This case report illustrates how the benefits of FMT may apply to AD in a very meaningful way and quickly. The 82 year old patient had C. diff, which made them eligible for FMT and they also had AD which was greatly improved after the FMT was administered. Considering the established safety profile of FMT and the fact that if the FDA would approve it for AD, it could be available in as little as two or three years to the masses of AD patients who desperately need a working remedy that can potentially improve their condition as discussed in this link to a case report :
Here is a very relevant quote from the case report :
' An 82-year-old man presented for opinion and management of recurrent CDI following hospitalization for methicillin-resistant Staphylococcus aureus pneumonia. The patient had previously failed several courses of antibiotics for CDI, including vancomycin, vancomycin with metronidazole, fidaxomicin, and bezlotoxumab, with relapse confirmed via symptom recurrence and positive stool test.
At the time of presentation, the patient was under the care of his primary care physician and his neurologist for the treatment of AD, following a gradual 5-year decline in memory and cognition. The patient was taking memantine (28 mg once daily) and donepezil (23 mg once daily). The patient’s dementia symptoms included confusion, memory loss, depression, and flattened affect. On his most recent Mini-Mental State Examination (MMSE) administered by the neurologist, the patient scored 20, indicating mild cognitive impairment. This result reflected the gastroenterologist’s findings and was within the expected range for patients with AD. The patient’s wife reported that he no longer appeared to enjoy socializing, and required considerable assistance with basic tasks such as food preparation, bathing, and taking his medication. Neuropsychiatric testing revealed significant impairments in the areas of memory and semantic language abilities, nonverbal learning, and divided attention and response inhibition. His scores in these areas were within the first through fifth percentiles for function.
Following a detailed discussion regarding the potential risks and benefits associated with the procedure, the patient underwent a single 300 mL FMT infusion (per the Borody method)15 using stool from the patient’s 85-year-old wife as a donor. The patient’s wife was intellectually acute, with normal affect and stable mood. Following the procedure, the patient’s CDI symptoms resolved, and repeat stool testing 2 months later was negative.
At the follow-up visit 2 months post-FMT, the patient’s wife reported improvements in the patient’s mental acuity and affect. The MMSE was re-administered by the gastroenterologist (and subsequently by the neurologist) and the patient scored 26, indicating normal cognition. Four months post-FMT, the patient reported continued improvement in memory, with no progression in symptoms. The patient now remembered his daughter’s birthday, which he had not been able to recall previously, and was able to correct the physician’s recollections of his symptoms. Six months post-FMT, the patient reported a marked improvement in mood, was more interactive, and showed more expressive affect. Readministration of the MMSE revealed that the patient’s score had further increased to 29.
Because no study was conducted, no ethics approval or consent was required. Verbal consent was obtained from the patient for the publication of the report; however, this was merely a courtesy because all data have been de-identified.
Will the government allow such alternative uses of FMT for people with dementia or continue to let them waste away in front of their families, friends and caregivers using the currently ineffective drug options that the government has approved for AD or dementia? What patient with dementia, who is still cognizant enough to understand the potential of FMT for AD, would not want to try FMT?
Art
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Without a study conducted, not only for the screening value of an ethics study, and consent, then whoever authorizes and administers the implantation is legally and financially covered, it would be up to any practitioner you could get to do the procedure. But without all that, with no study there's also an absolute lack of value about all the myriad assumptions and conclusions one must make about AD, so just about everything one could say or conclude, or divine (same thing at the stage) is pure "single case out of millions" speculation. Obviously. Far better to do as an actual study.
But nothing inherently wrong with people doing it as an individual matter of personal exploration of course. Very interesting case and definitely worth looking into and noticing for sure, because of the horrible symptoms involved, such things are their own justification. Expectations, on the other hand, well, should be zero. Welcome surprises are always really wonderful to encounter. If I had all those symptoms and a major demonstrated infection like c difficile, which is a real horrible infection disease, I would do it too, in a heartbeat.
I wouldn't think to expect any help from the big drug and treatment industries with research proposals or support of course. In fact maybe the opposite with respect to lobbying various authorities in the other direction.
There is no point for the pharmaceutical industry to fund a study for which they could make no money, because they are strictly in the business of making money. Nothing wrong with that, but this case study seemed to reverse the patients AD and that is very desirable for anyone with AD! Here is an important quote from that case :
' Six months post-FMT, the patient reported a marked improvement in mood, was more interactive, and showed more expressive affect. Readministration of the MMSE revealed that the patient’s score had further increased to 29. '
A score of 25 or higher on the MMSE is considered "normal".
Given that AD is the number one neurodegenerative disorder and a nasty one at that, with only ineffective treatments currently approved by the FDA, it would seem that the NIH would want to fund such a study if they are there to actually help protect are health???
The following multi study review of FMT and AD seems very telling :
Here is a relevant quote from the multi study review :
' Numerous studies have shown that FMT can improve AD, which may be related to reducing the abundance of pathogenic bacteria, exerting the anti-inflammatory effects, decreasing the deposition of Aβ, regulating synaptic plasticity, increasing short chain fatty acids, and curbing histone acetylation. '
From my point of view and seeing what AD does to people, family and friends and including the very good safety profile of FMT, it is hard to believe that anyone with AD would not want to test FMT, but it will take the FDA getting on board to make it a reality and I don't know that the FDA would ever do that or even consider it?
Agree 100% but can't docs & other prescribers already do off label or for their own justification? Not familiar at all with how you go about getting FMT. How does one go about it?
FMT is only approved for C diff and in severe IBS it has also been used. These two uses are usually only done when standard therapy has failed or if the C diff keeps coming back. A doctor in the US using FMT for an off label use is mostly unheard of. I think most doctors won't take the risk because if a problem developed, related to the FMT or possibly related to the FMT, that doctor would have to explain the reason they used FMT for an off label and non FDA approved medical use. That could put their medical license at risk.
When FMT is used in c-diff there is significant screening for pathogens and other health issues and then I wonder what are the specifics of what they want in terms of positive aspects in the sample. In this research there is a table showing the lab tests that are used to ensure the sample is safe.
They now have "washed microbiota transplantation (WMT) which might be considered the next generation of FMT and is currently used in some newer studies. Here is a link to info on WMT :
interesting and they have the system to evalute so I guess what I was wondering about is the "estimate of the taxonomic composition of the microbiome population" in the samples that brought improvements -
"Metatranscriptomics analysis enables understanding of how the microbiome responds to the environment by studying the functional analysis of genes expressed by the microbiome. It can also estimate the taxonomic composition of the microbial population"
It sounds like to have success with FMT the taxonomic composition needs to be appropriate to the condition and this research was on using FMT to help with ulcerative colitis so likely other health issues would require specific taxonomic composition.
"Response to faecal microbiota transplantation was mainly influenced by the taxonomic composition of the donor's microbiota. Stool of donors with a high bacterial richness (observed species remission 946 ± 93 vs no response 797 ± 181 at 15367 rps) and a high relative abundance of Akkermansia muciniphila (3.3 ± 3.1% vs 0.1 ± 0.2%), unclassified Ruminococcaceae (13.8 ± 5.0% vs 7.5 ± 3.7%), and Ruminococcus spp. (4.9 ± 3.5% vs 1.0 ± 0.7%) were more likely to induce remission. In contrast antibiotic treatment alone (AB-group) was poorly tolerated, probably because of a sustained decrease of intestinal microbial richness.
After treatment with FMT, proportions of selective families within the phylum Firmicutes increased significantly, while proportion of microbiota belonging to Proteobacteria were significantly reduced. Objective motor findings showed only temporary improvement while subjective symptom improvements were reported compared to baseline in the group receiving FMT. Constipation, gut transient times (NS), and gut motility index (p = 0.0374) were improved in the FMT group.
I hope this has not already been covered. I am starting to think that I need to write everything of importance in a notebook
Cognitive function improvement after fecal microbiota transplantation in Alzheimer’s dementia patient: a case report tandfonline.com/doi/full/10...
After fecal microbiota transplantation (FMT) to treat Clostridioides difficile infection (CDI), cognitive improvement is noticeable, suggesting an essential association between the gut microbiome and neural function. Although it is known that the gut microbiome is linked with cognitive function, whether FMT may lead to cognitive improvement in patients with neurodegenerative disorders remains to be elucidated. We present the case of a 90-year-old woman with Alzheimer's dementia and severe CDI who underwent FMT. Cognitive function testing (Mini-Mental State Examination, Montreal Cognitive Assessment, and Clinical Dementia Rating assessment) was performed one month before FMT and one week and one month after FMT. We collected the patients’ fecal samples before FMT and 3 weeks after FMT to compare the microbiota composition. The 16S rRNA gene amplicons were analyzed using the QIIME2 platform (version 2020.2) and the Phyloseq R package. The linear discriminant analysis effect size was performed to determine the taxonomic difference between pre- and post-FMT. Functional biomarker analysis using the Kruskal–Wallis H test was performed between the pre- and post-FMT. The cognitive function tests after FMT showed an improvement compared to the tests before the procedure. FMT changed the microbiota composition in recipient feces. We found that the genera were reported to be associated with cognitive function. In addition, short-chain fatty acids were found to be significantly different between before and after FMT. This finding suggests the presence of an association between the gut microbiome and cognitive function. Further, it emphasizes the need for clinical awareness regarding the effect of FMT on the brain-gut-microbiome axis and its potential as a therapy for patients with dementia.
More reason to do the appropriate testing of FMT in people with AD. It is relatively inexpensive when compared with a lifetime of drugs as well as the cost of caregivers and care in AD facilities. Cost effective, relatively inexpensive, easily given via capsules and apparently more effective than the currently available drugs with a very good safety profile that is proven in humans.
I am having trouble finding this, but I am pretty sure that 82 year old man eventually reverted back to Alzheimer's. I'm still looking for where I found that. This does not in any way cast shade on this treatment idea.
I asked why it was necessary to keep taking probiotics and this is the information I was given
"You should continue to take probiotics long-term because they don't stay in your gut unless you take them. The duration of time you should take probiotics depends on the specific product and bacterial strains.
You might want to take probiotics daily if you're prone to gut health issues"
Maybe the benefits of the FMT are similar and need to be replenished? I don't know
Here is a 5 patient AD preliminary study also showing significant improvement in patient scoring after FMT. Currently available AD meds can't do this :
Here is a relevant quote from the preliminary study :
' Significant improvements in cognitive function, as measured by the MMSE (pre- and post-FMT was 13.00 and 18.00) and MoCA were seen. The MoCA scores at 3 months post-FMT (21.0) were the highest (12.0). The CDR-SOB scores at pre- and post-FMT were 10.00 and 5.50, respectively. Analysis of the gut microbiome composition revealed changes via 16S rRNA sequencing with an increase in Bacteroidaceae and a decrease in Enterococcaceae. Gene expression analysis identified alterations in lipid metabolism-related genes after FMT. '
' Lachnospiraceae and Streptococcaceae were dominant (25–30% and 17–45%, respectively) in the mice feces collected before fiber feeding and from the cellulose-fed mice, while in the feces from the inulin-fed mice, the abundance of Bacteroidaceae increased relative to other bacteria (17% in morning and 41% in evening), while that of Lachnospiraceae decreased (20% in morning and 12% in evening). These relative abundance profiles indicate a microbial composition increment of Bacteroidaceae in the feces of inulin-fed mice beyond typical diurnal oscillations in comparison to that in the cellulose-fed mice (p values < 0.005, Tukey’s HSD test). '
Probiotics have also shown the ability to improve the gut microbiome of people with advanced AD and improve their MMSE scoring as discussed here :
' Overall, the current study demonstrated that probiotic consumption for 12 weeks positively affects cognitive function and some metabolic statuses in the AD patients. '
Combine this with the inulin effects and perhaps higher dose inulin in addition to probiotics has value for AD as it has shown for PD as I discussed as a potential substitute for FMT here :
In the UK the most well known FMT clinic, Taymount, has operated for must be 20 odd years by now. Lots of success in various conditions from of course gut related, autism, ME etc. I haven’t looked at them for many years so not kept up to date.
I also follow a ME charity who managed to raise over £600.000 to instigate an official FMT trial, alas yet to happen as it concurred with the pandemic madness.
And as sadly has been said above no big interest for clinical trials as FMT can’t (yet?!) be patented aka no profits just cured patients…
Hi I’m sorry I am not sure, the lady I knew who had FMT there (about 15 years ago now) was from England. I would be surprised if they didn’t accept international patients though?!?
I found this on their website which might help as a guide. I assume this does not include accommodation…
”– Initial FMT consultation, including advice on FMT preparation
– 1:1 support from an experienced FMT Practitioner
– FMT implants from 10 different screened donations
– Complimentary follow-up consultations for one year
Ten Day FMT Programme Price £5175.00”
There is more information on their website - I’m not sure if I’m allowed to share links on here?
It was many years ago I looked into them I admit I am not sure what other clinics are operating in today’s market. Maybe worth asking in a new post if anyone has more recent experience.
While the studies I linked to showed that FMT could improve AD symptoms in humans, this March 2024 study goes a step further suggesting that probiotics can slow disease progression in animal models of AD.
' Our results suggest that probiotic supplementation could be effective in delaying or mitigating early stages of neurodegeneration in the 3xTg-AD animal model. It is vital to explore new possibilities for palliative care for neurodegeneration, and probiotic supplementation could provide an inexpensive and easily implemented adjuvant clinical treatment for AD. '
Studies in AD and PD seem to frequently point to gut dysbiosis in both disease states as a major disease driving factor and treatment of said gut dysbiosis through various means has shown the ability to reduce symptoms, disease test scoring and now, potentially slow disease progression.
C diff / CDI is Clostridioides difficile infection and is a very serious bacterial gut infection which can be life threatening and that FMT is approved for and an effective treatment often times when standard medical treatment has failed. FMT has the ability to help many health conditions including PD, AD and ALS as I discussed at length here :
Hello Art, you guys are having advanced discussions on your post, meanwhile I'm trying to get a basic understanding.... so please help out with acronyms to start with. Thanks
What's C.diff?
What is CDI? Google gives me
Clinical Documentation Improvemen
Clostridioides difficile infection
I'm guessing its the second, but what does it mean?
I have to apoligize about this question but . . . what is FMT exactly?. I suposse it should be a (new?) kind of drug . . . , so I would like to know more about it!
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