Doctors trial 'poop transplant' to help children with autism

Cai Wenjun
Shanghai Children's Hospital is testing whether fecal microbiota transplants can not only treat the intestinal ecosystem but also influence cognition.
Cai Wenjun
Shot by Jiang Xiaowei and Dong Jun. Edited by Sun Chao. Subtitles by Sun Chao and Cai Wenjun.

There is no cure for children with autism at present. But their behaviors could be improved with a "poop transplant."

The Shanghai Children's Hospital opened the city's first multidisciplinary outpatient clinic for children with autism last week. Different from normal approaches, doctors introduced a clinical trial using a donor's stool. The first batch of 60 autistic children are taking part in a clinical trial.

The treatment is called fecal microbiota transplant, in which fecal matter or a stool is collected from a tested donor, mixed with a saline or other solution, strained and infused into the colon by doing a colonoscopy or oral capsules.

Doctors trial 'poop transplant' to help children with autism
Dong Jun / SHINE

Dr Zhang Ting, director of digestive disease department of Shanghai Children's Hospital, explains fecal microbiota transplant to a father with his 5-year-old autistic son during a multidisciplinary outpatient on autism.

Doctors trial 'poop transplant' to help children with autism
Jiang Xiaowei / SHINE

Xu Qiao, a nurse in the Shanghai Children's Hospital's digestive department, makes oral capsule for fecal microbiota transplant treatment.

Doctors trial 'poop transplant' to help children with autism
Jiang Xiaowei / SHINE

The hand-made capsules for FMT.

According to experts, FMT is an effective treatment for patients with recurrent Clostridioides difficile colitis, a serious infection.

But now it is being trialled in many other fields thanks to a greater understanding of the brain-gut axis, which has found a connection between the central nervous and digestive systems.

"FMT has an evolving medical use," said Dr Zhang Ting, director of digestive disease department of Shanghai Children's Hospital and an expert at the autism multidisciplinary clinic. "It is a traditional treatment and mostly used on digestive problems."

After the world-leading medical journal New England Journal of Medicine published a positive reevaluation of the effects of FMT in 2013, medical industries home and abroad expressed strong interest in the therapy and started various trials.

Now it has been expanded to treat different diseases, as the intestinal ecosystem is believed to influence immunity, cognition, personality, mood, sleep and eating behavior and can contribute to a range of neuropsychiatric diseases like autism and schizophrenia.

"In medical practice, we found up to 50 percent of autistic children have digestive problems and their intestinal ecosystem is unbalanced," she said.

"Moreover, children with more serious intestinal problems also show more severe behavioral symptoms. Previous trials have found that while some children whose intestinal microbial environment improves after FMT, their autistic condition also gets better."

She said each autistic child will undergo strict evaluation before taking part in the clinical trial.

"FMT is not a cure for autism," Zhang said. "But it can fix certain digestive symptoms and may help some children improve their autistic problems.

"The multidisciplinary clinic is also a new trial to offer such children various treatment in line with their needs, as they needn't go between departments, because many autistic children have other symptoms such as skin and sleep in addition to mental symptoms."

Parents with autistic children are keen to attend the clinic.

"They take their kids to different hospitals, rehabilitation facilities and experts when they learn about any new information on autistic treatment and care," said a local father with an 8-year-old autistic boy.

"We contacted the clinic soon after learning about this information. We don't know whether it is useful to my child but we don't want to miss any chance.

"Even if there is a very small progress that my son can achieve through the therapy, we are happy and it deserve all the efforts," he said, calling for more social awareness and support.

"In addition to medical treatment, understanding and support from the society are important. A social connection is extremely important to autistic children. My son's teachers and classmates are very kind to him. Teachers share with us any improvement he has made and we will try our best to look for any useful treatment and rehabilitation for him."

"It is my child and we will never stop helping him," he said.

Doctors trial 'poop transplant' to help children with autism
Dong Jun / SHINE

Doctors from Shanghai Children's Hospital conduct checks on autistic children.

Donors are needed

Doctors from Shanghai Children's Hospital, which has adopted fecal microbiota transplant, are calling for more people to become fecal donors.

Healthy people who don't smoke or drink alcohol and have a healthy diet and regular stools can contact the hospital.

"After health checks and tests, qualified people can become stool donors," said Xu Qiao, a nurse at the hospital and a fecal donor herself. "It is very meaningful, as you can help children who need help. The age for donors is between 16 and 30 years old."

People who are likely to be donors can follow Dr Zhang Ting's official microblog to leave information, and medical staff will contact them.

Shot by Jiang Xiaowei. Edited by Sun Chao. Subtitles by Sun Chao.
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