URC-ACTSI Award Planned as First in Series for Virginia Shaffer

July 2016

After such procedures as total proctocolectomy, which involves surgical removal of the large intestine and rectum, a pouch is often created for storing and eliminating solid waste by connecting the ileum, or lowest part of the small intestine, to the anus. The method generally works well, but 40% of patients with pouches created after surgery for ulcerative colitis—an inflammatory bowel disease—experience pouchitis, or inflammation of the reservoir.

Having extensive experience treating colorectal cancer, anal cancer, and other gastrointestinal diseases, Emory GI and general surgeon Virginia Shaffer, MD, is well acquainted with the debilitating impact pouchitis can have on patients' quality of life.

"We don't know exactly what causes pouchitis, but it can create significant morbidity, with the most extreme repercussions being pouch failure requiring permanent ileostomy, pouch excision, or revision surgery," Shaffer says. "Certain drugs, combinations of antibiotics, anti-inflammatories, and steroids are used for treating chronic pouchitis, but none have proven completely effective."

One of Shaffer's primary research objectives is to develop better therapies for the condition, and a joint award she has received from the University Research Committee (URC) and the Atlanta Clinical and Translational Science Institute (ACTSI) will enable her to further investigate her hypothesis that fecal microbiota transplantation (FMT) could offer consistent relief from pouchitis.

FMT is the delivery of healthy bacteria via placement of donor stool. FMT replaces the good bacteria that has been killed or suppressed by a surfeit of bad bacteria, and restores balance to the trillions of microorganisms that live in the digestive tract (gut microbiota). Dysfunctional microbiota is also believed to be one of the factors that contributes to pouchitis.

Shaffer plans to use the grant to develop templates for evaluating, analyzing, and tracking FMT's ability to eradicate pouchitis that can be used in future studies. She and her team, which will include Dean Jones, PhD, professor of medicine and director of the Emory Clinical Biomarkers Laboratory; Yuan Liu, PhD, a biostatician of the Winship Cancer Institute; Tom Ziegler, MD, professor of medicine and director of the Emory Center for Clinical and Molecular Nutrition; and Tanvi Dhere, MD, assistant professor of the Emory Division of Digestive Diseases; will design and evaluate metabolic tests that can measure any improvements to intestinal microbiota following FMT as well as identify the molecular interactions in the gut microbiome that influence pouchitis. They will also establish protocols for recruiting patients, performing subsequent surgeries, and comparing microbiota before and after transplant, as well as define the assessment components for three-month follow-up that will gauge changes to quality of life before and after transplant.

Shaffer has already performed several FMTs in collaboration with Colleen Kraft, MD, medical director of Emory Microbiology, who has also led several promising studies involving the procedure. By combining her familiarity with FMT and her observance of its fairly uniform ability to improve patients' conditions with standardized parameters for determining whether FMT's positive effects have true longevity, Shaffer hopes to use the URC-ACTSI study to provide a blueprint for larger, more comprehensive studies.

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