by doing that, then why not?”

C. diff infection can result in a debilitating illness marked by severe abdominal pain, weight loss and diarrhea 10 to 20 times per day. About 20 percent of people who recover from C. diff experience a relapse.

“For patients suffering from the disease, it’s going to provide hope,” Anderson said. “For patients who have gone through a transplant and are able to then live their lives at a normal level again, they can live forward.”

Call The Bee’s Sammy Caiola, (916) 321-1636.

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