Thursday, June 15, 2017

Researchers at Virginia Commonwealth University School of Medicine have successfully demonstrated that transferring stool from a healthy donor to cirrhosis patients who suffer from recurrent hepatic encephalopathy can improve brain functioning, reduce confusion and reduce hospitalization for that patient population. Hepatic encephalopathy is a brain disorder that commonly manifests as a complication of cirrhosis. It can lead to fatigue, inability to concentrate, confusion and, in some cases, death.

Results from the first randomized human trial of the procedure were recently published online in the journal Hepatology.

“Fecal transplantation has been used to treat other conditions, but this is the first randomized trial of this kind in liver disease and cirrhosis,” said Jasmohan S. Bajaj, M.D., an associate professor in the School of Medicine. Bajaj led the team of researchers who oversaw fecal microbial transplantation in cirrhosis patients at Hunter Holmes McGuire VA Medical Center. All of the patients in the study were receiving the maximum treatment possible for HE, but continued to suffer from disease-related symptoms.

Cirrhosis, which is characterized by prominent and irreversible scarring of the liver, is caused by a variety of conditions such as viral hepatitis and chronic alcohol abuse. The disease affected about 2.8 million people and resulted in 1.3 million deaths in 2015, according to an article published last year in the medical journal The Lancet.

Bajaj led a study published last year in the journals Hepatology and Scientific Reports that revealed that the gut bacteria found in the intestinal tract and in stool was associated with hepatic encephalopathy. The most recent finding builds upon that research.

“This initial small study shows that even in very sick patients with liver disease, fecal transplants can be safe and can improve brain functioning,” Bajaj said. “Patients with cirrhosis who are already on maximum treatment could potentially benefit from this research.”

Bajaj, who practices medicine and teaches at VCU School of Medicine’s Department of Internal Medicine and at the McGuire VA Medical Center, is already planning next steps. He plans to build on the most recent scientific findings with a new National Institutes of Health-funded research trial that uses oral capsules instead of enemas to achieve the same outcome.  

“Dr. Bajaj’s latest research embodies VCU School of Medicine and VCU Health’s ongoing commitment to applying novel research in the clinical and basic sciences, and then translating those research discoveries into excellent patient care,” said Peter F. Buckley, M.D., dean of the VCU School of Medicine. “The discoveries would not be possible without the support of our colleagues at McGuire VA Medical Center, where 100 percent of the research was conducted, and we are grateful for that collaboration.”

Donor materials for both studies are provided by nonprofit stool bank OpenBiome, which is also a collaborator in the research project.