An article was published Sept. 13, 2017 in a journal of the American College of Gastroenterology that featured case reports of the spectrum of digestive system diseases.
One described 38-year-old and 20-year-old males, who had recurrent infections with a nasty intestinal bacterium called Clostridium difficile, which is notoriously hard to treat, but who also had a hair loss disease called alopecia (AL-o-PEE-she-ah) areata (air-ee-AH-ta) (AA). After being treated unsuccessfully with antibiotics for the severe diarrhea in case 1 and severe Crohn’s disease, a form of inflammatory bowel disease, in case 2, they were treated with fecal microbiota transplants (FMT for short), and both experienced hair regrowth!
Case 1 had total body hair loss, called alopecia universalis, for 10 years. Case 2 also had alopecia universalis, but for two years. The first patient had patchy regrowth in all body areas, and the second had almost complete regrowth on scalp but some elsewhere as well. Each had had no response to the usual treatments for AA.
The idea that a stool sample transplanted from what is considered a “normal person” could help one with a diseased state seems far-fetched. An article from the magazine Science, Nov. 2, 2016, cites two other gastroenterologists 2008 who each reported a patient with AA, who had hair regrowth after FMT for C. difficile infections.
Fecal microbiota transplants go back 1958. The connections being made between gut microbes and so many unrelated illnesses has developed over the last 10 years or so. The direct relationships are mostly discovered by chance.
Both the bowel and hair follicle maladies here are considered “auto-immune,” or our own immune system attacking various tissues. AA is not ordinary hair loss. A biopsy of scalp with it shows white blood cells surrounding and destroying follicles. Likely the duration of AA in the first patient accounted for less regrowth.
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The mechanism(s) by which the fecal microbiota transplants can suppress AA is unknown. The hypothesis is too complicated to elaborate here, but it has to do with the “normal flora” maintaining the defenses of the gut lining cells and mucus they secrete. One paper from 2016 in the Journal of Investigative Dermatology did reeeally complicated experiments with mice and AA, fiddling with their bowel bugs, transplanting skin grafts and stool samples, etc. It seemed to confirm the gut-scalp direct connection in them.
All the organisms in an ecosystem are labeled its microbiome, gut being the system here. Our bowels contain in the trillions of bugs, between three and six pounds. A review of the human intestinal microbiome from the December 15, 2016, New England Journal of Medicine listed the potential disease indications for an fecal microbiota transplant. They include neurologic, psychiatric, especially depression, respiratory, cardiovascular, gastrointestinal, hepatic, autoimmune, metabolic, like diabetes, etc., and cancer (!). This is sounding a lot like the list of cures for any and everything that stem cell groups are making. And that’s a whole different frontier of medicine that is in its Wild West stage, as is fecal microbiota science.
The entire science of what bugs are “good” and what are “bad” is undetermined yet. The route of administration is equally uncertain to date. The obvious place to put the microbes is where we know they live. Could you ask if direct application of the microbiota to scalp might work better? I’m sure volunteers for that study would be hard to find. Nobody wants to be known as a poop head, even for science.
We’re not at a point where fecal microbiota transplants are recommended treatment for much but bowel diseases unresponsive to other approaches. However, one company that sells probiotics, the freeze-dried bowel bugs in pills so popular over the counter, has come out with a version called Cardio-Health for cardiovascular preventive use. Whatever sells, I guess.
It is fascinating how interconnected our body parts and the trillions of microscopic critters living in and on us are one big happy (not always) family. I would recommend a book, “I Contain Multitudes” by Ed Yong. It is very readable, and explores many of the world’s microbiomes, from corals to mosquitoes, to us. Up to now I have exercised incredible restraint from making SO many obvious poop puns, because they would be deleted immediately by my editor. I will close by saying that perhaps in the future we may actually reap marvelous therapeutic benefits “from being in deep doo-doo.”
Admirable effort, doctor; admirable effort. — The Editor