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Faecal transplants involve stool and the microbes it contains being taken from one individual and introduced into the gut of another person.

The approach has become a promising treatment for recurring clostridium difficile infections, and is also being explored for a host of other conditions including inflammatory bowel disease.

Now researchers say it may also help patients with melanoma – a potentially deadly form of skin cancer that can be treated with immunotherapy.

“[Immunotherapy] works by essentially unleashing the body’s own immune cells against the cancer,” said Dr Diwakar Davar, a co-author of the new study from the University of Pittsburgh. “The problem is that these drugs don’t work perfectly, in that they don’t work all the time.”

According to Davar, only 30-50% of melanoma patients given immunotherapy respond to it, and even among that group, the response can change over time.

But a growing body of research suggests that such figures could be boosted by turning to the gut.

“What other people have shown [is that] it appears that the microbes that inhabit our gut mediate some measure of response,” said Devar.

Writing in the journal Science, Davar and colleagues report how they took stool from seven individuals who had previously shown either a full or partial response to immunotherapy, called pembrolizumab, for melanoma. 

They then screened the stool for potentially harmful viruses, bacteria or fungi before transferring it to patients with melanoma who had previously not responded to the immunotherapy. After receiving the transplant these patients were given pembrolizumab, which was repeated every three weeks, and the patients’ progress was followed for an average period of 12 months.

The results from 15 patients, enrolled between June 2018 and January 2020, who received a faecal transplant reveal that six appeared to show benefits, with three showing a large reduction or complete eradication of the cancer.

“The other three had cancers that stopped growing,” said Davar.

The team found that when the 15 patients were taken together, the median overall survival time after the faecal transplant was seven months. But for the six patients who responded to immunotherapy after receiving a faecal transplant, it was 14 months. Benefits were also seen when the team looked at how long patients lived with the cancer without it getting worse.

Further work showed that the six transplant recipients that went on to respond to pembrolizumab developed a community of gut microbes similar to those of the donor stool, in particular becoming richer in two broad types of bacteria, firmicutes and actinobacteria, that have previously been linked to a good response to immunotherapy. They also showed a drop in particular cells and proteins that suppress the body’s immune response to the cancer, and signs of a boosted immune response.

“The bacteria work by reducing the amount of adverse immune cells,” said Devar.

The study has limitations, including that it is based on only a small group of patients.

It is also unclear why the faecal transplant only led to benefits in six of the transplant recipients although the team offer a number of possibilities, including that some patients might not have had a big enough shift in their gut microbe to change their response to the immunotherapy, or that the patients’ immune system was unable to tackle the cancer regardless of the microbes present.

Davar said the next step is to carry out trials with larger groups of patients, and for other cancers that are treated with immunotherapy. And there’s another goal: replacing faecal transplants with a pill containing the necessary collection of microbes.

Prof Jennifer Wargo of the University of Texas MD Anderson Cancer Center, who was not involved in the study, said the work was exciting, but there is a long way to go, with research needed on ways to determine the best stool donors and key components of the stool.

“This really does paint a bright future for being able to modulate gut microbes to improve responses to cancer treatment and maybe even improve overall immune health,” she said 

What’s the story?

It was the race the Kremlin was desperate to win.

The global effort to find and develop an effective vaccine for the coronavirus was not just a matter of life and death for the countries that took part: it was a matter of national pride.

Yesterday interim trial data showed that the Russian vaccine, known as Sputnik V, is almost 92 per cent effective against symptomatic Covid after two doses, bringing it in line with many of the jabs that have been developed in the West.

Phase three trials reported by the Gamaleya National Research Centre, which developed the vaccine in Moscow, show little or no side effects in 20,000 participants.

The Russian vaccine works in a similar way to the Oxford/AstraZeneca jab: by placing the genetic material of Covid-19 into a harmless adenovirus, then injecting it into the patient.

So-called “viral vector” vaccines are easier to store and cheaper to produce – making them more convenient than “spike protein” jabs, like the Pfizer and Moderna offerings.

For the Russian government, the apparent safety of the Sputnik vaccine represents not just a national and public health victory but a relief, since authorities began distributing the vaccine before the results of the trials.

More than 1.5 million people, including the Telegraph’s Moscow Correspondent Nataliya Vasilyeva, have already received it. That gamble appears to have paid off.

Ian Jones, professor at the University of Reading, and Polly Roy, professor at the London School of Hygiene & Tropical Medicine, yesterday pointed out that the jab’s development “has been criticised for unseemly haste, corner cutting, and an absence of transparency”.

“But the outcome reported here is clear and the scientific principle of vaccination is demonstrated,” they said.

“Another vaccine can now join the fight to reduce the incidence of Covid-19.”

Others are more circumspect. Boris Johnson, the Prime Minister, has been reluctant to address the news about Sputnik V, despite his enthusiastic support for Pfizer/BioNTech, Moderna and Oxford/AstraZeneca.

In a briefing with reporters yesterday, the Prime Minister’s spokesman insisted any comment on vaccines was a matter for scientists, not Downing Street. Asked why Mr Johnson had not yet welcomed the news, the spokesman would not comment further.

Mr Johnson’s reluctance to welcome the news was shared by his Cabinet, who made no mention of the vaccine all day.

Looking back

That could be explained by the fact that the news follows months of anxiety about the UK’s own vaccine rollout, which began with the first NHS jab in December.

Russia’s first dose, meanwhile, was injected in August. Vladimir Putin, the President, announced on television that his daughter was one of the first to receive it.

The Russians have not been shy about treating the development of the jab as a competition, either. The product’s name is a reference to Sputnik 1, the first artificial satellite to be launched from Earth.

That satellite was launched by the Soviet Union in 1957, and marked both a major turning point in the space race and bitter defeat for the United States.

For UK politicians, who pride themselves on their “world-beating” international comparisons, Russia’s vaccine success is problematic, while the timing of the announcement could not have been worse.

Hours later, Dominic Raab, the Foreign Secretary, issued a statement condemning the Russian courts for their imprisonment of Alexei Navalny, an opposition politician who returned to the country following a near-miss poisoning with a

toxic nerve agent, thought to have been carried out by Russian intelligence services.

Anything else?

All that could mean the UK is unlikely to want to cooperate with Russia on the rollout of its jab – but Russian scientists have already suggested a partnership with Britain.

Kirill Dmitriev, chief executive of the group that funded Sputnik V and a close ally of Mr Putin, said combining a shot of his vaccine with one of the AstraZeneca jab could “actually work better because immunity gets stronger”.

“This idea, called heterogeneous boosting, is at the core of the Sputnik vaccine because we use two different shots and we believe this is the best way to fight with mutations and this also fosters a partnership between different vaccine manufacturers,” he told the BBC.

The proposal presents ministers with an interesting diplomatic question, as well as potential concerns about vaccine efficacy and logistics.

Mixing supplies of Sputnik and AstraZeneca would mean unprecedented co-operation between public health bodies between the two countries. Before coronavirus, the last major incident Public Health England dealt with was the poisoning of Sergei Skripal in Salisbury by Russian GRU agents, which marked a significant cooling of relations.

Elsewhere, both countries also want to use vaccines as a diplomatic tool overseas. With supplies running short and almost all manufacturers based in richer countries, inoculations could become a major source of soft power for the states that have funded their development – including both the UK and Russia.

Matt Hancock, the Health Secretary, has already announced the UK will use its war chest of more than 400 million vaccines to help poorer countries around the world once Britons have been protected. Russia, meanwhile, has taken tens of millions of orders from Egypt, Nepal, Brazil, Mexico and Argentina for Sputnik.

Both will likely use vaccines to strengthen their influence in regions of diplomatic interest, as well as through politically neutral schemes like the WHO’s Covax.

The Refresher take

The development of any new vaccine is a boon for the global fight against coronavirus because the disease will not be brought under control until it has been tackled everywhere.

But the apparent success of the Sputnik V jab presents Russia’s Western rivals with an interesting dilemma: to embrace and support Mr Putin’s vaccine and consider combining it with their own, or to continue to ignore it.

Mr Johnson’s current strategy, to continue to talk up Britain’s successes while jealously guarding its supplies for the first-phase rollout, will come to an end when all UK adults have received their doses.

What he and others do next about Sputnik V could mark a major shift in Russia’s relationship with the West and in the course of the pandemic.