A fluid transplant cures intractable vaginal infections

Antibiotics are one of the most useful health tools ever invented, but decades of use have given time for some of the bacteria that fight to generate resistance. To overcome this setback, a particular type of transplants have begun in recent years to cure stubborn infections. Scientists have long understood that some of these infections are caused by an imbalance in the ecosystem of microbes that inhabit a part of the body. When good bacteria weaken, most of those that live with humans on a daily basis, the harmful can take power and do harm. The transfer of a healthy person's ecosystem, through a stool transplant, for example, has shown its effectiveness in ending intestinal infections against which antibiotics did not serve

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This week, the journal Nature Medicine publishes the results of a new paper to treat antibiotic-resistant infections with a microbe transplant. The researchers, led by Eran Elinav, of the Weizmann Institute in Rejovot, Israel, aimed to treat five women with vaginal infections who did not respond to other treatments

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These types of treatments need to be monitored to prevent unwanted pregnancies

Vaginal bacteriosis is an alteration of the microbial communities of the vagina in which the species of Lactobacillus, the bacteria that normally dominate that part of the body, are overcome by other problems. Up to one in three women may have this imbalance, although in many cases they do not even have symptoms. In 16% of infected people can cause bad odors and increase the risk of problems during pregnancy or contracting sexually transmitted diseases.

When these versions of infections are treated with antibiotics, 30% fail within the first three months after initial treatment and up to 70% may return to symptoms one year after taking the antimicrobials. In some cases, the introduction of some types of Lactobacillus were used to restore balance, but as explained in the article Elinav and his colleagues, the results are not clear

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The alternative posed by the Israeli team was to transfer the microbiome of healthy women to five patients between the ages of 27 and 47 who had had four or more episodes of vaginosis during the previous year. All patients recognized that infections had caused "devastating consequences" for their relationships, sexual intimacy and self-esteem, and all needed to take a lot of different antibiotics on an ongoing basis so as not to suffer symptoms . After receiving vaginal fluid from donors, four of the five patients experienced a clear improvement that continued until 21 months after treatment. One fifth, he enjoyed a momentary improvement, but ended up falling,

Micron transplants through the stool may be helpful against cancer or depression

Elinav explains, his team wants to try this same technique in a large study developed in many medical centers and adding controls to see if treatment is safe and works better than placebo. In addition, they also want to try a "microbe cocktail" designed as an alternative to donor fluid transfer. Rafael Cantón, head of the microbiology service of the Hospital Universitario Ramón y Cajal de Madrid, who has not participated in the study, points out that to create such combinations, "the most problematic is to define what is the normal microbiota and which is the sick one". "These types of studies are going to be done more and more regularly. Fecal transfer began to treat resistant infections such as Clostridium difficile, and now arises for other diseases such as Crohn's, and the relevance of the fecal microbiota in diseases is beginning to be understood neurological and some kind of cancer," Guangzhou says. "This approach is also being explored for other ailments, such as chronic bronchial infection, to see if it could be treated by restoring the normal respiratory microbiota," he adds.

Researchers working with these types of treatments also want to make sure their safety. In June this year, in the U.S., it was learned that two people became seriously ill and another died after an experimental fecal transplant that transmitted a dangerous bacteria found in the donor's intestine. This caused the FDA, the agency that regulates the use of medicines in that country, to stop stool transfers while waiting for patient safety to be ensured. Elinav recalls that no adverse effects were observed in his work, but "the theoretical risk of transferring a pathogen that goes unnoticed is not disposable." In addition, it considers it necessary to prevent the risk of unwanted pregnancies that could occur through the vaginal fluid of donors. "Finally," he concludes, the long-term consequences of these microbiota transplants are unknown and require further studies.

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