EASD: Fecal Transplant Flushes Insulin Resistance

Finally, some really good news. After all the s**t the rest of us have had to take from fatsos, it is payback time.

Note that we help them, while they have hurt us.

Clearly, lean people are better people.

EASD: Fecal Transplant Flushes Insulin Resistance

STOCKHOLM -- Obese patients with a constellation of symptoms known as prediabetes improved insulin sensitivity with a fecal transplant from healthy thin donors, researchers here reported.

After six weeks, peripheral insulin sensitivity significantly improved in 18 patients who received feces from lean donors compared with those who received an autologous transplant (P<0.05), said Anne Vrieze, MD, of the Academic Medical Center in Amsterdam, and colleagues.

There was also a trend toward improvement in hepatic insulin sensitivity but it wasn't significant, they reported at the European Association for the Study of Diabetes Meeting here.

"This confirms the potential role of gut microbiota in the disturbance of glucose and lipid metabolism in obesity," Vrieze said during the presentation. "The challenge is to use this knowledge to develop therapies."

John Buse, MD, PhD, of the University of North Carolina at Chapel Hill, cautioned that the researchers didn't yet present data on actual differences in gut bacteria after transplantation, but the idea was promising.

"It's interesting," he told MedPage Today. "There's little data, so it's hard to tell. But it's a cool idea."

Fecal transplantation programs -- while far from common -- actually are already in place at a few centers in the U.S. based on some evidence suggesting efficacy in tough-to-treat gastrointestinal infections with the bacteria Clostridium difficile.

Since the gut plays an active role in regulating hormones that impact both obesity and diabetes associated with obesity, the focus has expanded to bacteria in the gut.

Animal studies affirmed an association between obesity and gut microbiota, as animals given bacteria from the feces of obese mice had a significantly greater increase in total body fat than those colonized with a "lean" microbiota, Vrieze said.

But data on a clinical roll for gut microbiota are scarce.

This pilot study is the first randomized controlled trial in humans of fecal transplantation for metabolic dysfunction.

Vrieze and colleagues enrolled 18 obese men ages 21 to 65 with metabolic syndrome who weren't taking medication for their condition and who hadn't used antibiotics in the last three months. All of them kept a food and exercise diary over the study period.

Vrieze said her institution already has an approved fecal transplantation program approved for the treatment of Clostridium difficile, so they applied the technology to their own study.

All patients had jejunum biopsies and a bowel lavage to clear their own native bacteria. They were then randomized to either allogenic transplant of feces from lean male donors or autologous transplantation.

Vrieze noted that all feces were screened for parasites and Clostridium difficile, and blood samples confirmed the absence of several infections including HIV.

Excrement was collected from morning stool and inserted into patients via a duodenal tube.

The researchers found no changes in weight in either group after six weeks. Vrieze said they had expected some weight loss since it was seen in animal models, but it proved not to be the case in humans.

However, there were significant improvements in peripheral insulin sensitivity after six weeks in the group that received feces from lean donors compared with those who had an autologous transplant (P<0.05).

This group also had improvements in hepatic insulin sensitivity, but it wasn't significant (P=0.08).

Triglyceride levels fell significantly for the lean transplants compared with the autologous transplants, but returned to normal after 12 weeks, Vrieze said.

"This is probably a dose-response relationship," said Michaela Diamant, MD, PhD, of VU University Medical Center in Amsterdam, who moderated the session, noting that it appeared that the benefit would be greater with more transplants.

The researchers also saw increased inflammation in both groups following transplant, and cytokines are currently being analyzed. Jejunal bacteria are also in the process of being assessed to determine specific changes to the gut microbiome.

She noted, however, that there were no changes in patients' diets or their physical activity levels that would have accounted for changes in insulin sensitivity.

Vrieze added that there were no adverse events associated with the treatment but warned that its small size was a limiting factor.

Other researchers were also cautious that there were not yet data on changes in the gut microbiome.

"You have to ask what other material do you introduce when you perform this transplant," Diamant said.

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