James Burgess and Mark Smith were equal parts disturbed and inspired when a friend gave himself a DIY fecal transplant (yup, just what it sounds like) in a desperate attempt to cure his serious intestinal infection. The pair channeled their MIT educations into OpenBiome, the nation’s first stool bank for meticulously screened stool samples. When transplanted into the large intestine via colonoscopy or taken in a frozen-pooppill, healthy fecal matter, which is laden with beneficial bacteria, has a 90% success rate in eliminating Clostridium difficile, a lethal antibiotic-resistant infection. The nonprofit also offers its, er, goods (considered experimental by the FDA aside from C. diff use) to those researching bacteria’s incredible inpact on digestive systems. We talked with these unorthodox entrepreneurs to discuss what it’s like to be in the business of, well, poop—and where this exciting research is headed. PREVENTION: What do you say when someone asks, “What do you do?“BURGESS & SMITH: It’s a tricky one to explain at a dinner party [laughs]. Sometimes we’ll just say banking. But more often we’ll say we run the nation’s first stool bank. There has been a fair amount of media in the last 6 months about fecal transplants; it’s common enough now that, when we explain it, usually someone says they’ve heard of it. What made you want to start the nation’s first stool bank? We’ve always talked about business ideas with each other, knowing it would be great working together. But we got into this because of our friend who had C. diff for a year and a half before he gave himself a fecal transplant because he couldn’t get it done in a hospital—he did it at home with the stool from his roommate. Before we came along, not many physicians were providing fecal transplant therapies, because of the long and expensive screening and testing process. C. diff hospitalizes 300,000 patients each year, doesn’t respond to antibiotics, and often results in colon surgery or death. Photo by Carolyn Edelstein/OpenBiome Okay, lay it on me. How do you get the samples, as you say, from butt to butt? We have a multiple stage screening program. The first stage is sitting down with a nurse to go through your medical history. Any conditions linked to the biome—gastrointestinal, neuropsychiatric, anyone who’s taken antibiotics recently, recent travel to any countries with high risk to waterborne infections—and you’re out. It’s a 107-point questionnaire. If you pass, the next step is a blood sample and stool sample. We run it through 27 tests, looking for pathogens like HIV, hepatitis, syphilis, white and red blood cell counts, E. coli, salmonella, and any parasites. Whoa. How many people pass? Less than 20% of people end up becoming donors. That’s why, once they make it through both of those, we encourage them to come in as much as possible. We’ve spent a lot of money and time getting them through, and they can actually make a big difference. We pay them $40 a specimen, and one sample can save anywhere from 3 to 10 people. That’s one of the biggest advantages of having a stool bank instead of doing it ad hoc; even though it costs many thousands to get someone screened, we can spread that cost out among many treatments. Photo by Carolyn Edelstein/OpenBiome How does it get to the patient who needs it? The doctor and the patient decide together. The patient has probably had C. diff reoccur between two and four times, even with antibiotics. After a few rounds of this, you get really sick, to the point it starts affecting your quality of life. At that point, the physician says lets do a fecal transplant—it has a 90% chance of success. If they’re working with us, it’s easy from that point. They order 250 ml of stool at about $250 a pop, and that’s if the insurance doesn’t cover it, and we send it to them on dry ice. It shows up at the hospital and the doc and the team will thaw it out and they’ll deliver it through a colonoscopy—all the way up to where the small and large intestines meet. Our samples are in over 150 hospitals in 36 states. That’s a pretty low cost to the patient. At the end of the day, this is poop. We didn’t invent this stuff! This is a medical commodity. Yes, it’s a lot of extra work to make it high quality, but we want it to be cheap. Photo by Carolyn Edelstein/OpenBiome Is the future of good health really in the form of poop pills? When it comes to personalized medicine, this is about as personal as it gets, right? It’s definitely the beginning of engineering the microbiome; a lot of the excitement is there are so many conditions—from gastrointestinal issues to obesity to depression—that are associated with the microbiome. It’s a crude way of doing it, taking everything you’ve got and putting it in someone else. We’re just really scratching the surface on how to do this type of engineering and ultimately this will have broad reaching effects on how we improve everyday health, treat infectious diseases, or more complex conditions. In the long term we imagine a future where everyone will go to get a checkup and give a blood sample, a stool sample, and a urine sample and get them sequenced and figure out what metabolites and bacteria they have, and from there, be able to deduce what’s going on in your immune system. MORE: 5 Incredible Advances In Animal Stem-Cell Medicine
