The Bellvitge and Clínic hospitals will carry out a campaign to recruit fecal donors in autumn to be able to carry out microbiota transplants for all citizens who need them.
In addition, having a stable group of donors will make it possible to investigate which diseases can be treated in the future with microbiota transplants, an emerging field of research in Europe and North America. Candidates, in which the intestinal microbiota plays a relevant role but the clinical efficacy of fecal transplants has not yet been demonstrated, include different types of cancer and psychiatric disorders.
The project has the support of the Consorci de Salut i Social de Catalunya (CSC), which will contribute 600,000 euros in the second half of this year for the start-up of the Banc de Microbiota de Catalunya.
For now, the only disease in which microbiota transplants have shown efficacy is recurrent infection by Clostridioides difficile, a common bacterium in hospitals that causes diarrhea and can be fatal in people with fragile health. It is estimated that around one in a thousand people contract the infection each year, according to US data, which is equivalent to around 8,000 people a year in Catalonia and 48,000 in Spain.
Although the majority of cases are cured, fecal microbiota transplantation is the only treatment option for a minority of patients, for whom it offers an expectation of cure greater than 90%. "In Catalonia we should be treating between 150 and 300 people a year," reports Jordi Guardiola, head of the digestive system service at the Bellvitge hospital and one of the promoters of the project.
The funding from the CSC will make it possible to consolidate the already existing microbiota banks in Bellvitge and in the Clínic, which were created with limited resources at the initiative of a few professionals. This is where the donations will be received, processed and stored, and from where they will be distributed to centers throughout Catalonia that treat Clostridioides difficile infections. The hospitals of Vic, Granollers and Igualada participate in the project, among others.
In order to offer microbiota transplants to a greater number of patients starting in autumn, the Bellvitge and Clínic teams will need a greater number of donors. They must be healthy people under 50 years of age and must not have risk factors or behaviors that could compromise the safety of their intestinal microbiota.
Just as there are protocols to guarantee the safety of blood donations, "with the microbiota we must also take extreme precautions to ensure that a disease cannot be transmitted through donation," reports Climent Casals, head of the microbiology service. of the Hospital Clínic in Barcelona and one of the architects of the project.
Since the selection process for stool donors is longer and more expensive than that for blood donors, microbiota banks prefer to have few regular donors rather than many sporadic ones. In the Netherlands, about twenty donors supply microbiota for the entire country, reports Casals.
In Spain the donation is not remunerated. But they try to give the volunteers the maximum facilities, such as going to get donations at home so they don't have to travel.
When they arrive at the laboratory, the stools are processed to separate the microbiota from the waste and freeze-dried to obtain a powder that is packed into capsules. In this way, patients who receive the treatment will have the sensation of ingesting a medicine like any other.
Between 10 and 20 capsules are usually obtained for each donor stool, reports Jordi Guardiola, from the Bellvitge hospital. On average, the capsules obtained with a stool make it possible to complete a person's treatment.
Looking to the future, "having a stable group of donors will allow us to investigate the potential of the microbiota for the treatment of different diseases", highlights Climent Casals. Studies published in recent months have revealed that the gut microbiota is related to the efficacy of cancer immunotherapies, suggesting that modifying the microbiota could improve the efficacy of some cancer treatments.
“I also see enormous potential in psychiatry”, adds Casals, since the microbiota has been related to different mental health disorders such as -among others- depression, anorexia or autism.
In the shorter term, the Clínic and Bellvitge teams plan to investigate whether microbiota transplants can be effective for ulcerative colitis and recurrent urinary tract infections.
“The creation of the Banco de Microbiota de Catalunya will facilitate access to treatment for a large number of intestinal diseases that are increasingly present in our population, as well as facilitate and promote scientific research related to the role of the microbiota in health and illnesses”, points out Antoni Gilabert, director of Innovation and Partnership of the CSC.
“The microbiota represents a paradigm shift in microbiology”, concludes Climent Casals. "We are at the beginning."
