Associate Director, Crohn's and Colitis Center and Director, Fecal Microbiota Transplant Program, Brigham and Women’s Hospital; Assistant Professor of Medicine, Harvard Medical School, Boston, MA
Dr. Jessica Allegretti has quickly become a national expert in treating recurrent c. difficile infection (CDI) through fecal microbiota transplant (FMT). Her journey began unexpectedly, when she was a senior resident and one of her patients asked about FMT after seeing it as a plotline on a television drama.
“At the time, I hadn’t heard of FMT, so I looked into the literature. There was very little data on FMT in IBD, just a few case reports, and not one clinical trial,” said Dr. Allegretti. “Even still, I was intrigued by what I read, so I decided to do my senior talk on fecal transplantation. I remember that I got a lot of chuckles – it was very much viewed as science fiction. But I went into my fellowship really excited about the potential of this therapy, particularly for patients with recurrent c. difficile infection.”
CDI is a challenging problem in IBD. Patients have a ten percent lifetime risk of developing a single CDI, which then puts them at an almost five-fold increased risk of developing recurrent disease. This can then lead to escalation in therapy, hospitalization, and sometimes a colectomy (a procedure to remove all or part of the colon).
Dr. Allegretti made helping these patients the focus of her fellowship, conducting a meta-analysis of FMT trials in which she debunked the myth that the treatment didn’t work for IBD patients. She then went on to design and lead the first prospective clinical trial of FMT in IBD patients with recurrent CDI, which showed the therapy improved outcomes for these very difficult-to-treat patients.
“These patients are really sick and need help, but they have largely been left out of research.”
“Their CDI excludes them from IBD trials and their IBD excludes them from CDI treatment trials,” said Dr. Allegretti, “so I felt like I had to do all I could to find something to help them.”
Buoyed by her research findings, Dr. Allegretti joined the staff at Brigham and Women’s Hospital, seizing an opportunity to build one of the country’s largest FMT programs. Today, doctors across New England refer their patients to her and she advises institutions around the country on how to build their own FMT programs to help desperately ill people with IBD gain access to this life-altering treatment.
But Dr. Allegretti is the first to acknowledge that the therapy won’t work for everyone, which is why she’s been concurrently building out the clinical trials program at her IBD center – establishing it as a regional destination for trials that attracts patients from across the Northeast.
“It’s devastating to tell a patient that they’ve exhausted their therapeutic options, which is why I’ve been so focused on expanding our clinical trials program.”
“I’m pretty relentless when it comes to establishing new trials at our center,” said Dr. Allegretti, “because my goal is to have a medicine for everyone who comes to us.”
Dr. Allegretti sees a lot of work ahead to continue driving the research forward – towards more treatments for patients in need, and ultimately cures for these diseases. With her indomitable spirit, pushing the frontiers of scientific discovery, the IBD community will likely see more breakthroughs from Dr. Allegretti in the years to come.
Joseph B. Kirsner Professor of Medicine; Chief, Section of Gastroenterology, Hepatology and Nutrition; Co-Director, Digestive Diseases Center; University of Chicago Medicine, Chicago, ILRead his story