Sexual Dysfunction in Women with Inflammatory Bowel Disease

Background: Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases (IBDs) characterized by various clinical symptoms including abdominal pain, diarrhea, fatigue, and extraintestinal manifestations, which negatively affect a patient's quality of life. Both mainly occur in adolescence and young adulthood and therefore affect women in their sexually active period. The aim of this study was to assess the effect of IBD on female sexuality and attitudes towards contraception. Methods: A prospective cross-sectional survey study was conducted at the Medical University of Vienna, Austria. Data were collected using a self-designed questionnaire, which included questions on demographics, gynecological patient history, contraceptive choices, and fertility, as well as the Female Sexual Functionality Index (FSFI). Results: A total of 83 female patients with IBD (CD: n = 47, UC: n = 36) and 340 healthy control participants between the ages of 18 and 50 years were investigated. Demographic parameters did not differ between the groups; however, mean FSFI scores were significantly lower in the patient group (p < 0.001). Significantly fewer patients in the IBD group used contraception (p = 0.008). No significant differences regarding conception rates and infertility rates were noted between patients with IBD and control participants (p = 0.533 and p = 0.506, respectively). Conclusions: Female sexuality is significantly impaired in patients with IBD. Women with IBD do not receive sufficient information regarding contraception and should be screened for sexual dysfunction to optimize their quality of life.

Evaluation of remission in ulcerative colitis: Relationship between clinical, endoscopic, and histological markers as predictors of relapse

INTRODUCTION

In ulcerative colitis (UC), STRIDE-II consensus has established the long-term goal of achieving endoscopic remission (ER), which helps reduce inflammatory burden, prevent permanent intestinal damage, and improve patient's quality of life. However, achieving histological remission (HR) is also associated with a lower risk of experiencing outbreaks of inflammatory activity, the need for corticosteroids, hospitalizations, and the development of colorectal cancer.

OBJECTIVE

Evaluate the role of ER and HR in the development of inflammatory activity flares in patients who have achieved these long-term goals and are being followed in the Inflammatory Bowel Disease (IBD) Program.

MATERIAL AND METHODS

A retrospective study was conducted on patients with UC treated in the IBD Program at the Universidad de los Andes, between January 2021 and April 2023. Patients with ER (Mayo Endoscopic Index [MEI] 0) or endoscopic response (MEI 1), with at least one year of follow-up, were included. HR was defined using the Nancy (<2), Geboes (<2), and Robarts (<3) indices. Inflammatory activity was assessed by a Partial Mayo Index (PMI) ≥2 and fecal calprotectin >250μg/g.

RESULTS

A total of 84 patients were included, 57.1% were women, with a median age of 37 years (IQR 31-45). During follow-up, 71 patients continued in the study, and 24 (31%) experienced inflammatory flares. In the MEI 0 group, the percentage of flares at 12 and 44 months was 15% and 53%, respectively, compared to 43% and 67% in the MEI 1 group (p=0.0302). PMI and fecal calprotectin levels were significantly lower in MEI 0 than in MEI 1 (p<0.001 and p<0.05, respectively). Although the Nancy, Geboes, and Robarts indices showed significant differences between MEI 0 and MEI 1, none were associated with a lower risk of flares in the MEI 0 group. No cases of colorectal neoplasia or need for surgery were reported during follow-up.

CONCLUSION

In this cohort, ER is a significant predictor of the development of inflammatory flares in patients with UC, while HR did not show a clear impact in this regard. Further studies are needed to clarify the role of HR as a therapeutic target in UC.

Active Inflammatory Bowel Disease on Intestinal Ultrasound During Pregnancy Is Associated With an Increased Risk of Adverse Pregnancy and Neonatal Outcomes Independent of Clinical and Biochemical Disease Activity

BACKGROUND AND AIMS

Clinically active inflammatory bowel disease (IBD) is associated with an increased risk of adverse pregnancy outcomes. However, the validity of clinical scores to assess antenatal disease activity is questionable. We aimed to assess whether active disease defined by intestinal ultrasound (IUS) may predict adverse pregnancy outcomes.

METHODS

This international prospective cohort study recruited pregnant individuals with IBD from 2017 to 2023 from 3 specialist IBD pregnancy services. Participants underwent clinical assessments and fecal calprotectin (FCP) testing in the first (T1), second (T2), and third (T3) trimesters, and 6 weeks postpartum. IUS was performed in T1 or T2 when referral timing allowed. Univariable and multivariable log-binomial regression analyses were used to estimate the impact of IUS activity on pregnancy outcomes. Cohen's κ coefficients were used to determine agreement between FCP, IUS, and clinical disease activity.

RESULTS

The study recruited 377 participants, 198 with Crohn's disease (CD), and 234 women underwent an IUS during pregnancy. A maximal bowel wall thickness (BWT) >6 mm in T2 was associated with a 4-fold increased risk of prematurity (relative risk [RR], 4.01; 95% confidence interval [CI], 1.26-12.72; P = .018) and 2-fold increased risk of low-birth-weight delivery (RR, 2.19; 95% CI. 1.01-4.72; P = .046). Hyperemia on IUS in T2 was associated with a 3-fold increase in preeclampsia risk (RR, 3.46; 95% CI, 1.03-11.12; P = .046). Each 1-mm increase in BWT in T2 was estimated to increase the risk of gestational diabetes (RR, 1.08; 95% CI, 1.088-1.089; P < .001) Agreement between clinical (Harvey Bradshaw index or Simple Clinical Colitis Activity Index) and IUS/FCP activity during pregnancy was weak, particularly for CD.

CONCLUSIONS

Active IBD on IUS in pregnancy is associated with an increased risk of adverse pregnancy outcomes, independent of clinical activity and FCP. Use of IUS monitoring antenatally should be considered to guide therapeutic decision-making.

Serum Maresin-1 and Resolvin-D1 Levels as Non-Invasive Biomarkers for Monitoring Disease Activity in Ulcerative Colitis

Background: Specialized pro-resolving lipid mediators (SPMs), such as maresins and resolvins, play a key role in resolving inflammation and repairing tissues. This study aimed to evaluate whether maresin-1 (MaR1) and resolvin-D1 (RvD1) could serve as serum non-invasive biomarkers for monitoring disease activity in ulcerative colitis (UC). Methods: This cross-sectional study included 60 UC patients (30 active, 30 remission) and 30 healthy controls. Disease activity was assessed using the Mayo Endoscopic Subscore (MES). Inflammatory indices, including the neutrophil-lymphocyte ratio (NLR), monocyte-HDL cholesterol ratio (MHR), platelet-lymphocyte ratio (PLR), CRP-lymphocyte ratio (CLR), CRP-albumin ratio (CAR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII), were calculated. Plasma MaR1 and RvD1 levels were measured via enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) analysis was performed to evaluate biomarker accuracy. Results: CRP, NLR, PLR, CLR, CAR, SIRI, and SII were significantly elevated in active UC, whereas MaR1 and RvD1 were lower compared to remission and controls (p < 0.05). MaR1 levels were lower in the remission group than in controls. ROC analysis demonstrated high area under the curve (AUC) values for RvD1 (0.906), CAR (0.872), CLR (0.861), and CRP (0.858) in distinguishing active UC from remission, and for CRP (0.944), CAR (0.939), CLR (0.939), RvD1 (0.928), and MaR1 (0.889) in distinguishing active UC from controls. The specificity for detecting active UC was 60% for MaR1 and 80% for RvD1. Both RvD1 and MaR1 showed a negative correlation with the MES, with RvD1 demonstrating a stronger correlation (r = -0.754, p < 0.001). Conclusions: RvD1 shows a strong negative correlation with disease severity in ulcerative colitis, while low MaR1 levels in remission may indicate subclinical inflammation. Although MaR1 and RvD1 are not disease-specific, their role in inflammation resolution suggests they may complement conventional inflammatory markers for more comprehensive UC monitoring.

The Evolving Guidelines on Fiber Intake for Patients with Inflammatory Bowel Disease; From Exclusion to Texture Modification

PURPOSE OF REVIEW

Fiber restriction has been a long-standing strategy for patients with inflammatory bowel disease (IBD), ostensibly to improve symptoms and reduce complications. Fiber though has a well-documented trophic effect on gut barrier defenses and the intestinal microbiome. This report discusses how texture modification may allow the safe and effective provision of much needed fiber to this patient population.

RECENT FINDINGS

The effect of dietary fiber is characterized by maintenance of gut integrity, support of the microbiome, and immune modulation. Low-fiber diets in patients with IBD result in greater dysbiosis, intestinal permeability, and mucosal inflammation. New recommendations from international IBD guidelines now promote texture modification to allow for inclusion of fiber in certain conditions of IBD. For patients flaring with acute inflammation, or those with ileostomy, intestinal stricture, or ileal pouch anastomosis, continued fiber intake with softer textures and mechanical modification should be prioritized when feasible. For patients recovering from surgery, diet advancement should include reintroduction of soluble and insoluble fibers, while those in remission should have little or no dietary restrictions. Texture modification of high fiber foods may be accomplished by a variety of strategies involved in the selection, preparation, and cooking of fruits and vegetables. Greater effort to include dietary soluble and insoluble fiber should result in clinical benefit to the IBD patient, avoiding the adverse consequences of a low-fiber diet.

Sexual Health in Women with Inflammatory Bowel Diseases: A Narrative Review

Background/Objectives: Inflammatory bowel diseases (IBDs), such as Crohn's disease and ulcerative colitis, have a significant impact on overall well-being. Sexual health, a critical component of overall well-being, is often compromised in individuals with IBD, especially in women, owing to physical, psychological, and social factors. This narrative review aims to synthesize the fragmented existing evidence on the impact of IBD on women's sexual health by examining clinical manifestations along with patients' perceptions and lived experiences. Methods: Five databases (CINAHL Complete, Medline, APA PsycInfo, APA PsycArticles, and Psychology and Behavioral Sciences Collection) were searched using keywords related to IBD, sexual health, and women's experiences. Fifteen studies that met the predefined inclusion and exclusion criteria were analyzed. Results: Women with IBD often perceive their bodies as "damaged" or "mutilated," which profoundly affects their self-esteem and sexual satisfaction. Physically, debilitating symptoms such as abdominal pain, diarrhea, and chronic fatigue limit sexual desire and intimacy. Psychological factors, including anxiety, depression, and negative body image, exacerbate these challenges, and compromise emotional well-being and intimate relationships. Social stigma further isolates patients, making it more difficult for them to communicate their sexual needs to both partners and healthcare providers. Strategies such as psychological support, health education, and promoting open communication with partners emerge as promising avenues to improve sexual health and quality of life. Conclusions: IBD profoundly affects women's sexual health by intertwining physical, psychological, and social challenges. A holistic and personalized clinical approach that incorporates sexual well-being into routine care is essential to improve patients' quality of life.

Gut microbiota signatures in food allergy children without and with malnutrition: a cross-sectional study

BACKGROUND

Altered gut microbiota (GM) profiles have been documented in children with food allergies (FA) and experiencing malnutrition. This study explored the GM composition in children with FA across varying degrees of malnutrition including those without malnutrition and those with different severity levels.

METHODS

Fresh faecal samples were collected from 120 children aged 1-6 years, including 40 FA children with adequate weight (FANM), 40 FA children with malnutrition (FAM), and 40 healthy controls. The hypervariable region of the 16 S rDNA gene was subsequently sequenced to assess bacterial communities.

RESULTS

Compared with healthy controls, the FANM group displayed a greater increase in the alpha diversity index. The FAM group exhibited an increase in seven genera, including Alistipes and Parabacteroides, compared to the control group, whereas nine genera were enriched in the FANM group. An analysis of clinical characteristics revealed a positive correlation between the relative abundance of the genus Faecalibacterium and the total IgE level. Fourteen pivotal microbial markers demonstrated substantial classification potential (AUC: 89.86%, 95% CI: 76.40-99.73% for FAM; AUC: 88.92%, 95% CI: 73.58-99.65% for FANM).

CONCLUSION

FA children exhibit distinct GM profiles depending on the presence of malnutrition, which suggests the need for tailored microbiota-targeted therapies.

Effects of psychological stress on inflammatory bowel disease via affecting the microbiota-gut-brain axis

ABSTRACT

Inflammatory bowel disease (IBD) is an idiopathic intestinal inflammatory condition with chronic and relapsing manifestations and is characterized by a disturbance in the interplay between the intestinal microbiota, the gut, and the brain. The microbiota-gut-brain axis involves interactions among the nervous system, the neuroendocrine system, the gut microbiota, and the host immune system. Increasing published data indicate that psychological stress exacerbates the severity of IBD due to its negative effects on the microbiota-gut-brain axis, including alterations in the stress response of the hypothalamic-pituitary-adrenal (HPA) axis, the balance between the sympathetic nervous system and vagus nerves, the homeostasis of the intestinal flora and metabolites, and normal intestinal immunity and permeability. Although the current evidence is insufficient, psychotropic agents, psychotherapies, and interventions targeting the microbiota-gut-brain axis show the potential to improve symptoms and quality of life in IBD patients. Therefore, further studies that translate recent findings into therapeutic approaches that improve both physical and psychological well-being are needed.

Vaping-Associated Pneumothorax: A Systematic Review of Case Reports and Case Series

Background and Objectives: Pneumothorax is a medical condition characterized by the accumulation of air in the pleural cavity, leading to lung collapse. While cigarette smoking is a well-known risk factor, the role of electronic cigarettes is less understood. This systematic review aimed to evaluate the outcomes of vaping-associated pneumothorax, in addition to its clinical features and management strategies, by compiling published case reports and case series. Materials and Methods: The choice to use case reports and case series was due to the limited availability of other types of studies on this emerging condition, as vaping-associated pneumothorax is relatively rare and primarily reported in isolated cases. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic search of six databases for case reports and case series. Data extraction and quality assessment were performed independently by multiple reviewers. Results: Seven case reports and four case series with a total number of 16 patients were included. Most patients were young, underweight men who presented with chest pain and shortness of breath. Conventional cigarette and cannabis use were commonly reported alongside vaping. The main treatment was the insertion of a chest tube, with surgical interventions reserved for severe cases. Patients who were treated non-surgically exhibited a higher recurrence rate. Additionally, specific symptoms such as chest pain radiating to the ipsilateral shoulder were associated with a higher recurrence rate. Conclusions: Clinicians should be vigilant for pneumothorax in at-risk individuals, consider targeted screening for symptomatic vapers, and prioritize early surgical intervention in recurrent cases to reduce complications. Further research is needed to understand the pathophysiology of vaping-associated spontaneous pneumothorax and optimal management strategies.

Research Status and Trends of Gut Microbiota and Intestinal Diseases Based on Bibliometrics

Gut microbiota plays an important role in gut health, and its dysbiosis is closely related to the pathogenesis of various intestinal diseases. The field of gut microbiota and intestinal diseases has not yet been systematically quantified through bibliometric methods. This study conducted bibliometric analysis to delineate the evolution of research on gut microbiota and intestinal diseases. Data were sourced from the Web of Science Core Collection database from 2009 to 2023 and were scientometrically analyzed using CiteSpace. We have found that the number of annual publications has been steadily increasing and showing an upward trend. China and the Chinese Academy of Sciences are the country and institution with the most contributions, respectively. Frontiers in Microbiology and Nutrients are the journals with the most publications, while Plos One and Nature are the journals with the most citations. The field has shifted from focusing on traditional descriptive analysis of gut microbiota composition to exploring the causal relationship between gut microbiota and intestinal diseases. The research hotspots and trends mainly include the correlation between specific intestinal diseases and gut microbiota diversity, the mechanism of gut microbiota involvement in intestinal diseases, the exploration of important gut microbiota related to intestinal diseases, and the relationship between gut microbiota and human gut health. This study provides a comprehensive knowledge map of gut microbiota and intestinal diseases, highlights key research areas, and outlines potential future directions.

Assessing the gut microbiota composition in older adults: connections to physical activity and healthy ageing

The composition and functionality of the gut microbiota (GM) changes throughout the life course. As we move into older age, it starts to shift towards a less healthy one, which may lead to an imbalance in the GM community. Strategies that can reverse age-related dysbiosis are an important part of healthy aging. Little is known about the GM composition of older adults with different physical activity (PA) levels and whether it might contribute to healthy ageing. The aim of this study was to compare the GM composition of older adults with different PA levels and assess if it is associated with healthy ageing. 101 participants aged between 65-85 years undertook anthropometric measures, a 6-min walking test, wore an accelerometer for 7 days and provided a faecal sample. Faecal GM composition was analysed using 16S rRNA sequencing. We found that those who fulfilled the WHO/UK PA recommendations had higher relative abundance of several health-related bacteria such as Lactobacillus, F. prausnitzii and Roseburia intestinalis and lower abundance of disease-associated bacteria such as D.piger or Enterobacterales when compared to those who did not reach PA recommendations. These findings suggest that PA might improve the GM composition and has the potential to, at least partially, revert age-associated dysbiosis and promote healthy ageing.

TXM-CB13 Improves the Intestinal Mucosal Barrier and Alleviates Colitis by Inhibiting the ROS/TXNIP/TRX/NLRP3 and TLR4/MyD88/NF-κB/NLRP3 Pathways

The activation of inflammasomes (NLRP3 and NLRP1) is central to the pathogenesis of inflammatory bowel disease (IBD). Here we examined the protective effects of a thioredoxin-mimetic peptide CB13 (TXM-CB13), known for its antioxidative stress and anti-inflammatory properties. We examined the effects of TXM-CB13 on dextran sulfate sodium (DSS)-induced colitis and lipopolysaccharide (LPS)-induced NLRP3 inflammasome activation in RAW264.7 macrophages. TXM-CB13 appeared to alleviate symptoms of DSS-induced colitis and to significantly suppress the protein and mRNA levels of NLRP3, Mlck, and IL-1β in colonic tissues. Additionally, TXM-CB13 treatment increased the levels of the intestinal barrier proteins Occludin, ZO-1, and NLRP1, as shown through immunohistochemistry and Western blot analysis. In vitro, TXM-CB13 inhibited LPS-induced TLR4 signaling, reducing MyD88 levels and consequently attenuating the activation of the NF-κB pathways, including p-IκB-α/IκB-α and p-NF-κB-p65/NF-κB-p65. This inhibition further reduced the activation of the NLRP3 inflammasome components, NLRP3, ASC, Caspase-1, GSDMD, and IL-1β. In addition, TXM-CB13 prevented the ROS-mediated dissociation of TXNIP from TRX, inhibiting NLRP3 activation. These findings suggest that TXM-CB13 is a potential therapeutic candidate for IBD through its modulation of the TLR4/MyD88/NF-κB/NLRP3 and ROS/TXNIP/TRX/NLRP3 pathways.

Correlation of periodontitis with hepatic and intestinal inflammation and glycemic control, and effects of bioconverted Artemisia herba-alba by Lactiplantibacillus plantarum SMFM2016-RK

Periodontitis has been linked to systemic inflammation, however research on its role in causing systemic diseases remains limited. Recent studies explore probiotics for microbiome modulation and enhancing natural compound bioavailability. This study investigated periodontitis-related systemic disease mechanisms, and evaluated the mitigation effects of bioconversion product using Lactiplantibacillus plantarum SMFM2016-RK and Artemisia herba-alba extracts. Four types of bioconverted milk [BM1 (L. plantarum SMFM2016-RK), BM2 (BM1 + A. herba-alba ethanol extract), BM3 (BM1 + A. herba-alba hot-water extract), and BM4 (BM1+ both A. herba-alba extracts)] were studied in a periodontitis-induced rat model. Rats were divided into six groups: normal control, skim milk with ligature, and four BM groups with ligature.   Periodontitis induction elevated trabecular resorption (0.325 ± 0.057 mm³) and histopathological symptoms. Serum ALT (55.6 ± 6.6 U/L), glucose (261.7 ± 64.3 mg/dL), insulin (1.90 ± 0.87 ng/mL), inflammation in the liver and colon, and gluconeogenesis-related enzyme expression increased. Periodontitis-induced rats showed gut dysbiosis, with decreased Lactobacillaceae level and increased Oscillospiraceae level. BM3 administration significantly reduced the serum glucose (190.9 ± 27.8 mg/dL), ALT (40.5 ± 5.0 U/L), inflammation, and gluconeogenesis-related enzymes, while increasing tight junction proteins expression and phylum Actinobacteria levels in the gut microbiome. The findings highlight the systemic impact of periodontitis on inflammation, glycemic control, and gut microbiome balance. BM3 effectively alleviated these effects suggesting therapeutic potential.

The probiotic enhances donor microbiota stability and improves the efficacy of fecal microbiota transplantation for treating colitis

INTRODUCTION

The stability and metabolic functionality of donor microbiota are critical determinants of fecal microbiota transplantation (FMT) efficacy in inflammatory bowel disease (IBD). While probiotics show potential to enhance microbiota resilience, their role in optimizing donor microbiota for FMT remains underexplored.

OBJECTIVES

This study investigated whether pretreatment of donor microbiota with L. plantarum GR-4 could improve FMT outcomes in a DSS-induced colitis model by modulating microbial stability, metabolic activity, and host-microbiome interactions.

METHODS

Donor mice received L. plantarum GR-4 for 3 weeks to generate modified FMT (MFMT). DSS-colitis mice were treated with MFMT, conventional FMT, or 5-aminosalicylic acid (5-ASA). Multi-omics analyses and functional assays (stress resistance, engraftment efficiency) were used to evaluate therapeutic mechanisms.

RESULTS

GR-4 pretreatment conferred three key advantages to donor microbiota: Ecological stabilization: 1. GR-4-driven acidification (pH 3.97 vs. 4.59 for LGG, p < 0.0001) enriched butyrogenic Butyricicoccus (73 % butyrate increase, p < 0.05) and improved stress resistance to bile acids/gastric conditions (1.25 × survival vs. FMT). 2. Metabolic reprogramming: GR-4 metabolized 25.3 % of tryptophan (vs. 10.3 % for LGG) to generate immunomodulatory indoles (ILA, IAA), activating aryl hydrocarbon receptor (AHR) signaling and upregulating anti-inflammatory IL-10/IL-22. 3. Bile acid remodeling: MFMT restored sulfolithocholic acid and β-MCA levels, outperforming FMT in resolving DSS-induced dysregulation. MFMT achieved an 83 % remission rate (vs. 50 % for FMT), enhanced gut barrier integrity, and reversed colitis-associated metabolic dysregulation (e.g., elevated spermidine, 7-sulfocholic acid). Probiotic preconditioning improved donor engraftment by 1.25 × and enriched success-associated taxa (Sporobacter, Butyricimonas), while suppressing pathogens (Clostridium papyrosolvens).

CONCLUSIONS

L. plantarum GR-4 optimizes donor microbiota via pH-driven niche engineering, immunometabolic reprogramming, and bile acid modulation, addressing key limitations of conventional FMT. The multi-targeted efficacy of MFMT, evidenced by superior remission rates and metabolic restoration, establishes this approach as a translatable strategy for IBD therapy. This study establishes probiotic-enhanced FMT as a paradigm for precision microbiome interventions.

Gut Microbiota in Different Treatment Response Types of Crohn's Disease Patients Treated with Biologics over a Long Disease Course

Background and Aims: Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) with a globally increasing prevalence, partially driven by alterations in gut microbiota. Although biological therapy is the first-line treatment for CD, a significant proportion of patients experience a primary non-response or secondary loss of response over time. This study aimed to explore the differences in gut microbiota among CD patients with divergent long-term responses to biological therapy, focusing on a long disease course. Methods: Sixteen CD patients who applied the biological agents for a while were enrolled in this study and were followed for one year, during which fecal specimens were collected monthly. Metagenomic analysis was used to determine the microbiota profiles in fecal samples. The response to biological therapy was evaluated both endoscopically and clinically. Patients were categorized into three groups based on their response: R (long-term remission), mA (mild active), and R2A group (remission to active). The differences in the gut microbiota among the groups were analyzed. Results: Significant differences in fecal bacterial composition were observed between the groups. The R2A group exhibited a notable decline in gut microbial diversity compared to the other two groups (p < 0.05). Patients in the R group had higher abundances of Akkermansia muciniphila, Bifidobacterium adolescentis, and Megasphaera elsdenii. In contrast, Veillonella parvula, Veillonella atypica, and Klebsiella pneumoniae were higher in the R2A group. Conclusions: Gut microbial diversity and specific bacterial significantly differed among groups, reflecting distinct characteristics between responders and non-responders.

The systemic immune-inflammation index is superior to predicting clinical remission and relapse for ulcerative colitis patients treated with vedolizumab

Background

Vedolizumab (VDZ), a novel biologic targeting α4β7 integrin, is safe and effective for the treatment of patients with ulcerative colitis (UC). The objective of this study was to compare the potential of the Platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) in predicting clinical remission and treatment failure in patients with moderate-to-severe UC on VDZ therapy and to explore the risk factors for treatment failure.

Methods

Seventy-four UC patients treated with VDZ at our institution between December 1, 2020, and October 1, 2023, who had medical records were included in this study. We retrospectively collected baseline NLR, PLR, and SII values and assessed the predictive ability of the three indices for clinical remission and treatment failure using the receiver operating characteristic (ROC) curves.

Results

Patients in the severe group (n = 47) had significantly higher baseline PLR and SII values than those in the moderate group (n = 27) (p < 0.05). Patients with MES3 had significantly higher PLR and SII values than patients with MES2 (p < 0.05). At 14 weeks after VDZ treatment, 28 patients obtained steroid-free clinical remission, whereas 46 did not. The area under the ROC curve (AUC) for SII was 0.659 for predicting clinical remission and exhibited the best predictive ability. Of the 52 patients who achieved long-term remission, 35 patients responded consistently to VDZ, whereas 17 patients experienced disease relapse. The SII, with an AUC of 0.793, showed the best predictive ability (sensitivity: 94.1%; specificity: 57.1%; cut-off value: 602.0). Cox regression analysis revealed that SII ≥602.0, was a potential predictor of relapse after VDZ treatment in UC patients (p = 0.048, hazard ratio: 8.651; 95% confidence interval: 1.017-73.593).

Conclusion

The SII performed better than NLR and PLR in predicting clinical remission and relapse for UC patients on VDZ therapy. Moreover, patients with high SII may relapse after VDZ treatment and should be treated with caution.

High-throughput workflow for cultivation and characterization of gut microbiota strains with anti-inflammatory properties and metabolite signature associated with gut-brain communication

The gut microbiota is deeply interconnected with the brain, a phenomenon often referred to as the gut-brain axis. Dysfunction in the microbiota-gut-brain axis can cause various neurological and psychiatric disorders associated with chronic inflammation and gut microbiota dysbiosis. Therefore, cultivation of anaerobic human gut microbiota strains, and characterization of their safety status and immunomodulatory potential could contribute to deciphering the molecular mechanisms underlying the microbiota-gut-brain communication and revealed their biotherapeutic potential. However, poor cultivability of gut microbiota members, makes research into their physiological role challenging. Hence, we report a high-throughput workflow based on targeted cultivation linked to metagenome sequencing, combined with the bioinformatic search for gut members with anti-inflammatory properties which produce the most important microbial metabolites that affect brain function. With this approach, we isolated 147 bacterial strains, and 41 were characterized for their immunomodulatory status with 12 strains showing immunosuppressive features with ability of producing brain important metabolites. Through this workflow we established the best growing conditions essential for cultivation, archiving, phenotyping, and characterization of anaerobic gut bacteria important for microbiota-gut-brain-axis research, and characterized the safety and probiotic potential of 7 extremely oxygen-sensitive strains.

Heart rate variability, daily cortisol indices and their association with psychometric characteristics and gut microbiota composition in an Italian community sample

The microbiota-gut-brain axis is a complex communication system that plays a crucial role in influencing various aspects of our physical and mental health. The goal of this study was to determine the extent to which individual differences in resting measures of vagally-mediated heart rate variability (HRV) and cortisol levels were associated with psychometric and specific gut microbiota characteristics in seventy-five (38 females) healthy individuals. Participants were assessed for vagally-mediated HRV, daily salivary cortisol levels, psychometric characteristics, and gut microbiota composition. Using a categorical approach based on the median split of HRV and cortisol values, we identified an association between low vagally-mediated HRV, greater depressive symptomatology, and altered gut microbiota (e.g., a higher abundance of Prevotella and a smaller abundance of Faecalibacterium, Alistipes, and Gemmiger). This suggests that vagally-mediated HRV may be a useful biomarker of microbiota-gut brain axis function, and that low vagally-mediated HRV may play an important role in the bidirectional link between gut dysbiosis and depression. On the other hand, daily cortisol parameters (e.g., cortisol awakening response, diurnal cortisol slope) were associated either with higher anxiety and perceived stress, or with a specific gut microbiota profile. Therefore, their utility as biomarkers of microbiota-gut-brain axis function needs further scrutiny.

Comparative Efficacy of Subcutaneous Versus Intravenous Interleukin 12/23 Inhibitors for the Remission of Moderate to Severe Crohn's Disease: A Systematic Review and Meta-Analysis

Background/Objectives: Interleukin 12/23 inhibitors are a newer class of monoclonal antibodies used to induce and maintain remission for Crohn's disease (CD), a chronic inflammatory bowel disease, when patients do not respond to conventional immunomodulatory drugs or first-line monoclonal antibody therapies. Although biologics are best administered intravenously, subcutaneous administration has been trialed, with mixed results. This research synthesized evidence on the efficacy and safety of subcutaneous compared to intravenous administration of interleukin 12/23 inhibitors for moderate to severe CD. Methods: In this systematic review and meta-analysis, we searched Cochrane, PubMed, SCOPUS, CINHAL, and preprint archives for randomized controlled trials (RCTs) that compared the efficacy and safety of subcutaneous to intravenous interleukin 12/23 inhibitors for the remission of CD. After study quality assessment, a meta-analysis was carried out using a bias-adjusted inverse variance heterogeneity model, heterogeneity was assessed using I2, and publication bias was performed using Doi plots. Evidence certainty was assessed using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Results: Seven RCTs, with 2179 participants, all with moderate to severe CD, were included. After meta-analysis, subcutaneous compared to intravenous administration showed similar efficacy for the induction of remission (OR 0.77, 95%CI 0.53-1.12), with no-to-low heterogeneity (I2 = 0%, p = 0.97). For the maintenance of remission, only two studies had analyzable data, and they showed that subcutaneous interleukin 12/23 inhibitors were equal or better compared to intravenous administration. Further syntheses showed that subcutaneous compared to intravenous administration of interleukin 12/23 inhibitors had almost similar odds of adverse events (OR 0.91, 95%CI 0.63-1.32, I2 = 39%), serious adverse events (OR 0.97, 95%CI 0.61-1.53, I2 = 0%), and treatment discontinuation (OR 1.06, 95%CI 0.67-1.68, I2 = 0%). Conclusions: In individuals with moderate to severe CD, subcutaneous administration has similar efficacy for inducing remission with comparable safety. More RCTs are needed to confirm these findings.

Draft genome sequence of Lactobacillus rhamnosus C25, isolated from an Indian dairy cheese

We announce here the draft genome sequence of Lacticaseibacillus rhamnosus C25, a lactic acid bacterium participating in fermentation processes and having probiotic potential, isolated from Cheddar cheese. The C25 genome is 2.97 Mb in size, comprising 2,885 gene sequences assembled into 62 scaffolds.

Gut microbiome reveals the trophic variation and significant adaption of three sympatric forest-dwelling ungulates on the eastern Qinghai-Xizang Plateau

BACKGROUND

The gut microbiome of herbivorous mammals regulates numerous physiological processes, including digestion and energy metabolism. The complex stomach architecture of ruminants, in conjunction with the metabolic capabilities of their microbiota, confers a considerable adaptive advantage to these animals. Nevertheless, a significant gap persists in comparative studies on the variations in the gut microbiome among sympatric ruminants and their potential adaptive implications. Accordingly, in this study, 16S rRNA gene sequencing and metagenomic approaches were used to analyse the composition and functional attributes of the gut microbiome of sympatric Moschus chrysogaster, Capricornis sumatraensis, and Cervus albirostris inhabiting the eastern periphery of the Qinghai-Xizang Plateau.

RESULTS

The gut microbiome of C. albirostris exhibited a higher diversity than that of M. chrysogaster and C. sumatraensis, whereas those of M. chrysogaster and C. sumatraensis were similar. Although species-specific variations existed among the three mammalian microbiomes, the microbiomes of C. albirostris and C. sumatraensis were more similar, whereas that of M. chrysogaster was markedly distinct. Metagenomic analysis revealed a pattern of functional convergence in the gut microbiome of the three species, with the gut microbiome of C. albirostris exhibiting a pronounced emphasis on carbohydrate metabolism, significantly surpassing that of M. chrysogaster and C. sumatraensis. Compared to the other two species, the gut microbiome of C. sumatraensis presented significantly elevated levels of amino acids and energy metabolism, whereas that of M. chrysogaster presented an increased capacity for 3-hydroxyacyl- [acyl carrier protein]-dehydratase production.

CONCLUSION

These findings suggest that the gut microbiome of sympatric M. chrysogaster, C. sumatraensis, and C. albirostris tend to converge. Metabolic variations within their gut microbiome may result in differential food resource utilisation, potentially indicating significant nutritional and ecological trait characteristics for stable coexistence.

Artificial Intelligence-Driven Personalized Medicine: Transforming Clinical Practice in Inflammatory Bowel Disease

Inflammatory bowel disease is marked by significant clinical heterogeneity, posing challenges for accurate diagnosis and personalized treatment strategies. Conventional approaches, such as endoscopy and histology, often fail to adequately and accurately predict medium- and long-term outcomes, leading to suboptimal patient management. Artificial intelligence is emerging as a transformative force enabling standardized, accurate, and timely disease assessment and outcome prediction, including therapeutic response. Artificial intelligence-driven intestinal barrier healing assessment provides novel insights into deep healing, facilitating the discovery of novel therapeutic targets. In addition, the automated integration of multi-omics data can enhance patient profiling and personalized management strategies. The future of inflammatory bowel disease care lies in the artificial intelligence-enabled "endo-histo-omics" integrative real-time approach, harmoniously fusing endoscopic, histologic, and molecular data. Despite challenges in its adoption, this paradigm shift has the potential to refine risk stratification, improve therapeutic precision, and enable personalized interventions, ultimately advancing the implementation of precision medicine in routine clinical practice.

Microbiota in inflammatory bowel disease: mechanisms of disease and therapeutic opportunities

Perturbations in the intestinal microbiome are strongly linked to the pathogenesis of inflammatory bowel disease (IBD). Bacteria, fungi and viruses all make up part of a complex multi-kingdom community colonizing the gastrointestinal tract, often referred to as the gut microbiome. They can exert various effects on the host that can contribute to an inflammatory state. Advances in screening, multiomics and experimental approaches have revealed insights into host-microbiota interactions in IBD and have identified numerous mechanisms through which the microbiota and its metabolites can exert a major influence on the gastrointestinal tract. Looking into the future, the microbiome and microbiota-associated processes will be likely to provide unparalleled opportunities for novel diagnostic, therapeutic and diet-inspired solutions for the management of IBD through harnessing rationally designed microbial communities, powerful bacterial and fungal metabolites, individually or in combination, to foster intestinal health. In this Review, we examine the current understanding of the cross-kingdom gut microbiome in IBD, focusing on bacterial and fungal components and metabolites. We examine therapeutic and diagnostic opportunities, the microbial metabolism, immunity, neuroimmunology and microbiome-inspired interventions to link mechanisms of disease and identify novel research and therapeutic opportunities for IBD.

Microbiome functional gene pathways predict cognitive performance in older adults with Alzheimer's disease

Disturbances in the gut microbiome is increasing correlated with neurodegenerative disorders, including Alzheimer's Disease. The microbiome may in fact influence disease pathology in AD by triggering or potentiating systemic and neuroinflammation, thereby driving disease pathology along the "microbiota-gut-brain-axis". Currently, drivers of cognitive decline and symptomatic progression in AD remain unknown and understudied. Changes in gut microbiome composition may offer clues to potential systemic physiologic and neuropathologic changes that contribute to cognitive decline. Here, we recruited a cohort of 260 older adults (age 60+) living in the community and followed them over time, tracking objective measures of cognition, clinical information, and gut microbiomes. Subjects were classified as healthy controls or as having mild cognitive impairment based on cognitive performance. Those with a diagnosis of Alzheimer's Diseases with confirmed using serum biomarkers. Using metagenomic sequencing, we found that relative species abundances correlated well with cognition status (MCI or AD). Furthermore, gene pathways analyses suggest certain microbial metabolic pathways to either be correlated with cognitive decline or maintaining cognitive function. Specifically, genes involved in the urea cycle or production of methionine and cysteine predicted worse cognitive performance. Our study suggests that gut microbiome composition may predict AD cognitive performance.

Faecalibacterium prausnitzii Colonization Attenuates Gut Inflammation and Epithelial Damage in a DSS-Induced Colitis Mice Model

Background: Reduction of Faecalibacterium prausnitzii abundance is related to inflammatory bowel diseases (IBDs), and supplement of it exists protective effects. Aim: This study aimed to establish a F. prausnitzii-colonized mouse model and investigate that the presence of F. prausnitzii in the gut can ameliorate the severity of dextran sulfate sodium (DSS)-induced colitis. Methods: A F. prausnitzii (ATCC 27768) strain was maintained on the PS-BHI agar plates and manipulated in a strictly anaerobic chamber. A F. prausnitzii-colonized C57BL/6 mice model was tested by a rectal enema with 1 × 109 bacteria/day for 3 days. The 5% DSS was added to drinking water for 3 days to induce colitis and diarrhea in experimental mice. The clinical, cytological, and histological severities were compared between groups. Results: The F. prausnitzii-colonized mice model was successfully established via rectal enema with the property of transfer to offspring. DSS treatment altered gut microbiota and significantly attenuated the abundance of F. prausnitzii in colonized mice. Mice with F. prausnitzii colonization had significantly improved weight loss, anal bleeding, stool consistency, cecum weight, colon length, and serum amyloid A (SAA) level than those without after DSS treatment. Furthermore, the F. prausnitzii-colonized mice significantly reduced the transcription levels of TNF-α, INF-γ and IL-18, and epithelial damage and PMN infiltration in the lamina propria and had better preservation of goblet cells than the control group. Conclusion: We have successfully established a mouse model colonized with F. prausnitzii via rectal enema administration and showed colonization of F. prausnitzii in the gut has a protective effect against DSS-induced colitis.

Superb Microvascular Imaging Is Superior to Doppler Imaging in Ruling Out Ulcerative Colitis Disease Activity

BACKGROUND

There is an unmet medical need for noninvasive techniques to determine disease activity in inflammatory bowel disease (IBD) and intestinal ultrasound (IUS) has shown promising performance in this regard. In addition to parameters such as bowel wall thickness, stratification, and mesenteric fat, color Doppler signals are used to determine inflammatory activity in the gut. However, whether superb microvascular imaging (SMI), a microvascular flow imaging technique, improves the diagnostic accuracy is currently unclear.

METHODS

We performed a prospective single-center cross-sectional cohort study including 62 patients with ulcerative colitis (UC). IUS was performed on the sigmoid colon within 30 days of colonoscopy and the International Bowel Ultrasound (IBUS) group Segmental Activity Score (SAS) as well as SMI signals were determined and correlated to established endoscopic, clinical, and biochemical read-outs of disease activity.

RESULTS

Semiquantitative scoring of SMI signals had a substantial interobserver agreement between 2 blinded and expert central readers. It showed excellent correlation to endoscopic, clinical, and biochemical disease activity. While SMI did not improve the overall diagnostic performance of the IBUS-SAS to predict endoscopic disease activity, SMI alone was highly precise and superior to Doppler imaging in predicting endoscopic remission.

CONCLUSIONS

IUS is a highly precise noninvasive diagnostic tool to monitor disease activity in UC, in particular for predicting endoscopic remission. Assessing the SMI signals in the bowel wall of patients with IBD seems a promising tool to simplify IUS diagnostics in IBD that warrants further research.

Small Bowel Motility Quantified by Cine MRI to Predict Longer-Term Response in Patients with Crohn's Disease Commencing Biological Therapy: The Motility Study

BACKGROUND

Small bowel Crohn's disease (SBCD) is increasingly treated with biological therapies. Predicting response or remission (RoR) for individual patients is difficult and complicates treatment strategy. We aimed to determine if motility magnetic resonance imaging (mMRI) is superior to CRP and fecal calprotectin (FC) for the prediction of RoR at 1 year in patients commencing biologics for SBCD.

METHODS

Prospective, multicenter (n = 13) cohort study of patients with active non-stricturing SBCD requiring anti-TNFα or anti-IL-12/23 treatment. We measured mMRI and CRP at baseline and post-induction (visit 2: 12-30 weeks), and FC in a subset. RoR was assessed at 1 year using clinical and structural magnetic resonance enterography parameters. We compared sensitivity, specificity, and area under the receiver operating characteristic curve (ROC-AUC) of changes in mMRI and CRP to predict RoR at 1 year. Secondary outcomes compared mMRI with FC, and prediction of improved quality of life (QoL).

RESULTS

Eighty-six participants completed all assessments. Stable or improved mMRI at visit 2 was more sensitive than normalization of CRP for RoR (mMRI:71.0%, 95%CI 52.0-85.8; CRP:45.2%, 95%CI 27.3-64.0%, P = .008) but less specific (mMRI:30.9%, 95%CI 19.1-44.8; CRP:67.3%, 95%CI 53.3-79.3%, P < .001). There was no significant difference in ROC-AUC (mMRI:0.48; CRP:0.53, P = .65). Similar results were obtained for FC. None of mMRI, CRP, or FC predicted patient QoL at 1 year.

CONCLUSIONS

Although improved mMRI is more sensitive than CRP and FC to predict RoR at 1 year, it is less specific. No factor predicted patient QoL. Motility MRI remains a marker of disease activity at given timepoints.

Relapse Rates and Predictors for Relapse in Ulcerative Colitis and Crohn's Disease Patients After Discontinuation of Vedolizumab or Ustekinumab: The REVEUS Study

Background/Objectives: In the current era of tailored therapy, biologics such as vedolizumab (VDZ) and ustekinumab (UST) are increasingly administered to inflammatory bowel disease (IBD) patients. The decision to discontinue biologics after side effects or a lack of response is usually simple, but the decision to stop treatment in patients in remission is more difficult: to date, no study has been conducted to investigate the effects of VDZ or UST withdrawal. Our study aims to investigate the rates and predictors of relapse of IBD after the discontinuation of VDZ and UST during a well-controlled disease phase and to evaluate the response to retreatment. Methods: In this observational, multicenter, retrospective study, we included IBD patients who discontinued VDZ or UST during a well-controlled disease phase after at least 1 year of treatment. We collected demographic and clinical data for each patient at the time of discontinuation and at follow-up visits. Results: We included 36 IBD patients from 5 different centers; 80.0%, 58.5%, and 48.3% of patients maintained clinical remission at 12, 24, and 48 months after discontinuation, respectively. Crohn's disease (CD) patients were more likely to maintain remission than ulcerative colitis (UC) patients at 48 months (70.0% vs. 40.0%). No predictors of relapse were identified, but UC patients had a higher risk of early relapse than CD patients (HR = 3.23); 81.3% of retreated IBD patients achieved clinical remission after induction and at 12 months. Conclusions: No predictors of disease relapse after treatment discontinuation were identified. Half of the patients had a relapse within 48 months after discontinuation, but most of them achieved clinical remission after retreatment.

Butyrate-producing Faecalibacterium prausnitzii suppresses natural killer/T-cell lymphoma by dampening the JAK-STAT pathway

BACKGROUND

Natural killer/T-cell lymphoma (NKTCL) is a highly aggressive malignancy with a dismal prognosis, and gaps remain in understanding the determinants influencing disease outcomes.

OBJECTIVE

To characterise the gut microbiota feature and identify potential probiotics that could ameliorate the development of NKTCL.

DESIGN

This cross-sectional study employed shotgun metagenomic sequencing to profile the gut microbiota in two Chinese NKTCL cohorts, with validation conducted in an independent Korean cohort. Univariable and multivariable Cox proportional hazards analyses were applied to assess associations between identified marker species and patient outcomes. Tumour-suppressing effects were investigated using comprehensive in vivo and in vitro models. In addition, metabolomics, RNA sequencing, chromatin immunoprecipitation sequencing, Western blot analysis, immunohistochemistry and lentiviral-mediated gene knockdown system were used to elucidate the underlying mechanisms.

RESULTS

We first unveiled significant gut microbiota dysbiosis in NKTCL patients, prominently marked by a notable reduction in Faecalibacterium prausnitzii which correlated strongly with shorter survival among patients. Subsequently, we substantiated the antitumour properties of F. prausnitzii in NKTCL mouse models. Furthermore, F. prausnitzii culture supernatant demonstrated significant efficacy in inhibiting NKTCL cell growth. Metabolomics analysis revealed butyrate as a critical metabolite underlying these tumour-suppressing effects, validated in three human NKTCL cell lines and multiple tumour-bearing mouse models. Mechanistically, butyrate suppressed the activation of Janus kinase-signal transducer and activator of transcription pathway through enhancing histone acetylation, promoting the expression of suppressor of cytokine signalling 1.

CONCLUSION

These findings uncover a distinctive gut microbiota profile in NKTCL and provide a novel perspective on leveraging the therapeutic potential of F. prausnitzii to ameliorate this malignancy.

From big data and experimental models to clinical trials: Iterative strategies in microbiome research

Microbiome research has expanded significantly in the last two decades, yet translating findings into clinical applications remains challenging. This perspective discusses the persistent issue of correlational studies in microbiome research and proposes an iterative method leveraging in silico, in vitro, ex vivo, and in vivo studies toward successful preclinical and clinical trials. The evolution of research methodologies, including the shift from small cohort studies to large-scale, multi-cohort, and even "meta-cohort" analyses, has been facilitated by advancements in sequencing technologies, providing researchers with tools to examine multiple health phenotypes within a single study. The integration of multi-omics approaches-such as metagenomics, metatranscriptomics, metaproteomics, and metabolomics-provides a comprehensive understanding of host-microbe interactions and serves as a robust hypothesis generator for downstream in vitro and in vivo research. These hypotheses must then be rigorously tested, first with proof-of-concept experiments to clarify the causative effects of the microbiota, and then with the goal of deep mechanistic understanding. Only following these two phases can preclinical studies be conducted with the goal of translation into the clinic. We highlight the importance of combining traditional microbiological techniques with big-data approaches, underscoring the necessity of iterative experiments in diverse model systems to enhance the translational potential of microbiome research.

The Short- and Long-Term Effects of a Short Course of Sauerkraut Supplementation on the Gut Microbiota of Active Athletes: A Pilot Follow-Up Study

Objectives: The application of whole fermented foods in sports nutrition for gut microbiota personalization is a promising area of investigation. Sauerkraut, a traditional fermented food, has not been extensively studied in this context. This study aimed to replicate earlier findings of a proof-of-concept study on the potential of sauerkraut for gut microbiota personalization in active athletes. Methods: A pilot follow-up study was conducted on active recreational athletes who consumed 250 g of organic pasteurized sauerkraut daily for 10 days. Changes in gut microbiota composition and functionality were assessed using 16S rRNA sequencing and metabolic pathway analysis across three time points: pre-intervention, postintervention, and one-month postintervention. Laboratory parameters, bowel function, and side effects were monitored throughout the study. Results: In total, 11 male participants with an average age of 30 years completed the study. The pilot follow-up study did not replicate the original study's findings on sauerkraut's short-term effects on β-diversity and taxonomic and functional groups. However, long-term effects of sauerkraut supplementation were demonstrated, including a significant reduction in α-diversity variance and increased gut microbiota composition similarity (β-diversity) as well as several significant changes in bacterial taxa and metabolic pathways after a washout period. The intervention also induced a transient decrease in B12 vitamin levels and a short- and long-term increase in leukocyte concentrations. The probability for physiological types of stools increased after one week of sauerkraut supplementation as well as the incidence of gastrointestinal side effects, such as bloating, diarrhea, pain, nausea, and constipation. Conclusions: This study suggests that the short-term effects on the gut microbiota of sauerkraut supplementation depend on its baseline status, but it can induce long-term effects. Sauerkraut supplementation requires a seven-day adaptation period. Further research is needed to explore the mechanisms behind the short- and long-term effects of sauerkraut supplementation.

Characterization of Salivary Microbiota in Japanese Patients with Oral Cancer

This study aimed to characterize salivary microbiota in patients with oral cancer using 16S rRNA amplicon sequencing. DNA was extracted from saliva samples of 23 patients with oral cancer and 95 age-matched controls. A metagenomic analysis was performed using 16S rRNA amplicon sequencing. Patients with oral cancer exhibited lower α-diversity, as indicated by the Chao-1 index, compared to the control group, and significant differences in β-diversity were observed between the two groups. At the genus level, 25 bacterial species such as Lautropia, Megasphaera, Lactobacillus, Kingella, Gemella, Staphylococcus, and Propionibacterium were identified in patients with oral cancer, with more than half being Gram-positive facultative anaerobes or anaerobes. The reduced bacterial diversity in saliva of patients with oral cancer suggests dysbiosis during oral carcinogenesis may contribute to changes in bacterial distribution within the oral cavity.

Fecal microbiota transplantation restores gut microbiota diversity in children with active Crohn's disease: a prospective trial

BACKGROUND

Clinical data on oral fecal microbiota transplantation (FMT), a promising therapy for Crohn's disease (CD), are limited. Herein, we determined the short-term safety and feasibility of FMT for pediatric patients with active CD.

METHODS

In this open-label, parallel-group, single-center prospective trial, patients with active CD were treated with oral FMT capsules combined with partial enteral nutrition (PEN) (80%). The control group comprised pediatric patients with active CD treated with PEN (80%) and immunosuppressants. Thirty-three patients (11.6 ± 1.82 years)-17 in the capsule and 16 in the control groups-were analyzed. Data regarding the adverse events, clinical reactions, intestinal microbiome composition, and biomarker parameters were collected and compared post-treatment.

RESULTS

At week 10, the clinical and endoscopic remission rates did not differ between the two groups. By week 10, the mean fecal calprotectin level, C-reactive protein level, erythrocyte sedimentation rate, simple endoscopic score for CD, and pediatric CD activity index decreased significantly in the capsule group (all P < 0.05). The main adverse event was mild-to-moderate constipation. Core functional genera, Agathobacter, Akkermansia, Roseburia, Blautia, Subdoligranulum, and Faecalibacterium, were lacking pre-treatment. Post-treatment, the implantation rates of these core functional genera increased significantly, which positively correlated with the anti-inflammatory factor, interleukin (IL)-10, and negatively correlated with the pro-inflammatory factor, IL-6. The combination of these six functional genera distinguished healthy children from those with CD (area under the curve = 0.96).

CONCLUSIONS

Oral FMT capsules combined with PEN (80%) could be an effective therapy for children with active CD. The six core functional genera identified here may be candidate biomarkers for identifying children with CD.

TRIAL REGISTRATION

ClinicalTrials.gov, retrospectively registered, ID# NCT05321758, NCT05321745, date of registration: 2022-04-04.

Cancer Characteristics, Prognoses, and Mortality of Colorectal Cancer in Patients With Crohn's Disease-A Danish Nationwide Cohort Study, 2009-2019

BACKGROUND AND AIMS

The aim of this study was to investigate the impact of Crohn's disease (CD) on patient and cancer characteristics and mortality in patients with colorectal cancer (CRC).

METHODS

This was a nationwide cohort study of patients diagnosed with CRC in Denmark from 1 January, 2009 to 31 December, 2019. Cancer characteristics were retrieved from the Danish Colorectal Cancer Group registry and merged with a nationwide cohort for inflammatory bowel disease. The main outcome was all-cause mortality in CRC patients with and without CD, comparing CD patients with CRC with those in the general CRC population (non-CD CRC), evaluated by adjusted Cox regression analysis and propensity score matching.

RESULTS

Of 38 077 CRC patients, 245 (0.6%) had CD. The median age at cancer diagnosis was 69 years (interquartile range [IQR]: 60-76) for CD-CRC and 71 years (IQR: 64-78) for non-CD CRC (p < 0.001). Most cancers were located in the right colon in the CD-CRC group. CD was not associated with increased all-cause mortality in the cohort overall. CD patients with colon and rectal cancers and UICC Stage III tumors had a higher mortality rate in both multivariate {hazard ratio (HR) 1.60 (95% confidence interval [95% CI], 1.13-2.27), p = 0.008} and univariate analyses (HR 1.57 [95% CI, 1.11-2.22], p = 0.011). In the propensity score-matched analysis, CD was not associated with increased mortality for colon cancer (HR 1.06 [0.82-1.36], p = 0.7) or rectal cancer (HR 1.25 [0.79-1.98], p = 0.3).

CONCLUSIONS

This nationwide study identified distinct features of colon and rectal cancers in patients with CD that have implications for the timing of diagnoses, disease course, and mortality specifically in UICC Stage III disease.

Gut microbiome in dermatology - A narrative review

The gut microbiome and human body have co-evolved in a synergistic host-microbial relationship. The ideal composition of human gut microbiota is an elusive concept, but every individual has a unique gut microbiota profile with regional differences. Newer diagnostic techniques have helped identify different bacteria and their roles in health and disease. The gut microbiome composition is affected by various factors like age, diet, immune system, environmental factors, exercise, and drugs. The microbiome has varied roles in metabolism, immune response, immune tolerance and antimicrobial protection. Diet plays an important role in maintaining the gut microbial diversity. Loss of homoeostasis in the microbiome results in dysbiosis. Dysbiosis plays a role in many dermatological diseases like atopic dermatitis, psoriasis, acne, rosacea, hidradenitis suppurativa, connective tissue disorders and many other systemic conditions like obesity, diabetes, neurological disease and malignancy. Reconstitution of the gut microbiome ecology in the form of bacteriotherapy with the reintegration of certain strains of microbiota has a beneficial role in many of these disorders.

Amelioration of metabolic syndrome in high-fat diet-fed mice by total sesquiterpene lactones of chicory via modulation of intestinal flora and bile acid excretion

Chicory (Cichorium intybus L.) is a commonly used vegetable in Europe and is also regarded as a plant for both medicinal and edible uses in China. Chicory exhibits a substantial abundance of sesquiterpene lactone compounds within its composition. The prevalence of metabolic syndrome (MetS) is increasing and has become a global public health issue threatening the well-being of the general population. Recent studies have identified plant secondary metabolites as potential substances for treating MetS. Sesquiterpene lactones, a type of secondary metabolite with diverse biological activities, have been reported to exhibit anti-inflammatory effects, reduce lipid accumulation, and normalize blood glucose levels. However, the therapeutic effects of chicory sesquiterpene lactones on MetS remain to be explored, and little is known about sesquiterpene lactones' effects on intestinal flora and bile acids (BAs). Therefore, the effects of total sesquiterpene lactones (TSLs) from chicory on metabolic disorders, intestinal flora, and BAs were investigated in this study. In this study, C57BL/6J mice were fed a high-fat diet (HFD) for 8 weeks, followed by administration of TSLs, total chicory extract (TCE), and pioglitazone (Pio) for another 8 weeks. TSL, TCE, and Pio interventions reduced body weight gain, hepatic lipid accumulation, and lipogenesis in HFD-fed mice and attenuated plasma biochemical parameters. Among them, TSLs exhibited more significant effects, prompting further analysis of their impact on intestinal flora and bile acid metabolism. TSL intervention influenced the composition and structure of intestinal flora and BAs. TSL intervention impacted the composition and structure of the intestinal flora, characterized by a decrease in the abundances of Allobaculum, unidentified_Coriobacteriaceae, and Odoribacter, while the abundances of Prevotella, unidentified_Erysipelotrichaceae and Akkermansia were increased. Additionally, the levels of BAs TCDCA, GDCA, UDCA, 12-ketoLCA, 7-ketoLCA, and 6,7-diketoLCA were reduced. The research results indicated that TSLs from chicory may serve as potential agents for regulating metabolic abnormalities associated with MetS, as their effects can influence intestinal flora and BAs. The conclusions of this study are expected to open new research trajectories in the field of food science and nutrition, providing a solid scientific basis and innovative intervention approaches for the development of strategies targeting MetS prevention and management.

Circulating Extracellular Matrix Products as Indicators of Disease Burden and Predictors of Disease Course in Ulcerative Colitis

BACKGROUND

Ulcerative colitis (UC) is characterized by recurrent inflammation and challenging disease monitoring, with invasive endoscopy as the primary diagnostic tool despite the inadequacy of standard noninvasive biomarkers. This study evaluates serum extracellular matrix (ECM) fragments, which reflect the remodeling of mucosa and submucosa, as potential indicators of disease burden and treatment efficacy. We aim to determine whether serum ECM levels correlate with the extent and severity and predict treatment response.

METHODS

We conducted a prospective study comparing serum ECM formation (PRO-C3, PRO-C7, PRO-C11, PRO-C22), turnover (PRO-C4), and degradation markers (C1M, C3M, C4M, C7M) at Weeks 0, 12, and 24 in 49 UC patients and 50 healthy controls measured by enzyme-linked immunosorbent assay.

RESULTS

ECM biomarkers, notably PRO-C11, differentiated UC patients from controls (area under the curve [AUC] 0.77), and PRO-C3 predicted endoscopic treatment response vs nonresponse (AUC 0.74). C7M separated moderate from severe disease in endoscopy (AUC 0.74) as well as mild from severe disease (AUC 0.84), as did the ratio C7M/PRO-C7 (AUC 0.82). Combining new and conventional markers, including hemoglobin, C-reactive protein, PRO-C3, and PRO-C22, achieved a combined AUC of 0.84 for predicting 24-week endoscopic response, adding index endoscopic activity increased the AUC to 0.92 compared to an AUC of 0.84 for endoscopy alone.

CONCLUSIONS

Soluble ECM fragments reflect endoscopic disease severity and extent and are also predictive of therapeutic efficacy. They may as well reflect degenerative aspects of UC and may as such be future therapeutic targets aimed at prevention of intestinal damage.

Deaminase inhibitor and casein hydrolysates drive microbial shifts favoring Campylobacter jejuni in an in vitro poultry cecal model

AIM

The dietary proteins in poultry feeds, including the polypeptide chain size, influence gut microbial composition and function. This study assessed the microbial preference for peptide size using the same protein source in three polypeptide forms.

METHODS AND RESULTS

We investigated the effects of diphenyliodonium chloride (DIC) on poultry cecal microbiota inoculated with Campylobacter jejuni and supplemented with various casein hydrolysates (intact casein, enzyme hydrolysate, acid hydrolysate, and a mix of all three) using an in vitro cecal model. The incubation occurred over 18 h at 42°C under microaerophilic conditions. We hypothesized a decrease in C. jejuni abundance by limiting nitrogenous metabolites while promoting the growth of protein fermentative bacteria. Additionally, we speculated that the response to DIC would vary with different polypeptides. Genomic DNA was extracted, amplified, and sequenced on an Illumina MiSeq platform. Analysis within QIIME2-2021.11 showed that DIC treatments did not significantly affect C. jejuni abundance but drastically decreased Enterobacteriaceae abundance (ANCOM, P < 0.05). DIC-treated groups exhibited a more stable community structure, especially in the peptide-amended group. Microbial interactions likely aided C. jejuni survival in DIC groups with casein hydrolysates. Methanocorpusculum, Phascolarctobacterium, and Campylobacter formed a core microbial community in both DIC-treated and non-treated groups. DIC altered co-occurrence patterns among core members and differentiated taxa in abundance in acid and peptide-DIC treated groups, changing negative relationships to positive ones (Spearman's Correlation, P < 0.05). Variations in polypeptide composition affected metabolite abundance, notably impacting the urea cycle in Campylobacter and Clostridiaceae. DIC shifted communal energy metabolism in microbiota on casein sources.

CONCLUSION

Campylobacter's adaptability to the deaminase inhibitor indicates reliance on the microbial community and their metabolic products, showcasing its metabolic versatility.

Antibiotic Resistance Gene Expression in Veterinary Probiotics: Two Sides of the Coin

The rapid proliferation of antimicrobial resistance has emerged as one of the most pressing animal and public health challenges of our time. Probiotics, extensively employed in human and veterinary medicine, are instrumental in maintaining a balanced microbiome and mitigating its disruption during antibiotic therapy. While their numerous benefits are well documented, probiotics also present potential risks, notably the capacity to harbor antimicrobial resistance genes. This genetic reservoir could contribute to the emergence and spread of antimicrobial resistance by facilitating the horizontal transfer of resistance genes to pathogenic bacteria within the gut. This review critically examines the presence of antimicrobial resistance genes in commonly used probiotic strains, explores the underlying mechanisms of resistance, and provides a balanced analysis of the benefits and risks associated with their use. By addressing these dual aspects, this paper highlights the need for vigilant evaluation of probiotics to preserve their therapeutic potential while minimizing public health risks.

How to Approach the Difficult Perineum in Crohn's Disease

Crohn's disease (CD) is a chronic, inflammatory bowel disease with a wide range of presentations, including perianal disease. Presentation is variable, ranging from skin tags to complex fistulas, strictures, and nonhealing wounds. Symptoms of perianal CD can be devastating and may impact quality of life. Optimal management requires coordinated medical and surgical therapy. When possible, conservative treatment of perianal disease should be attempted. However, surgical treatment is often required, and some patients may ultimately require total proctocolectomy with permanent diversion due to the severity of disease. Even with close attention and treatment, disease can be recurrent, and complications of treatment are sometimes worse than the initial presentation. Novel treatments, including use of mesenchymal stem cells and autologous fat grafting, hold some promise, but are not yet widely available. Thorough knowledge of treatment options, careful patient selection, coordination between medical and surgical providers, and setting realistic expectations are important in the successful treatment of difficult perineal CD.

Sulfoglycolysis sustains Eubacterium rectale in low-fiber diets

The production of short-chain fatty acids (SCFAs) by Firmicutes (Bacillota) within the human gastrointestinal tract is recognized as critical for gut health and the progression of a range of disease states. Firmicutes are the most diverse phylum of human gut bacteria, are highly studied, and are often specialized to degrade just a few polysaccharide substrates. Members of the Firmicutes include key bacteria that produce butyrate, an SCFA that is generally not produced by members of the other major phyla. Recently, it was shown that Eubacterium rectale, a widespread member of the Firmicutes belonging to the Clostridiales cluster XIVa, can grow on the unusual but ubiquitous plant-derived sugar SQ using a sulfoglycolytic sulfofructose transaldolase pathway. Here, we show that in addition to SQ, E. rectale can also grow on the SQ glycoside sulfoquinovosyl glycerol (SQGro). The 3D structure of the E. rectale sulfoquinovosidase (SftG) shares strong structural conservation with other carbohydrate-active enzyme family GH31 SQases. Using sequence-similarity networks, we provide new biological context to a conserved domain of unknown function protein SftX belonging to DUF4867, which is conserved in the sulfoglycolytic sulfofructose transaldolase pathway, and determine its 3D structure. Finally, with the aid of a synthetic mini-human microbiome reconstituted in germ-free mice, we show that an SQ dietary supplement can rescue E. rectale from population crashes that occur upon switching from a high-fiber to a low-fiber, high-fat diet. This suggests that SQ or SQGro has the potential as a prebiotic for promoting the maintenance of this important butyrate-producing bacterium within the colonic microbiota.

Long-term outcome of pediatric acute severe colitis: A prospective 5-year follow-up of the PRASCO trial

OBJECTIVES

The PRASCO trial reported the short-term superiority of an antibiotic cocktail plus intravenous corticosteroids (IVCS) over IVCS alone in children with acute severe colitis (ASC). Here, we report the extension of the PRASCO trial and the long-term outcomes of the antibiotic cocktail in ASC.

METHODS

This prospective follow-up of the PRASCO trial documented disease outcomes and treatments annually through 5 years. The primary outcome was colectomy, and the secondary outcome was escalation to biologics, analyzed descriptively.

RESULTS

A total of 26 children were included (12 receiving IVCS and 14 receiving IVCS + antibiotics), 19% of whom underwent colectomy during the follow-up period. The estimated probability of colectomy at 3, 6, and 12 months from admission were 7.1%, 7.1%, and 21% with IVCS + antibiotics and 0%, 8.3%, and 17% with IVCS. No children required colectomy after the first year of follow-up. The estimated probability of escalating to biologics were 66%, 77%, and 77% after 1, 2, and 3 years with IVCS + antibiotics and 42%, 51%, and 76% with IVCS. Clinical remission was higher in the IVCS + antibiotics group at each timepoint (e.g., 30% vs. 11% at 5-years). Delta of Pediatric Ulcerative Colitis Activity Index (PUCAI) score from baseline to day three of admission predicted future escalation to biologics (area under curves (AUC) 0.84 [95%CI 0.59-1.0]).

CONCLUSION

While adding antibiotics to IVCS may provide better short-term outcomes, the long-term benefits were comparable to IVCS alone. At 5 years, about one-fifth of children had undergone colectomy, and almost four-fifths had escalated to biologics, particularly during the first year after admission.

Personalized nutrition studies of human gut microbiome-polyphenol interactions utilizing continuous multistaged in vitro fermentation models-a narrative review

The gut microbiota, a complex community of microorganisms primarily inhabiting the human large intestine, plays a crucial role in human health. Gut dysbiosis, characterized by an imbalance in gut bacterial populations, has been increasingly recognized as a significant factor in the pathogenesis of metabolic diseases such as type 2 diabetes, inflammatory bowel disease, and colorectal cancer. Polyphenols are critical modulators of gut microbial composition and metabolism. However, the extent of polyphenol-induced modulation of the gut microbiome remains largely unexplored. In vitro models offer a convenient and ethical alternative to in vivo studies for investigating nutrient-gut microbiome interactions, facilitating easy sampling and controlled experimental conditions. Among these, continuous multistaged in vitro fermentation models, which simulate different sections of the human gastrointestinal tract (e.g., proximal colon, transverse colon, and distal colon), provide a more accurate representation of the human gut environment compared to single-batch fermentation. Various configurations of these multistaged models have been developed and widely employed in studies examining the effects of polyphenols on the gut microbiome. This review aims to summarize the different configurations of multistaged in vitro fermentation models and recent advancements in their development, highlight key aspects of experimental design, outline commonly used analytical workflows with complementary analyses, and review the restorative effects of polyphenol interventions on dysregulated gut microbiota.

A practical approach to positioning therapies in ulcerative colitis

The therapeutic landscape of ulcerative colitis (UC) has undergone significant change over the last 2 decades. While there are multiple new therapies for the management of UC, long-term remission rates remain low, and this may be in part due to the difficulty of navigating a successful treatment strategy. In this review, we propose a rational framework for treatment selection, sequencing, and optimization in patients with UC. We outline treatment goals and targets for UC, followed by a discussion of the challenges in treatment selection and considerations to help guide a sequencing strategy. These include an assessment of a therapy's efficacy and safety, the convenience in the delivery of the therapy, ease of access, and patient-related factors. We then provide an overview of the currently approved therapies for UC, with an in-depth analysis of their advantages and disadvantages. Finally, we conclude with future directions in the management of UC, which include the use of naturopathic therapies, faecal microbiota therapy, the use of precision medicine, and other strategies such as combination therapy.

The Impact of Postoperative Prophylactic Medication on Long-Term Surgical, Severe Endoscopic and Endoscopic or Radiologic Recurrence Following Primary Ileocecal Resection in Patients With Crohn's Disease

BACKGROUND

The impact of prophylactic medication following ileocecal resection (ICR) for Crohn's disease (CD) merits further elucidation. Prophylactic medication following ileocecal resection (ICR) is recommended in patients with Crohn's disease (CD), particularly in patients at increased risk of recurrence, but the impact on long-term outcomes needs to be further elucidated.

AIM

To evaluate the effect of postoperative prophylactic medication on long-term prognosis.

METHODS

A retrospective cohort study was performed in patients with CD who underwent primary ICR between 2000-2020 in the Netherlands. Patients were divided into two groups: postoperative prophylactic medication [< 12 weeks following ICR] versus no postoperative prophylactic medication. Outcomes were surgical recurrence [re-resection for CD], severe endoscopic recurrence [modified Rutgeerts score (mRS) ≥ i3] and endoscopic or radiologic recurrence [mRS ≥ i2b or radiologic recurrence]. Inverse probability of treatment weighting [IPTW] method was used to adjust for confounding and selection bias. Survival and association between postoperative prophylactic medication and outcomes were assessed with Kaplan-Meier analyses and Cox proportional hazard models.

RESULTS

807 patients underwent ICR (median follow-up 5.0 years); 36% received postoperative prophylactic medication. Surgical, severe endoscopic and endoscopic or radiologic recurrence rates were significantly lower in those who received prophylactic medication (p = 0.01; p < 0.01; p < 0.01). IPTW analysis showed a lower risk of severe endoscopic and endoscopic or radiologic recurrence in patients treated with postoperative prophylactic medication (aOR 0.64; 95% CI 0.43-0.97; aOR 0.65; 95% CI 0.47-0.91), which also was identified as a protective factor for severe endoscopic (aHR 0.5; 95% CI 0.4-0.6) and endoscopic or radiologic recurrence (aHR 0.6, 95% CI 0.5-0.7) in multivariable analysis after correction for confounding factors. A comparable protective effect of postoperative prophylactic medication was sustained in patients who underwent ileocolonoscopy <1 year postoperatively and who underwent surgery on or after 2010.

CONCLUSIONS

Prophylactic medication following primary ICR significantly reduces long-term recurrence rates in CD and was identified as a protective factor for severe endoscopic and endoscopic or radiologic recurrence.

Intestinal ultrasound at diagnosis of pediatric inflammatory bowel disease compared to endoscopy

OBJECTIVES

Intestinal ultrasound (IU) has emerged as an alternative to detect bowel wall inflammation. The aim of this study was to compare IU findings to clinical disease, fecal calprotectin (FC), and endoscopic findings in newly diagnosed pediatric inflammatory bowel disease (IBD) patients.

METHODS

This study was a 1-year, single-center, prospective study. Any pediatric patient undergoing colonoscopy could be recruited. Following ileo-colonoscopy, subjects were divided into two groups: patients diagnosed with IBD and patients without IBD. Participants had an IU within 1 month. Endoscopists and radiologists were blinded to each other. The IU findings were compared with clinical disease activity, FC, and endoscopic findings.

RESULTS

A total of 50 subjects were enrolled in the study; 29 (58%) were females, median age was 13.5 years, and 25 (50%) were diagnosed with IBD. IU sensitivity was 76%, specificity 84%, positive predictive value (PPV) 83%, and negative predictive value (NPV) 78%. For detection of moderate to severe disease, sensitivity, specificity, PPV, and NPV were 91.3%, 86.21%, 84%, and 92.6%, respectively. A significant correlation was noted between IU and FC, Mayo score, and Simple Endoscopic Score (0.513, 0.565, and 0.731, respectively). Pediatric Ulcerative Colitis Activity Index and Pediatric Crohn's Disease Activity Index scores had Pearson correlations of 0.070 and -0.159, respectively.

CONCLUSIONS

IU can be considered a screening tool for pediatric IBD. It has reasonable sensitivity, specificity, PPV, and NPV, particularly for moderate-to-severe disease. The severity noted on IU correlated with FC and endoscopic disease activity but did not correlate with clinical disease activity.

Expert Opinion: Place in Therapy of Probiotics in Infertility and Recurrent Implantation Failure

Infertility is a widespread medical condition, affecting a notable percentage of couples globally, with a rising prevalence in India. While assisted reproductive technologies (ART) provide hope, recurrent implantation failure (RIF) continues to challenge approximately one in 10 couples undergoing in-vitro fertilization (IVF). This expert opinion document intends to highlight the promise of probiotics, particularly from Lactobacillus, as a therapeutic approach for improving fertility and treating RIF. In India, on June 29-30, 2024, a physical expert meeting was organized involving 14 specialists from gynecology, obstetrics, and fertility fields. The role of probiotics in reproductive health was discussed in the meeting with an emphasis on infertility and RIF. All experts agree that microbial dysbiosis characterized by an imbalance among the dominant Lactobacillus species is associated with RIF leading to increased inflammation hence poor reproductive outcomes. Probiotics have emerged as possible therapies that restore microbial equilibrium while reducing inflammation and enhancing the intactness of the genital epithelium barrier. All experts have strongly supported the use of Lactobacillus-based oral probiotic supplementation particularly for preventing miscarriages and maintaining pregnancy. All the experts unanimously agreed that oral probiotic supplementation, particularly Lactobacillus-based, should be considered as a potential method to prevent miscarriages and aid in maintaining pregnancy. They recommend oral probiotic use prior to embryo transfer to enhance implantation and pregnancy rates. This expert opinion emphasizes the value of probiotics as a safe and non-invasive approach to treating infertility and RIF. By fostering a balanced microbiome, probiotics may increase the likelihood of successful pregnancies.

Maintenance treatment with vedolizumab in paediatric inflammatory bowel disease (VEDOKIDS): 54-week outcomes of a multicentre, prospective, cohort study

BACKGROUND

Infliximab and adalimumab are the only biologics thus far approved for paediatric patients with inflammatory bowel disease (IBD), so other biologics, such as vedolizumab, are prescribed off-label. Despite its frequent use, prospective data for vedolizumab treatment in children are available only for short-term induction outcomes. We aimed to evaluate the long-term efficacy and safety of maintenance therapy with vedolizumab in paediatric patients with IBD.

METHODS

In this multicentre, prospective, cohort study (VEDOKIDS), children younger than 18 years with Crohn's disease, ulcerative colitis, or IBD unclassified (analysed with the ulcerative colitis group) who had initiated intravenous vedolizumab were enrolled from 17 centres in six countries (Israel, the USA, Italy, Ireland, Denmark, and Slovenia). Patients initiating vedolizumab to prevent postoperative recurrence were excluded. Vedolizumab dose or schedule were not standardised, and concomitant treatment with any other medication was permitted. Patients were prospectively followed up for 54 weeks, with repeated biosampling. The primary outcome was complete remission at week 54, defined as clinical remission (weighted Paediatric Crohn's Disease Activity Index [wPCDAI] of <12·5 points in Crohn's disease and Paediatric Ulcerative Colitis Activity Index [PUCAI] of <10 in ulcerative colitis) without the need for surgery, exclusive enteral nutrition for children with Crohn's disease, or steroids (steroid-free and exclusive enteral nutrition-free clinical remission) plus CRP concentration lower than 1·5 times the upper limit of normal (ULN) of 0·5 mg/dL. In cases of missing data on CRP, ESR was used instead (concentrations <1·5 times the ULN, which was 25 mm/h). Data were analysed by intention to treat. This study is registered with ClinicalTrials.gov, NCT02862132.

FINDINGS

Between May 19, 2016, and April 1, 2022, we enrolled 142 patients. Five children who had received only one or two infusions of their three-infusion induction before switching drugs due to COVID-19 pandemic-related reasons were excluded, leaving 137 children (64 [47%] with Crohn's disease, 64 [47%] with ulcerative colitis, and nine [7%] with IBD unclassified; 63 [46%] male and 74 [54%] female; age range of 0·7-17·6 years) in the intention-to-treat population. The median wPCDAI score in children with Crohn's disease decreased from 35 (IQR 18 to 49) at baseline to 13 (0 to 25; median of differences -14 [95% CI -33 to 0]) at week 54, and the median PUCAI score in children with ulcerative colitis decreased from 25 (IQR 15 to 50) at baseline to 5 (0 to 25) at week 54 (median of difference -10 [-30 to 0]). Improvements in disease activity were significant by week 6, with no further significant changes between visits. At week 54, 16 (25%) of 64 children with Crohn's disease and 34 (47%) of 73 with ulcerative colitis or IBD unclassified were in complete remission. 38 vedolizumab-related adverse events were recorded in 29 (21%) of 137 children, the most common being headache (n=7), myalgia (n=4), and fever (n=4), and none were serious.

INTERPRETATION

Vedolizumab maintenance seems safe and efficacious in children, with a higher efficacy in those with ulcerative colitis than in those with Crohn's disease.

FUNDING

The European Crohn's and Colitis Organisation, the European Society for Paediatric Gastroenterology Hepatology and Nutrition, and Takeda.