EJ Insight – Hong Kong
Asia’s first stool bank gets down to business
By Maren Tam – July 5, 2017
Earlier this year, people walking along the streets in Central were taken aback as they were offered some unusual handbills. In the leaflets, an organization was seeking stool donors, promising them cash reward of HK$200 per sample and suggesting that a person can earn up to HK$4,800 a month for regular contributions.
The “poop for money” offer instantly became the subject of much laughter and discussions among young executives and office ladies in the financial district.
As the topic became a rage, there were reports of people greeting each other with phrases such as “How’s your poop? Have you donated?”
Giggles apart, we are talking about a very serious business here, and all for a good cause.
The organization that issued the ad was Asia Microbiota Bank (AMB), a newly-launched entity that aims to promote health and wellness through Human Microbiota Transfer (HMT) therapy.
To facilitate such efforts, AMB was seeking contributions for a stool bank which can be used to provide samples to research organizations and medical institutions.
According to AMB, HMT therapy offers many possibilities for health improvement and overall immune and digestive wellness.
The understanding of the gastrointestinal (GI) microbiome marks one of the most important advances in medical science, AMB says on its website, pointing out that the GI microbiome modulates everything from the breakdown of dietary nutrients to protection against a host of human illnesses.
After distributing the flyers, the commercial stool bank claimed that it received almost 10,000 applications from potential donors and that it swiftly completed the first batch of recruitment quota.
But as AMB’s co-founder Jon Chang told the Hong Kong Economic Journal, donors won’t find it easy to make the grade. Making money from your own byproducts of digestion is not as easy as it seems. Out of the 10,000 applicants, only 15 have so far been shortlisted as the samples have to be “healthy” and of high quality.
No laughing matter
AMB, the first of its kind in Asia, will cultivate and extract probiotics and other fecal bacteria from healthy donors for HMT therapy and fecal microbiota transplantation (FMT), a frontier medical breakthrough proven to be effective in curing “clostridium difficile infection” that has symptoms such as watery diarrhea, fever, nausea, abdominal pain and other gastrointestinal disorders.
Refrigerators inside a 200-square-foot laboratory, which is housed in a sleek office tower along the bustling Des Voeux Road Central, will store superior samples from donors before the faecal matter is processed.
Foul odor is the last thing you should worry about when Jon shows us the final product packed in white, semi-transparent plastic bottles. Instead, the smell in the lab is just the scent of lavender sesame oil.
The lab has entered into deals with around 10 local doctors for HMT, on top of research collaboration with the University of Hong Kong Faculty of Medicine for a study of the gut microbiome of Hongkongers for a localized profile.
“FMT was first experimented by a team of surgeons in the United States in the mid-20th century when they treated four patients with clostridium difficile infection with fecal enemas… While antibiotics have not worked, stool transplants are effective in those with severe cases of clostridium difficile colonization,” said Jon.
Open Biome, the first stool bank in the US, has supplied probiotics to a total of 20,000 patients in five years since its founding in 2012.
Ancient Chinese medical treatises also recorded curing critically poisoned patients by orally consuming decoction containing fecal matters.
“Luckily we don’t have to drink that ‘poop soup’ nowadays. We have odorless pills for even better effect,” joked Jon.
Each dose of FMT is made from around 50 grams of stool and an adult normally defecates 100-150 grams each time.
But healthy stools are not easy to find, as donors have to be screened in a way similar to a comprehensive checkup.
Those interested and confident about their poo-quality will be vetted on four criteria: no intestinal abnormalities, age in the 18 to 50 group, a body mass index (BMI) of 30 or less, and no antibiotic intake within the past three months.
All other rules are understandable but why is a donor required to be between 18 and 50?
Well, as Jon explains: “Most of the clostridium difficile infection patients are adults and we want to find donors of the similar age. Besides, gut microbiome quality may drop with ageing.”
A questionnaire consisting of 46 queries will follow once candidates pass the first round of vetting. Questions include if the person has had any tattoo within the past six months and whether he or she had more than one sexual partner within the past three months.
“Don’t get us wrong, we are not that conservative. We just have to make sure stool donated are virus-free,” says Jon.
Other questions concern the shape and appearance of the stools.
Type three (stools like a sausage but with cracks on its surface), type four (like a sausage or snake, smooth and soft), or type five (soft blobs with clear cut edges) of the Bristol Stool Form Scale are most ideal and most sought after by Jon and his colleagues.
Only 20 percent of the 10,000 eager applicants can enter the next stage of follow-up checks and 400 of them will be invited for interviews. That number finally comes down to an elite club of just 15 that are qualified as proud donors and perhaps having the best bowel motion in the city.
So what do these finalists of the stool contest have in common?
“They are Chinese and Caucasians of 20 to 40,” revealed Jon. They will donate at least three times per week for three months, either using the toilets at the lab or collecting their precious metabolic waste at home and storing it in a take-out box-like container and returning it to the lab within an hour.
“Some of them come to our lab during lunch break and others bring theirs each morning.”
Is there anything special about Hongkongers’ stools?
“We have found common traces of antibiotic-resistant bacteria in Hongkongers’ faeces, likely a result of excessive use of antibiotics,” says the AMB co-founder.
Asked why the lab was housed in an expensive area like Central, given that the stool bank will take a long time to breaking even, Jon says it’s all about convenience and “locational superiority”
“The cluster of clinics in Central means we can get all the products and testing services we need, and the location helps us build our presence.
“Those working in Central generally have deeper pockets and can afford organic food… We will never set up a lab near a university because college students usually guzzle too much junk food and we can’t expect any good stuff coming out of them.”
This article appeared in the Hong Kong Economic Journal on June 16
Translation by Frank Chen with additional reporting
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