Faecal transplants could provide a breakthrough in treating severely malnourished children, say scientists leading a trial that launches in Cape Town next month.
Transplants of healthy faeces from one person's gut to another's have already been used to cure a life-threatening infection in adults, leading to the procedure soaring in popularity in the US over the past few years.
For physicians and researchers involved in the Cape Town trial, dubbed Thrive, healthy faecal matter is like gold. They believe it could be a fix for the 40% of severely malnourished children who do not respond fully to nutritional feeding.
SA will be the first country on the continent to test if such transfers can prevent stunting from malnutrition, which impairs mental development and dramatically increases child mortality rates. Malnutrition is common in SA and affects 19-million children globally.
Dr Shrish Budree, Thrive's co-principal investigator, said: "We hope that therapy using bugs [in stool] and food will be a leap forward in treatment for severely malnourished children. For the past 20 years we have been adjusting the formulations of therapeutic foods with minimal impact."
Medical emergency nursing sister Tania Shobi, from the Red Cross Children's Hospital, will be co-ordinating the trial and recruiting children from 18 months to five years old. "I think parents will not be impressed at first with the idea of using poop but I hope the exciting results will encourage them to join," she said.
In the US, 600 children have received stool transplants for other conditions with positive results and no serious side-effects.
"Illnesses take over in a lot of the kids we see with malnutrition and we hope parents will join the trial," said Shobi.
Washington University researchers did studies on Malawian twins, focusing on twins where one was healthy and the other malnourished. When they gave mice stool with gut microbes from the malnourished twin, the mice lost weight. They recovered once they were housed with healthy mice and could eat each other's stool.
They found that mice that ate faeces from the malnourished twin lost weight. When the mice were housed together and ate each other's stool, they recovered.
About 37,000 Americans have had stool transplants, or faecal microbiota transplantation (FMT) approved, mostly for the common hospital infection Clostridium difficile.
In SA the revolutionary treatment has been used successfully to treat patients for the infection in private and state hospitals.
Professor Lizette van der Merwe, a critical-care specialist at Livingstone Hospital in Port Elizabeth, said the hospital's first FMT patient had been in acute care for weeks, not responding to other treatments for the infection. After the procedure he recovered enough to be discharged within one week.
FMT has proved effective for treating C difficile, and other conditions, in children and adults, in Europe, Australia and China.
OpenBiome, a nonprofit "stool bank", is supporting 30 clinical trials in the US and globally that are investigating the use of FMT for conditions including inflammatory bowel disease, ulcerative colitis, obesity and depression.
It will collaborate with the University of Cape Town on the pioneering trial in Cape Town hospitals, providing frozen faeces from donors whose health is carefully screened.
Cape Town gastroenterologist Dr Dave Epstein has been doing transplants since 2013 with "great" results - from the top down through a tube, or the bottom up through a colonoscopy - to treat C difficile in cases where antibiotics have failed.
"More and more people are taking powerful antibiotics, which wipe out their [gut] flora, leaving them prone to C difficile," said Epstein.
Dr Majdi Osman, Thrive co-principal investigator and OpenBiome clinical director, said a gut with healthy micro-organisms was like a forest with many trees.
"When everything is wiped out in a forest fire, how do you restore that complex ecological system? If you plant a tree [like taking a probiotic] you do not restore full function. You need all the organisms [delivered through FMT]."
The Thrive team intends to enrol 20 children who are in the rehabilitation stage of severe acute malnutrition but have not recovered after eight weeks of therapeutic nutritional feeding...