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Valcheva R, Koleva P, Martínez I, Walter J, Gänzle MG, Dieleman LA. Inulin-type fructans improve active ulcerative colitis associated with microbiota changes and increased short-chain fatty acids levels. Gut Microbes 2018; 10:334-357. [PMID: 30395776 PMCID: PMC6546336 DOI: 10.1080/19490976.2018.1526583] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The intestinal microbiota is involved in ulcerative colitis (UC) pathogenesis. Prebiotics are hypothesized to improve health through alterations to gut microbiota composition and/or activity. Our aim was therefore to determine if inulin-type fructans induce clinical benefits in UC, and identify if benefits are linked to compositional and/or functional shifts of the luminal (fecal) and mucosal (biopsy) bacterial communities. Patients (n = 25) with mild/moderately active UC received 7.5 g (n = 12) or 15 g (n = 13) daily oral oligofructose-enriched inulin (Orafti®Synergy1) for 9 weeks. Total Mayo score, endoscopic activity and fecal calprotectin were assessed. Fecal and mucosal bacterial communities were characterized by 16S rRNA tag sequencing, and short chain fatty acids (SCFA) production were measured in fecal samples. Fructans significantly reduced colitis in the high-dose group, with 77% of patients showing a clinical response versus 33% in the low-dose group (P = 0.04). Fructans increased colonic butyrate production in the 15 g/d dose, and fecal butyrate levels were negatively correlated with Mayo score (r = -0.50; P = 0.036). The high fructan dose led to an increased Bifidobacteriaceae and Lachnospiraceae abundance but these shifts were not correlated with improved disease scores. In summary, this pilot study revealed that 15 g/d dose inulin type fructans in UC produced functional but not compositional shifts of the gut microbiota, suggesting that prebiotic-induced alterations of gut microbiota metabolism are more important than compositional changes for the benefits in UC. The findings warrant future well-powered controlled studies for the use of β-fructans as adjunct therapy in patients with active UC.
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Shim HH, Ma C, Kotze PG, Seow CH, Al-Farhan H, Al-Darmaki AK, Pang JXQ, Fedorak RN, Devlin SM, Dieleman LA, Kaplan GG, Novak KL, Kroeker KI, Halloran BP, Panaccione R. Preoperative Ustekinumab Treatment Is Not Associated With Increased Postoperative Complications in Crohn's Disease: A Canadian Multi-Centre Observational Cohort Study. J Can Assoc Gastroenterol 2018; 1:115-123. [PMID: 31294352 PMCID: PMC6507292 DOI: 10.1093/jcag/gwy013] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Ustekinumab (UST), an anti-IL12/23 inhibitor is indicated for moderate-to-severe Crohn's disease (CD). However, it is unclear if patients treated with UST are at increased risk for postoperative complications. AIM To evaluate the postoperative safety outcomes in UST-treated CD patients. METHODS A multicentre cohort study of UST-treated CD patients at two tertiary care centres (University of Calgary, University of Alberta, Canada) undergoing abdominal surgery between 2009 and 2016 was performed. Postoperative outcomes were compared against a control cohort of anti-TNF-treated patients over the same time-period. The primary outcome was occurrence of postoperative complications up to six months postoperatively, stratified by timing (early <30 days vs. late complications ≥30 days). RESULTS Twenty UST-treated patients and 40 anti-TNF-treated patients were included with a median preoperative treatment exposure of 6.5 months and 18 months, respectively (p=0.01). Bowel obstruction was the most common surgical indication in both cohorts. UST-treated patients were more likely to require an ostomy (70.0% vs. 12.5%, p<0.001) and be on combination therapy with either systemic corticosteroids or concurrent immunomodulators (azathioprine or methotrexate) (25.0% vs. 2.5%, p=0.01). Despite the increased concomitant use of immunosuppression in the UST-treated cohort, there were no significant differences in early or late postoperative wound infections (1/20 in UST-cohort, 2/40 in anti-TNF cohort, p=1.00), anastomotic leak (0/20 in UST-cohort, 3/40 in anti-TNF cohort, p=0.54), or postoperative ileus/obstruction (3/20 in UST-cohort, 4/40 in anti-TNF cohort, p=0.67). CONCLUSIONS CD patients receiving preoperative UST did not experience an increase in postoperative complications, despite increased use of concurrent immunosuppression.
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Abstract
The incidence of celiac disease has risen quickly and has a worldwide distribution in Europe, North and South America, Asia, the Middle East and Africa. This is attributed in part to increased availability in screening but also to the fast-rising gluten consumption and perhaps unknown environmental factors. In daily practice, this means that more subclinical cases and very young and elderly patients are diagnosed. The pathogenesis of celiac disease is a T-cell driven process initiated by gluten, leading to increased intestinal permeability and villous atrophy. The process requires HLA genotypes DQ2, DQ8 or both. Additional non-HLA alleles have been identified in genome-wide association studies. Serological testing, followed by duodenal biopsies, are still required to confirm the diagnosis. Advances are in the making for novel biomarkers to monitor disease and for pharmacological support of celiac disease. Medical costs and patient-perceived disease burden remain high in celiac disease, which point to the need for ongoing research in drug development to improve quality of daily life. Drugs undergoing phase I and phase II clinical trials include intraluminal therapies and vaccines to restore immune tolerance. These therapies aim to reduce symptoms and mucosal injuries as adjunct therapies to a gluten-free diet.
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Turpin W, Bedrani L, Espin-Garcia O, Xu W, Silverberg MS, Smith MI, Guttman DS, Griffiths A, Moayyedi P, Panaccione R, Huynh H, Steinhart H, Aumais G, Shestopaloff K, Dieleman LA, Turner D, Paterson AD, Croitoru K. FUT2 genotype and secretory status are not associated with fecal microbial composition and inferred function in healthy subjects. Gut Microbes 2018; 9:357-368. [PMID: 29533703 PMCID: PMC6219652 DOI: 10.1080/19490976.2018.1445956] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/13/2017] [Accepted: 02/17/2018] [Indexed: 02/03/2023] Open
Abstract
Heritability analysis of the microbiota has demonstrated the importance of host genotype in defining the human microbiota. The alpha (1,2)-fucosyltransferase 2 encoded by FUT2 is involved in the formation of the H antigen and the SNP, rs601338 is associated with ABO histo-blood group antigen secretion in the intestinal mucosa. Previous studies have provided non replicated results for the association of this polymorphism with the composition and inferred function of intestinal microbiota. We aimed to assess this relationship in a large cohort of 1,190 healthy individuals. Genotyping was performed using the HumanCoreEXOME chip, microbial composition was addressed by 16S rRNA gene sequencing. Firmicutes, Bacteroidetes, and Actinobacteria were the dominant phyla in this cohort. Although we have sufficient power to detect significant associations of FUT2 genotype/ inferred phenotype with the microbiota, our data demonstrate that FUT2 genotype and secretor status is not associated with microbial alpha diversity, microbial composition or inferred microbial function after correction for multiple testing. Thus, FUT2 genotype and inferred phenotype are not associated with human fecal microbial composition and imputed function.
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Keshteli AH, Tso R, Dieleman LA, Park H, Kroeker KI, Jovel J, Gillevet PM, Sikaroodi M, Mandal R, Fedorak RN, Madsen KL. A Distinctive Urinary Metabolomic Fingerprint Is Linked With Endoscopic Postoperative Disease Recurrence in Crohn's Disease Patients. Inflamm Bowel Dis 2018; 24:861-870. [PMID: 29562272 DOI: 10.1093/ibd/izx070] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Crohn's disease (CD) patients who undergo ileocolonic resection frequently have disease recurrence. The aim of this preliminary study was to identify urinary metabolomic profiles associated with disease recurrence in order to identify underlying mechanisms of recurrence and possible disease biomarkers. METHODS Biopsies from the neoterminal ileum were collected from CD patients (n = 38) after ileocolonic resection in order to assess mucosa-associated microbiota using 16S rRNA multitag pyrosequencing. Urine samples were collected, and metabolomic profiling was done using high-resolution nuclear magnetic resolution spectroscopy and a combined direct infusion liquid chromatography tandem mass spectrometry. The Rutgeerts scoring system was used to assess endoscopic postoperative recurrence of CD. RESULTS There were 28 (73.7%) patients with endoscopic CD recurrence. CD patients who were in endoscopic remission had a higher abundance of Bacteroidetes and lower abundance of Fusobacteria and Proteobacteria in comparison with CD patients who had endoscopic recurrence. In addition, metabolomic profiling could also discriminate between these 2 groups of patients. Endoscopic recurrence was associated with increased concentration of urinary levoglucosan. Rutgeerts score was positively correlated with levoglucosan and propylene glycol levels. CONCLUSIONS CD patients who present with endoscopic disease recurrence after surgery have a unique urinary metabolomic fingerprint that can differentiate them from CD patients who are in endoscopic remission after ileocolonic resection. In addition, mucosal-associated microbiota in CD patients with or without disease recurrence after surgery differs and correlates with some urinary metabolites.
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Keshteli AH, Hoevers T, Madsen K, Hotte N, Nickurak C, Kroeker KI, van Den Brand F, Valcheva RS, Fedorak R, Dieleman LA. A84 HIGH FECAL CALPROTECTIN LEVELS IN ULCERATIVE COLITIS PATIENTS IN CLINICAL REMISSION ARE ASSOCIATED WITH SPECIFIC CLINICAL AND DIETARY INTAKE PARAMETERS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nguyen VV, Ambrosio L, Dunsmore G, Agrawal A, Hotte N, Dieleman LA, Halloran BP, Kroeker KI, Fedorak R, elahi S, Madsen K, Huang V. A145 BREASTFEEDING INCREASES COLONIC INFLAMMATION IN INFANTS BORN FROM HEALTHY MOMS, WHICH EFFECT IS LACKING IN INFANTS BORN FROM MOMS WITH IBD. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ma C, Fedorak R, Kaplan GG, Dieleman LA, Devlin S, Stern N, Kroeker KI, Seow C, Leung Y, Novak KL, Halloran BP, Huang V, Wong K, Ghosh S, Panaccione R. A108 USTEKINUMAB IS EFFECTIVE FOR INDUCING CLINICAL, ENDOSCOPIC, AND RADIOGRAPHIC RESPONSE IN REFRACTORY MODERATE-TO-SEVERE CROHN’S DISEASE: A MULTICENTRE COHORT STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Armstrong H, Alipour M, Valcheva RS, Shah P, Zaidi D, Jovel J, Lou Y, Mason A, Wong G, Carroll MW, Huynh HQ, Dieleman LA, Wine E. A11 IMMUNOGLOBULIN G AS A NOVEL SELECTIVE MARKER FOR THE IDENTIFICATION OF INTESTINAL PATHOBIONTS IN PAEDIATRIC INFLAMMATORY BOWEL DISEASES. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chibbar R, Nostedt J, Mihalicz D, Mclean R, deschenes J, Dieleman LA. A242 SIGMOID PERFORATION: A RARE CASE OF REFRACTORY CELIAC DISEASE TYPE II. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Laffin M, Perry T, Park H, Gillevet P, Sikaroodi M, Kaplan GG, Fedorak R, Kroeker KI, Dieleman LA, Dicken B, Madsen K. A83 THE MUCOSA-ASSOCIATED-MICROBIOTA IS ASSOCIATED WITH RELAPSE IN CROHN’S DISEASE PATIENTS UNDERGOING ILEOCECAL RESECTION. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Reeson M, Ambrosio L, Lam GY, Fedorak R, Dieleman LA, Kroeker KI, Huang V, Peters A, Halloran BP. A148 EBV STATUS AND IMMUNOSUPPRESSANT USE IN IBD PATIENTS WHO SUBSEQUENTLY DEVELOP LYMPHOMA: A RETROSPECTIVE AND PROSPECTIVE STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shim H, Ma C, Al-Farhan H, Aldarmaki AK, Pang J, Seow C, Fedorak R, Devlin S, Dieleman LA, Kaplan GG, Novak KL, Kroeker KI, Halloran BP, Panaccione R. A107 POSTOPERATIVE OUTCOMES AMONG USTEKINUMAB TREATED CROHN’S DISEASE PATIENTS: A MULTICENTRE CANADIAN PROVINCIAL EXPERIENCE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Alipour M, Armstrong H, Valcheva RS, Zaidi D, Jovel J, Lou Y, Mason A, Wong G, Madsen K, Dieleman LA, Carroll MW, Huynh HQ, Wine E. A299 IDENTIFICATION OF PATHOGENIC BACTERIAL STRAINS IN PAEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASES USING IMMUNOGLOBULIN G AS A MARKER OF VIRULENCE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Silva M, Chibbar R, Walter J, Goodman K, Keshteli AH, Valcheva RS, Dieleman LA. A159 A SURVEY FOR THE USE OF PROBIOTICS, PREBIOTICS AND DIETARY FIBRE SUPPLEMENTS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rodriguez N, Nguyen VV, Ambrosio L, Dieleman LA, Halloran BP, Kroeker KI, Peerani F, Wong K, Fedorak R, Huang V. A221 IMPACT OF A SPECIALIZED CLINIC IN IMPROVING IBD-RELATED PREGNANCY KNOWLEDGE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Turpin W, Bedrani L, Espin-Garcia O, Smith M, Guttman D, Madsen K, Griffiths A, Moayyedi P, Panaccione R, Huynh HQ, Dieleman LA, Steinhart A, Aumais G, Silverberg MS, Wei X, Paterson A, Croitoru K. A35 GENOME WIDE ASSOCIATION STUDY OF ABNORMAL INTESTINAL PERMEABILITY IN HEALTHY FIRST DEGREE RELATIVES OF CROHN’S PATIENTS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dong V, Dieleman LA. A151 MEDICATION INDUCED INTERSTITIAL LUNG DISEASE IN A PATIENT WITH ULCERATIVE COLITIS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Amin A, Prosser C, Kroeker KI, Wang H, Shalapay C, Dhami N, Fedorak DK, Halloran BP, Dieleman LA, Goodman K, Fedorak R, Huang V. A147 COMBINING INFLIXIMAB TROUGH LEVELS AND FECAL CALPROTECTIN LEVELS WITH CLINICAL DATA HAS THE POTENTIAL TO GUIDE CLINICAL DECISION-MAKING IN IMPROVING OUTCOMES FOR INFLAMMATORY BOWEL DISEASE PATIENTS ON MAINTENANCE INFLIXIMAB. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lytvyak E, Dieleman LA, Halloran BP, Huang V, Kroeker KI, Peerani F, Wong K, Fedorak R. A130 TABLEAU DASHBOARD AS A QUALITY IMPROVEMENT AND STRATEGIC DRIVING TOOL IN THE IBD OUTPATIENT SETTING: EARLY EXPERIENCE FROM THE IBD CENTRE OF EXCELLENCE AT THE UNIVERSITY OF ALBERTA HOSPITAL. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sutton RT, Wierstra K, Ambrosio L, Dieleman LA, Halloran BP, Kroeker KI, Fedorak R, Wong K, Berga K, Huang V. A105 AN ONLINE EDUCATIONAL PORTAL IMPROVES CONCERNS OF INFLAMMATORY BOWEL DISEASE PATIENTS REGARDING PREGNANCY AND MEDICATION. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ma C, Fedorak R, Kaplan GG, Dieleman LA, Devlin S, Stern N, Kroeker KI, Seow C, Leung Y, Novak KL, Halloran BP, Huang V, Wong K, Ghosh S, Panaccione R. A106 USTEKINUMAB IS EFFECTIVE FOR MAINTAINING CLINICAL RESPONSE IN REFRACTORY MODERATE-TO-SEVERE CROHN’S DISEASE: A MULTICENTRE COHORT STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Andrishak SR, Huang V, Kroeker KI, Dieleman LA, Halloran BP, Fedorak R, Manocha A. A283 THE IMPACT INFLAMMATORY BOWEL DISEASE HAS ON BREASTFEEDING PATTERNS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cookson TA, Fedorak R, Halloran BP, Dieleman LA, Wong K, Huang V, Peerani F, Kroeker KI. A157 THE THRESHOLD FOR INFLIXIMAB TROUGH LEVELS LEADING TO DOSE ESCALATION DIFFERS BETWEEN CROHN’S DISEASE AND ULCERATIVE COLITIS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Stern N, Wong K, Dieleman LA, Halloran BP, Huang V, Kroeker KI, Peerani F, van Zanten S, Fedorak R. A132 THREE QUARTERS OF INFLAMMATORY BOWEL DISEASE PATIENTS ON MAINTENANCE INFLIXIMAB THERAPY IN CLINICAL REMISSION SHOW EVIDENCE OF MUCOSAL INFLAMMATION WITH ELEVATED FECAL CALPROTECTIN. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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