A new storefront is opening steps from Cambridge City Hall. But instead of trying to sell you something, its mission is to buy something you produce: your poop.

OpenBiome is the world’s largest stool bank. It’s just like a blood bank but for fecal matter.

“As demand has gone up for poop, we need more donors,” says Majdi Osman, an infectious disease doctor and the clinical program director at OpenBiome. 

Osman’s betting the young, active people who frequent Central Square’s cafes and book stores will make good donors.

As his team hangs a ‘Welcome Donors’ banner and fills supply cabinets, Osman admits, “There are poop jokes all the time.”

The Stool And The Stool Bank

11/11/16 Somerville, MA -- Lab tech, Meyling Chang processes a fecal microbiota preparation at OpenBiome in Somerville, Mass. November 11, 2016. Photo by Erik Jacobs
Erik Jacobs

Osman’s goal is to be Number 1 in Number 2. His team collects stool for fecal transplants. That's exactly what it sounds like: putting very healthy poop in the gut of a very sick person.

This is a relatively new medical procedure with a growing team of physicians advocating for it. Fecal transplants are used in various clinical trials and they’re seen as a highly effective – although experimental – way to treat something called recurrent Clostridium difficile or C. diff.

“This is the most common hospital-acquired infection,” explains Osman. It's becoming increasingly common both in and out of the hospital with roughly half a million cases diagnosed and 30,000 deaths attributed to it per year. People with C. Diff suffer from debilitating diarrhea.

Here’s what’s going on inside: A normal gut is home to trillions of bacteria – together, they’re called the microbiome. They keep you healthy and help you digest food.

“The way you can think about the gut microbiome is as this finely balanced ecosystem, a bit like a rainforest,” says Osman.

But when you take antibiotics, they kill off the bad bacteria along with many of the good bacteria. They burn down that rainforest. And the bacteria C. diff takes over and releases toxins.

It can be hard to recultivate the microbiome. That's where the healthy poop – filled with trillions of happy bacteria – comes in.

"What we're doing is really replanting this forest and allowing it to get back to its original state," says Osman.

But, in order to do this, you need healthy people to be stool donors – people like Greg.

"Just A Boring, Every Morning Kinda Guy.”

Long-haired, mustachioed, with a bicycle helmet under his arm, Greg says he’s "just a boring, every morning kinda guy.”

He works in facilities management and on his way into work he swings by to make his morning donation. “So that's amazing – that a 10-minute process can save or drastically, drastically improve someone's life."

11/11/16 Somerville, MA -- Lab tech, Meyling Chang processes a fecal microbiota preparation at OpenBiome in Somerville, Mass. November 11, 2016. Photo by Erik Jacobs
Erik Jacobs

Other donors produce their donation at home, then race to the storefront or the processing facility in Somerville to deliver it within 45 minutes.

Greg’s a typical donor. He’s in his late 20s, slim and jazzed about the science of stool.

But before he could become part of OpenBiome’s donor pool, Greg faced extreme vetting: Any family history of colon cancer? Have you taken a recent trip to a far-off land? A long questionnaire plus a blood test and a stool test.

The vetting is so rigorous only about 3% of applicants are accepted. And once you pass, ideally you will donate every day.

When he's done each morning, Greg pulls out his loyalty stamp card like he would when buying a latte at a coffee shop. After 10 donations, which are paid at a rate of $40 a piece, he gets a $25 bonus.

That's part of OpenBiome's strategy to recruit more donors: make it feel normal and like donors are doing good. Their new tag line? Make Your Morning Routine Heroic.

After Greg walks out, his donation is blended, strained and frozen. Before long, it's on dry ice being shipped to physicians. One person's morning donation goes to about 8 patients all over the U.S. and across Europe.

Recasting Bacteria From Enemy To Ally

One of the physicians who eagerly receives those packages is Colleen Kelly.

With long dark hair and a long white coat, Kelly works in bustling doctor’s office in Providence. She’s a gastroenterologist, a professor at Brown’s Medical School and a leading expert on microbiota transplants.

“It’s an area that’s unexplored territory,” says Kelly. “It’s like you’re on a whole new planet.”

On this unexplored planet, Kelly and her colleagues are rejecting the long-held assumption that bacteria are bad or are the enemy. 

When the trillions of bacteria that make up the microbiome get out of whack, the usual answer is a dose of antibiotics intended to kill the bad bacteria. But what Kelly has learned is that it might be more effective to introduce a lot of good bacteria and let them take over the bad ones.

Kelly first came across this idea in 2008. "I had a patient who was in her mid-20s and she had had a couple of episodes of C. diff," she remembers.

For this patient, antibiotics weren't fixing it. So she came to Kelly with different idea for treatment: fecal transplant.

“She brought me a pile of papers and she said, 'I want you to do this for me,'” Kelly says.

In 2008, fecal transplants were rare, and few physicians knew about them. And for those who had heard of it, few were willing to give it a try.

But Kelly remembers thinking that the idea really made sense.   

She checked with her colleagues and her hospital, and then became one of the first few physicians in the U.S. to do fecal transplants. She made up the screenings for the stool donor and just guested on how much stool to transplant. At this point, it was all a crapshoot. But it worked.

Not all patients were lucky enough to find a physician willing to try.

“It’s Still Unreal To Me”

Catherine Duff now spends her days hopscotching the U.S. visiting family. Recently, she’s been in Virginia helping with a newborn grandchild. It’s something she never thought she'd live to do.

In the fall of 2005, Duff contracted C. diff.

“It was awful. I was basically a prisoner in my home,” says Duff. She had diarrhea 20 to 30 times a day.

"My bed in my bedroom is about 10 feet away from my toilet, and I had to have potty chair – a toilet chair – right beside my bed because I couldn’t make it to the toilet.”

This lasted – on and off – for 8 years. Duff’s doctors were at a loss. Eventually, they told Duff it was time to get her affairs in order because there was nothing else they could do for her.  

After a flurry of googling, one of Duff’s daughters suggested trying a fecal transplant. Duff’s doctors were skeptical, but one doctor agreed to test Mr. Duff’s stool.

"And then we did it at home," remembers Duff.

That was about 4pm. By that evening, “I felt good enough to take a shower, get dressed and go downstairs in my home, and I was hungry.” Duff hadn’t been hungry in months.

“It’s still unreal to me today that it could have worked that fast,” says Duff, who has since founded The Fecal Transplant Foundation.

Kelly and other physicians have reported similarly rapid results with recurrent C. diff. That's made researchers wonder whether this type of treatment might work for other health issues, too.

“Now, there’s over a hundred registered trials around the world in fecal transplant," Kelly says. "And for not just C. diff, but inflammatory bowel disease, pancreatitis, depression, autism [and] HIV.”

Everyone from dentists to dermatologists to gynecologists are exploring similar ways to use bacteria as a treatment. And the medical community is awash in shocking stories that suggest future research in areas like hair re-growth and obesity.

Kelly is quick to caution that while studies in this area have been exciting, it’s all quite new and there’s “certainly nothing ready for prime time.”

But, she guesses that in the next decade or so, drugs made of bacteria may start appearing on pharmacy shelves.