What is a fecal microbial transplant? - Kathryn M. Stephenson and David L. Suskind

譯者: Lilian Chiu 審譯者: Helen Chang

1,700 years ago, a Chinese alchemist named Ge Hong

一千七百年前，中國煉丹術家葛洪

was renowned for his special soup that could cure diarrhea-stricken patients.

因為發明了可以治癒 腹瀉患者的湯而聞名。

The stew was deep yellow, and had an intense aroma.

這種燉湯是深黃色的， 有種很強烈的氣味。

And, like many family recipes, it had a secret ingredient.

和許多家傳食譜一樣， 它也有種秘密原料。

But in this case, that ingredient didn’t come from the kitchen—

但在這個例子中，

那秘密原料不是來自廚房——

it came from the bathroom.

而是來自廁所。

It might seem unwise to consume feces,

食用糞便似乎是不明智的。

and today, there aren’t many doctors who would prescribe Ge Hong’s recipe.

現今也沒有很多醫生開的 處方會含有葛洪的食譜。

However, exciting new research suggests that taking poop into the body

然而，

讓人興奮的新研究指出， 用其他方式把便便攝入體內

in other ways might benefit our health.

可能對我們的健康有益。

One such treatment is fecal microbial transplantation,

這種治療方法之一 是糞便微生物移植，

and the secret to how it works lives in your gut.

它運作原理的秘密， 就活在你的腸道中。

Trillions and trillions of bacteria, viruses, fungi, and archaea

數不清的細菌、病毒、

真菌，和古菌

consider your bowels their home.

把你的腸子當作它們的家。

Collectively, these microbes make up what’s known as your gut microbiome,

腸道微生物群系就是所有 這些微生物的總稱，

and each of these organisms possesses dynamic, specialized abilities

而這些生物體，每個都具有 動態且專門的能力，

that seem to be essential for human life.

這些能力對於人類 生命維持似乎很重要。

They break down our food, make vitamins,

它們會分解我們的食物，

製作維生素，

train our immune system and circadian rhythm,

訓練我們的免疫系統和生理時鐘，

and even protect us from infections.

甚至保護我們不受感染。

In return, they receive a nice warm place to live,

回報它們的是溫暖的好住所，

complete with an all-you-can-eat buffet.

附帶吃到飽的自助餐。

Some research suggests our microbiomes might start forming in the womb,

有些研究指出我們的微生物群系 可能是在子宮中就開始形成。

but if not, they certainly get started when we're born.

就算不是，也肯定在我們 出生時就開始形成了。

During a vaginal birth, infants take in some of their mother’s fecal matter

在陰道分娩時，

嬰兒會攝入一些母親的糞便 物質及充滿微生物的液體。

and microbe-filled fluids.

From then on, our microbiomes are constantly diversifying

那之後，我們的微生物群系就會

隨著接觸到各種食物和環境 而變得越來越多樣化。

with exposure to various foods and environments.

This is essential for maintaining gut health.

要維持腸道健康，這點十分重要。

If poor nutrition, chronic disease or antibiotics disturb this delicate balance,

如果營養不良、慢性疾病，

或抗生素擾亂了這精密的平衡，

the body can become vulnerable to problems

身體可能會無法抵抗 一些問題，如細菌

like bacteria and fungal overgrowth or infectious diarrhea.

及真菌過度生長或感染性腹瀉。

But infusing a new batch of microorganisms into the intestine

但將一批新的微生物注入到腸道中

seems to help reset the gut microbiome—

似乎能協助重設腸道微生物群系——

this is where fecal microbial transplants come into play.

此時就該糞便微生物移植登場了。

This line of treatment is still very new,

這種治療方法仍然很新，

and there are tons of unanswered questions about how it works.

且關於它運作的原理， 還有一堆問題尚未解答。

So currently, the US Food and Drug Administration only allows doctors

所以目前，美國食品及藥物管理局

只允許醫生在實驗性治療中 使用糞便移植

to use fecal transplants experimentally

for battling one of the toughest gut infections—

對抗最棘手的腸道感染之一——

antibiotic-resistant Clostridiodes difficile.

抗生素抗藥性困難梭狀 芽孢桿菌感染。

This infectious bacterium forms spores in the colon that are immune to antibiotics

這種有感染性的細菌 會在結腸形成孢子，

這些孢子對抗生素免疫， 且非常難摧毀。

and very difficult to destroy.

Patients dealing with this infection can experience months of intermittent fevers

遭受這種感染的病人

可能會有間歇性發燒，長達數個月，

alongside bouts of abdominal cramping and extreme diarrhea

還會反復出現腹絞痛和嚴重腹瀉。

despite antibiotic treatment.

儘管用抗生素治療仍然如此。

So when symptoms get this bad, it’s time for a fecal microbial transplant.

所以，當症狀這麼糟糕時，

就是做糞便微生物移植的時候了。

To start the process,

流程的一開始，消化科醫生

a gastroenterologist first retrieves some feces,

要先取得一些糞便， 通常來自糞便銀行。

typically from a stool bank.

These frozen samples are particularly impressive number twos—

這些冰凍的樣本是 特別厲害的「大號」——

the selected donors go through a strict process

被選中的捐贈者必須要 通過嚴格的流程，

to ensure their samples are infection-free.

確保他們的樣本沒有感染。

In fact, these protective protocols are so stringent,

事實上，這些保護性協議非常嚴格，

one prominent stool bank’s acceptance rate is less than 3%.

以致於一家知名糞便銀行的 接受率就不到 3%。

Next, the gastroenterologist gets that sample inside the patient via a pill,

接下來，消化科醫生

要讓糞便樣本進入病人體內， 可能會用一顆藥丸，

or, more commonly, a tube into the stomach or colon.

或，更常見的是用一根管子 送到胃部或結腸。

Finally, the transplanted microbes migrate through the tract

最後，被移植的微生物會穿越腸道，

until they find the colon,

直到找到結腸，

where they quickly multiply and displace the infectious invader.

它們的數量在那裡快速倍增， 逼走感染性的入侵者。

This process is so effective that it cures over 80% of patients

這個流程非常有效，

一次治療就能治癒 超過 80% 的病人。

in just one treatment.

Because each stool sample is unique,

因為每個糞便樣本都獨一無二，

the FDA still classifies fecal transplants as an experimental treatment

食品及藥物管理局 仍然將糞便移植歸類為

實驗性治療，

rather than a formal medication.

而非正式的藥物治療。

But promising research in rodents suggests new ways

但很有前景的齧齒目動物研究

意味著未來可能可以運用 糞菌治療的新方法。

we might use fecal bacteriotherapy in the future.

For example, fecal transplants from non-diabetic mice

舉例來說，

從沒有糖尿病的老鼠移植來的糞便

improved insulin resistance in mice with type 2 diabetes.

能在患有第二型糖尿病的 老鼠身上改善胰島素阻抗，

Similarly, some studies have shown mice exhibiting anxiety and depression

還有類似的，

有些研究發現 出現焦慮和憂鬱的老鼠

become calmer after transplants from their less anxious peers.

得到從較不焦慮的老鼠 移植來的糞便後就變得較平靜。

Scientists studying humans have even started finding

研究人類的科學家甚至開始

different microbial patterns

發現不同的微生物模式，

associated with various intestinal, autoimmune, oncologic,

連結到各種腸道、 自我免疫、腫瘤，

and even psychiatric disorders.

甚至精神相關疾病。

So, it seems entirely possible that altering a patient’s microbiome

所以，似乎完全有可能

改變病人的微生物群系

could allow for multiple new modes of treatment.

有機會能開啟數種新的治療模式。

We still have a lot to learn about what makes the “best” gut microbiome,

我們還有很多需要學的，

要更了解「最佳」腸道 微生物群系的條件，

or the most beneficial fecal transplants.

或者什麼樣的糞便移植 才算是最有益的。

But for now, at least we can say that our feces have a bright future.

但，目前，

至少我們可以說，我們的 糞便有個光明的未來。