Page 96 - Forbes - USA (March 2020)

→ Sharp pains shot through the

patient’s stomach, and he had

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constant diarrhea. Seven rounds

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N
E
R
T
of antibiotics over 18 months had
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H
T
only made him feel worse.

A previously healthy man in his 20s who wishes to remain anonymous, he had contracted a recur-
ring case of Clostridium difficile, or C. diff, after having his gallbladder removed in 2012. Hospital
patients are prone to C. diff since antibiotic treatment for other maladies decimates the infection-
fighting capacity of what scientists call the gut microbiome, the trillions of cells that move through
the human digestive system. “It didn’t just affect my gut,” he says. “I was exhausted all the time.
I had really bad brain fog. I couldn’t concentrate.”

Desperate, he researched possible therapies and discov- longer distances. A new drug for obesity alone could be
ered articles about fecal transplants wiping out the infec- worth more than $20 billion.
tion. But his gastroenterologist refused to perform the pro- So far, the most compelling microbiome-derived therapy is
cedure. So he took matters into his own hands. He asked a live fecal transplant for C. diff, which strikes half a million
his roommate to supply a stool sample, bought an enema Americans annually, killing 15,000. In 2013, the New England
kit from CVS, pulsed the mixture in a blender, strained Journal of Medicine published a paper that caught the scien-
it through a coffee filter and pumped it into his gut. As tific community by surprise and jump-started investment in
though a wizard had cast a spell, he made a full recovery microbiome drug development. In a randomized trial, 94%
within days. of recurrent C. diff patients recovered after receiving fecal
Welcome to the most promising new frontier in medicine: transplants. To put that in context, cancer drugs with efficacy
poop. By focusing on what’s coming out of patients’ rear rates as low as 10% have been approved by the FDA.
ends, a growing body of scientific research over the last 15 Billions of dollars are pouring into microbiome medicine.
years has highlighted the crucial role the microbiome plays Gbola Amusa, a medical doctor and partner at Chardan, a
in human health. That new understanding could lead to health care–focused investment bank in New York, pegs the
breakthrough treatments for a huge range of illnesses, from total amount invested since 2014 at more than $5 billion.
obvious ones like digestive ailments and food allergies to sur- Techie billionaires including Bill Gates, Salesforce founder
prising ones like cancer and autism. A microbiome-derived Marc Benioff and Silicon Valley venture capitalist Vinod
drug is already in the works to prevent childhood asthma. Khosla are funding microbiome startups, and Gates, Be-
Put crudely, the idea is to use gut bugs as drugs. More nioff and Mark Zuckerberg have all made donations to sup-
than 50,000 scientific papers in the last five years have ex- port microbiome research at institutions including Stan-
plored the microbiome’s effects. Various kinds of gut bac- ford, Washington University in St. Louis and the University
teria appear to stimulate or suppress immune responses of California, San Francisco.
in the body, while others seem to fight off disease-causing The race is on for FDA approval of the first drug made
microbes. A groundswell of cutting-edge research has the from gut bacteria. But the science is young and unproven.
potential to deliver a burst of new therapies that will vastly At Oppenheimer in New York, Mark Breidenbach says
reduce human suffering—and generate huge paydays for investor enthusiasm in microbiome companies is on a
the field’s pioneers. downswing because “there is no consensus about what the
When scientists transferred gut microbiome cells from microbiome can do.”
obese mice into lean ones, the recipients gained weight. In Amusa is more bullish. “The science is turning,” he says.
one study, melanoma patients with the most diverse mi- “When it comes through with proof, these biotech compa-
crobiomes had the best response to immunotherapy. And nies will be worth not hundreds of millions of dollars, but
mice injected with gut bacteria from marathon runners ran billions.”

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