- [futuristic narrator] in the future, many people perform health checks by profiling their microbiomes at home. in real time, toothbrushes sequence the dna of billions of microbes in the digestive tract. the data is networked with appliances, allowing individuals to receive automatic daily food deliveries that are personalized for optimal health. this data also syncs with medication dispensers, which fine tune prescriptions to diversity the microbiome and boost the immune system. - since studies have shown that microbiome transplants can be used to transfer diseas from one animal to another, i wonder if this same technique could be used to cure disease as well. i'm outside boston to meet carolyn edelstein. her openbiome organization is combating a notorious bacteria, c. difcile or c. diff. openbiome is helping fight this life threatening gut infection with a radical treatment, human fecal transplants. - c. diff or c. difficile is the most comm hospital incurred infection in the u.s., actually. - who is at risk of contracting it? - oftentimes what happens is someone will go into a hospital or a long term care facility, they'll go on antibiotics and they'll acquire a c. diff infection. what happens when you go on antibiotics is a lot of the microbes that are normally present in your gut get wiped out. and without that competition c. diff is able to spread and to start producing the toxin that makes you sick. c. diff is really difficult to kill and to get rid of, because it makes little spores. - [julia] these toxic spores are c. diff's most ruthless weapon against the body. - because of this, it's pretty easy for patients to be colonized by c. diff. - [julia] c. diff infects a half a million americans every ar, with a staggering mortality rate as high as 30%. but a novel solution has been developed to change the gut's ecosystem and restore and rebalance the gut microbiome of those infected. - most of the time c. diff can be treated with a fecal transplant. so you take a sample of stool fr a healthy person. and in that stool is trillions of bacteria that live inside our guts, and what we're doing is transferring that community of bacteria to the colon of the patient to out compete the pathogen. - [julia] similar approaches were pioneered by the chinese inhe fourtcentury when they preribed yeow soup made with fecal matter to treat colon diseases. by rebalancing and re-diversifying the gut microbiome, the return of beneficial bteria shou keep thc. diff inction inheck. associate director of bio-manufacturing, delasie dela-seshie, is going to show me how they make this cutting edge science a reality. - [delasie] hair net first, face mask, a couple pairs of gloves, lab, coat, and shoe covers. - [julia] and why do we have to wear all of this here? - [delasie] it's purely to make sure that as humans, we're not contaminating the product that's going into an already compromised patient. - [julia] i mean, i'm looking fantastic, so. - [delasie] great. - [julia] feeling great, looking great. i'm ready to go. - [delasie] perfect, awesome. this is essentially the first step. this is where they'll do a visual assessment of the sample. - [julia] and what are the assessment criteria for a piece of poo? like what is a good piece? - [delasie] so there's a visual assessment for color. it's also assessed for size. there's also a scale that we grade the stool on. it's gonna give you viscosity, texture, hardness. - [julia] i never thought i'd say i'm looking forward to seeing a piece of poo. - [delasie] yeah, yeah. - [julia] but here we go, i'm excited. - [delasie] so this is the actual stool that's gonna be processed. what would you say this one is? - [scientist] we determined that it would be a four. - [delasie] a bristol four, essentially that's kind of known as the perfect texture for a stool sample to come in and then she'll continue processing. - [julia] i feel like it's really interesting though. you guys are obviously quite immune to it maybe, because you work with this every day. for me, that was like, whoa. once the microbial diversity of the stool samples are determined to be sufficient, they are stored in giant freezers. oh wow, there are a lot of freers. - those are the freezer firms. - that's amazing. these remedies are stored at minus 80 celsius to keep the healthy bacteria viable before shipping to hospitals and clinics. - so they're mixed with a saline and glycerol solution. this is a fecal microbial preparation that'll be delivered by colonoscopy. so this is the most common treatment format that we make. and this is what it looks like. - [julia] to date, openbiome has shipped over 50,000 fecal transplant treatments around the world. they're not fully approved by the fda yet, but treatment looks promising. - about 85, 90 percent of the time you deliver a single infusion of stool to a patient's colon and they'll beat the diff infection. - that's really amazg. for one lucky survivor of c. diff, jenn cooper, this fecal transplant procedure was her only hope. hi. can you tell me when you first got sick? - i first got sick a feyears back when i'deen hospalized with gall bladder infection, which turned into a blood infection. so they put me on extremely strong antibiotics. all the antibiotics i had just killed all that good bacteria in my tummy. and finally i got diagnosed with c. diff. - what were your symptoms of the c. diff? - i'd go to the toilet 15 times a day. the exhaustion was just crippling, so, so much fatigue. i would spend days in bed. it messed wi your head it messed with your body it was just, it was a nightmare. - so it really did flip your life upside down, having this condition. - , absolute, you just get to a point where you're so over it, you just want help. - [julia] but the fecal transplant had a tremendous impact, as beneficial bacteria kept the c. diff infection in check. - i feel like a different person, i feel years younger. i have energy, it's above and beyond what i thought it would do. - oh, well, i'm wishing you all the luck. scientists are now investigating whether this treatment might work for other conditions, like obesity and autoimmune disorders as well. novel medical approaches like this, that harness the power of a balanced microbiome, are forging the future to a disease free world. - [futuristic narrator] in the future, full microbiome replacements are mainstream procedures to fight modern diseases. recipients first select from a large catalog of ultra healthy donors. in the clinic, patients microbiomes are completely replaced with entirely new microbial ecosystems. once the re-calibrated microbiome takes hold, it re-engineers the dy itself, promptinhealthier eating habits, more desire for physical activity, and a heightened mental state. - [julia] if there's one thing, i've come to realize, it's that microbes can be as much a source of good as they can be for harm. but to find our way to a disease free future, the trick is getting the balance and diversity just right. and it's not a straightforward path at all. no one knows this better than dr. jack gilbert, whose own path of restoring the healing power of microbial diversity has been full of twists and turns. one very important reason jack is motivated to pursue this research is his own son. - i have a child with autism. as soon as i found out that my son might be slightly different to other people, i always wanted to figure out a way that i could help him. i don't think autism is a disease that we need to fix, but i did want to be able to help him to realize his full potential as any parent would. - [julia] about two percent of children in the u.s. are diagnosed with autism. recent studies show that individuals with autism have abnormal gut microbes. so jack has been working on rebalancing the microbial diversity of those with autism, including his son. - we actually developed a dietary supplement to improve his health, so he eats a lot of fiberow and he takes butyrate supplements and omega three supplements that help him to regulate his behavior and his health. - [julia] bujack has found that the most effective way to boost microbial diversity is to boost humanity's interaction with non-sterile natural environments. - kids need physical interaction with the environment. physically interacting with the world around them shapes how their immune system works, which can protect them from allergic disease, asthma, maybe even obesity and neurological diseases like depression and anxiety. we think this might be fundamental to the process by which a human body develops. i think that's the best recipe is let kids play in the dirt. - [julia] and it's not just natural environments that give this kind of boost. in the fight against modern diseases, exposure to animals can also play an important role. - we published some research which suggested that when you've had dogs interacting with your family, it actually increased the amount of microbial exposure children got. and it increased the degree of microbial sharing between people. we know that children that grow up with interacting, physically interacting with a dog under the age of one years old, when they're very young, have a 13 percent reduction in the likelihood of developing asthma. it's huge, right? if they grow interacting with a farm environment, there's almost a 50% reduction in the likelihood of developing asthma. - [julia] to investigate this relationship between microbial diversity and the natural environment, jack spent time studying two different communities that live on farms, both of which practiced 19th century, agricultural ways of life. - we started exploring two groups of people in the united states called the amish and the hutterites. and they both live a very rural existence where they don't really like technology. you know, no cameras, no televisions, et cetera. but they have one very specific difference. - [julia] while both communities lead a rural lifestyle, hutterite children don't interact with farm animals or crops, but the amish children do. - the amish kids grow up milking cows and working with the animals, and we think that the exposure they get to that farming environment, to the microbes in the cows and in the sheep and in the horses actually trains their immune system. the hutterite kids are severed from their interaction with the farm and we see this reflected in their health. - [julia] as a result, hutterite kids d't acquire the subsequent immunity training from this exposure. - the amish have about four percent asthma in their population, that's half the u.s. average, whereas the hutterites have a significant elevation in the disease rate. - [julia] with these dramatic findings,ack's lab has been looking at ways that those of us who live in more sterile urban environments can bring the crobial diversity of the farm back to our bodies and our microbiomes. - we've got one strategy that we've been developing. we have living surface materials with bacteria that we could place in a home or a hospital even, and enable that home or hospital wall to have the beneficial properties of say, a farm. sounds a little bit science fictiony, but in the future, we may be able to build entire cities out of biologically alive materials, and maybe even spaceships. we work with nasa onrying to see if these materials could be beneficial for long term spacecraft missions to mars, for example. - oh, amazing, that is really interesting. on my journey towards a disease free future, it's become clear that humanity's relationship with our microbes is complicated. i didn't realize the importance of the human microbiome and how important it is for our individual health. we need to balance the bad with the good, but we are running out of time. in an era of deforestation and urbanization all over the globe, the struggle today is to preserve the diversity of microbes that make up the human micriome before it's too late. but as a scientist, i know to never underestimate human creativity and innovation for solutions. - in the future, what we want is really to understand which are the microbes that are essential, what is their function, and then be able to use them as probiotics. so we are part of an initiative called the microbiota vault. - [julia] a joint project of gloria, rob, jack, martin, and many others, the microbiota vault will be like a noah's arc for microbes. - microbiota vault, it's a project that has long-term storage in a very isolated place to collect microbial diversity om traditional peoples, and then be able in the future to use them to restore our microbiome because we know it's going to disappear. - [julia] i believe a vault like this may provide one important key to the disease free world of the future. and armed by this arsenal of microbes we evolved with, scientists will open up a trove of new methods to fine tune our microbiome and improve the health of everyone. - in the future, i think microbiome research is gonna lead to the possibility of having customized microbiome therapy, what we call personalized medicine. - by bio-augmenting our bodies with new microbes, we can train our immune system to attack cancer. we can alter the types of bacteria living inside us to treat depression and treat things like obesity and diabetes that will have a fundamental impact on how we deal with on our modern day plagues. the microbiome is gonna revolutionize medicine. - [julia] as for me, my hopes for medicinal applications hit a little closer to home and it's inspired my research in neuroscience. with any luck, microbiome therapy may one day provide a remedy for alzheimer's and other diseases, but for the world as a whole, my hope is that the restoration of the microbiome will not only boost the health of everyone, but lead people to happier and more fulfilling lives. (futuristic electronic mic) woman: our indigenous science is connected to a very ancient knowledge and teaches us in a meaningful way that we're responsible for the earth. man: this is my store. everything that i need to survive for a good, long life is right here. different man: we're still one with the land. we still greatly appreciate and identify with the land here. woman: we've been here a long time. what we do makes a lot of sense for this place. [insects chirping] [thunder]

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