Tiny Pioneer

Have You Heard Of VMT?

Tiny

I had this blog post all planned out.  It was going to be a bit different, because it was going to be aimed at medical professionals rather than pelvic pain patients.  I’d had what I thought was a revolutionary idea for the treatment of cystitis and related genitourinary conditions.  It seemed ridiculously simple, but I hadn’t heard of it being done before, so I had planned to blog about it in the hope that one day a medical professional might read it and be able to turn it into a reality.    

To provide some context for this blog post, I’ve been doing quite a bit of research into faecal transplants recently.  Also known as stool transplants or faecal microbiota transplants (FMT), these are exactly what they sound like – a stool sample from a healthy donor (or usually a saline mixture of stools from a selection of donors) is put into the gastrointestinal tract of someone else.  This normally occurs via enema or colonoscopy, but can also occur via orogastric tube, or even via freeze-dried capsules. 

It is now widely accepted that the population of bacteria in our gastrointestinal tract, known as our gut microbiome, has a huge impact on not only our digestion, but also things like our mental and cardiovascular health.  Even conditions like Alzheimer’s, multiple sclerosis, autism and Parkinson’s have been linked to altered gut bacteria.  The idea behind FMT is that bacteria from healthy donors might take up residence in the digestive tracts of recipients, altering their gut microbiome in a more favourable direction and leading to improved health. 

Faecal transplantation has actually been performed for hundreds of years, with the first records of its usage dating back to 4th century China.  It is by no means a new phenomenon – it just historically was risky and not very pleasant, so did not remain popular in the face of more sterile, more palatable treatment options!  However, many animals practise ‘traditional’ FMT by ingesting the stools of other animals.  I can personally bear witness to this:  I once found my old horse eating a steaming pile of droppings first thing in a morning when I went to get her ready for the farrier.  I had neither been awake long, nor eaten any breakfast, and the sight caused me to retch so much that I abandoned both animal and dung to rush indoors and line my stomach with some breakfast!  The horse lived well into her thirties, so presumably knew the secrets to good equine health. 

Faecal transplantation in humans is enjoying something of a resurgence, as it is has been found to be very effective at treating recurrent C. difficile colitis.  Although C. difficile colitis is currently the only condition for which FMT may be prescribed, FMT is being studied as a treatment option for other conditions.  People may already choose to pay to attend private clinics in order to receive a course of FMT and it is estimated that 10,000 people each year in the United States attempt DIY stool transplants at home.  (The latter is extremely risky – please note that Tiny Pioneer is in no way recommending this.) 

While researching faecal transplants, it occurred to me that there is another part of roughly half of human bodies where a strong microbiome is crucial to good health:  the vagina.  A strong vaginal microbiome can help protect against vaginal yeast infections, urinary tract infections, bacterial vaginosis and sexually transmitted diseases.  A disrupted vaginal microbiome not only leaves a woman more susceptible to these, but can also increase the risk of her having a premature baby.  Indeed, babies born by Caesarian section are known to have different gut microbiomes to those born vaginally; however, whether or not this is because of the lack of direct contact with the mother’s vaginal microflora is not fully understood. 

And so to my grand idea, which I’m sure you’ve guessed by now:  what if vaginal microbiota transplants could be performed?  Surely samples of microflora could be taken from healthy women and transferred to the vaginas of women suffering from conditions like recurrent urinary tract infections, bacterial vaginosis, recurrent yeast infections and maybe even interstitial cystitis and lichens sclerosus?  The vaginal microbiome is known to be considerably simpler than the gut microbiome.  Whereas diversity is advantageous in the gut, the vagina prefers to house mainly Lactobacilli strains.  It should therefore be relatively simple to determine which women would be good donors and to monitor the success of transplants. 

Vaginal flora samples would seem more pleasant to acquire and prepare than stool samples.  They would also seem easier to transplant, since the vagina is more easily accessible than the intestines.  Obviously vaginal microflora transplants would have different applications to faecal transplants, but the former seemed far simpler and more palatable than the latter.  Why, I wondered, had nobody thought of this before? 

Before I started writing the post, I thought I’d better do some research.  If it were so simple to take vaginal secretions from healthy women and pop them into unhealthy women, surely someone would have thought of it by now?  There must be a reason why it hadn’t been done.  Maybe the bacteria involved were the wrong sort, or wouldn’t take root in someone else’s vagina or something.  I decided I’d better Google it a bit and check before asking idiotic questions on my own blog!  And so it was that I found this article on the website Medical Xpress detailing how researchers at John Hopkins have taken the first steps towards trials of what is to be known as ‘vaginal microbiota transplantation’ (VMT).  Unbelievably, the article was published only five days before I actually decided to Google ‘vaginal microbiome transplants’.  Five days!!!

The piece on the Medical Xpress website is referring to this original research article published on Frontiers in Cellular and Infection Microbiology at the end of August 2019.  It looks as if a conceptual analysis of VMT may first have been published at the beginning of 2019, though I’m not entirely sure about this.  There may be earlier written material on the subject that I have been too lazy to find! 

At the moment, it seems that VMT is being researched purely in relation to bacterial vaginosis.  However, it is predicted that in the near future it will be available as a therapeutic method in treating various vaginal disorders.  And so my whole planned blog post is redundant really, because it turns out it was a good idea that I had, but somebody else has already had it after all!  Realistically, even if I had been the first to have the idea, I’d have had no means to implement it and no contacts I could persuade to implement it for me, so it would have remained just a musing on an obscure corner of the internet.  I may not be in line for any Nobel prizes, but at least this way there might soon be a new treatment available for a range of genitourinary complaints! 

I should point out that for safety reasons the actual procedure involved in obtaining vaginal microbiota samples is nowhere near as straightforward as simply swabbing one woman and rubbing her sample onto another.  If you want to know more about it, the details are in the linked articles, but please don’t go trying any DIY versions at home.  I have no idea how bacterial vaginosis sufferers could put themselves forward as guinea pigs during this research phase of VMT, but if you’re under the care of an eminent specialist or have friends in high places at John Hopkins, it might be worth printing off these articles and asking them the question – you never know your luck!  Meanwhile, remember VMT – one day in the not too distant future it might be something your own doctor can refer you for! 

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