When the going gets tough... - Wageningen UR

scienceWageningen microbiologists getinto top journals quite often. But apublication in a top medicaljournal is more unusual. Thisweek, they and their Amsterdammedical colleagues explain in TheNew England Journal of Medicinehow you can cure the moststubborn bowel infections. Thesecret? Faecal transplants.The experiment revolvedaround a group of diarrhoeapatients suffering from persistentbowel infections with theClostridium difficile bacterium.Doctors usually treat this ailmentby blitzing it – repeatedly – withantibiotics. But about 20 percentof the patients do not respond andevery time the infection comesback, their chances of recoverydiminish.An alternative to antibiotics isthe faecal transplant, anintervention in which patients aregiven new gut flora from a healthydonor. In more graphic terms:diluted faeces are pumped intotheir intestines (after colonicirrigation) via a nasal tube. Thistreatment has been in sporadicuse for decades but has neverreally caught on – possibly becauseof the ‘yuck factor’. By 2011 therewas still no verdict on it from theCochrane collaboration, whichassesses the evidence for the valueof medical treatments.However unappetizing the faecaltransplant might sound, the testwas a resounding success. Researcherscompared three groups ofpatients who were healthy, apartfrom their diarrhoea. The firstgroup took the usual antibiotics,the second was also put throughcolonic irrigation, and the lastgroup received new gut flora afterthe antibiotics and the colonic irrigation.MASSIVEIn the two control groups, between23 and 31 percent of the patientsgot better. But in the group that gotthe transplant, the diarrhoea disappearedin a massive 81 percentof cases. In the second round, thisfigure went up to 92 percent.The differences were so big thatthe experiment was stoppedhalfway. With such big differences,it would be unethical to withholdthe best treatment from two thirdsof the patients. These patientswere allowed the transplants aswell.In the microbiology departmentthey were ‘very pleased’ with thepublication and a bottle ofchampagne had already beenuncorked in its honour, says ErwinZoetendal, assistant professor ofMicrobiology. Their task was toidentify the gut flora of patientsand donors. ‘In the patients youcan see that their intestinal floraare totally disturbed,’ explainsZoetendal. ‘The composition isdifferent and the diversity ofbacteria is much lower. In thesecond round, after the transplant,they look much more like normalgut flora.’ RRFires are frequently started in theforests of the Pakistan province ofHaripur. The government forestservice blames the arson onlivestock holders who are thoughtto start the fires in order to obtaingrass for their stock. Butsociologist Arjumand Nizamithinks otherwise. Nizami workedfor years for NGOs in the field offorest management and got hisPhD last week in the RuralDevelopment Sociology chairgroup at Wageningen University.Trying to get to the bottom ofthe fires is a complicated business,says Nizami. ‘Everyone points tosomeone else as the culprit.’Livestock holders deny allinvolvement and say they only startfires on open ground. The landlesspoor point the finger at forestowners, who are forbidden byPakistani law to fell young trees ontheir land. After a forest fire,however, the owner is allowed tosell the wood from the now deadtrees. So fire can be lucrative forhim. Corrupt government foresterscould be implicated in the firestoo.According to Nizami, there is onlyone group that is above suspicion:women. Women also stand tobenefit the most from the forests,the sociologist explains. All thefirewood needed for cooking iscollected by women. The forestalso provides food in times ofscarcity, when the women pickwild vegetables and herbs there.The forest also produces wildpomegranates, the seeds of whichbring in an income as aningredient in Asian spices.So women are really the mostimportant forest managers,concludes Nizami. ‘I have seenthem with my own eyes, puttingout forest fires by hitting themwith branches.’ He thereforeadvises Pakistani foresters toimprove their collaboration withwomen. But there is a very longway to go, he admits. ‘In ruralPakistan, women hardly have a sayin anything.’ RESOURCE — 31 January 2013