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Harkins P, Burke E, Swales C, Silman A. 'All disease begins in the gut'-the role of the intestinal microbiome in ankylosing spondylitis. Rheumatol Adv Pract 2021; 5:rkab063. [PMID: 34557624 PMCID: PMC8452999 DOI: 10.1093/rap/rkab063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/26/2021] [Indexed: 12/21/2022] Open
Abstract
Ankylosing spondylitis is a chronic, debilitating arthritis with a predilection for the axial skeleton. It has a strong genetic predisposition, but the precise pathogenetic mechanisms involved in its development have not yet been fully elucidated. This has implications both for early diagnosis and for effective management. Recently, alterations in the intestinal microbiome have been implicated in disease pathogenesis. In this review, we summarize studies assessing the intestinal microbiome in AS pathogenesis, in addition to synthesizing the literature exploring the postulated mechanisms by which it exerts it pathogenic potential. Finally, we review studies analysing manipulation of the microbiome as a potential therapeutic avenue in AS management.
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Affiliation(s)
- Patricia Harkins
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Eoghan Burke
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Catherine Swales
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alan Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Hoffmann-Vold AM, Fretheim HH, Sarna VK, Barua I, Carstens MN, Distler O, Khanna D, Volkmann ER, Midtvedt Ø, Didriksen H, Dhainaut A, Halse AK, Bakland G, Pesonen M, Olsen I, Molberg Ø. Safety and efficacy of faecal microbiota transplantation by Anaerobic Cultivated Human Intestinal Microbiome (ACHIM) in patients with systemic sclerosis: study protocol for the randomised controlled phase II ReSScue trial. BMJ Open 2021; 11:e048541. [PMID: 34168032 PMCID: PMC8231046 DOI: 10.1136/bmjopen-2020-048541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/01/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION In the multisystem inflammatory disorder systemic sclerosis (SSc), gastrointestinal tract (GIT) affliction is highly prevalent. There are no known disease modifying therapies and the negative impact is substantial. Aiming for a new therapeutic principle, and inspired by recent work showing associations between gut microbiota changes and GIT symptoms in SSc, we performed a pilot study on faecal microbiota transplantation (FMT) with the single-donor bacterial culture 'Anaerobic Cultivated Human Intestinal Microbiome (ACHIM)'. Motivated by positive pilot study signals, we designed the ReSScue trial as a phase II multicentre, placebo-controlled, randomised 20-week trial to evaluate safety and efficacy on lower GIT symptoms of FMT by ACHIM in SSc. METHODS AND ANALYSES We aim to include 70 SSc participants with moderate to severe lower GIT symptoms, defined by the validated patient-reported University of California Los Angeles Scleroderma Clinical Trial Consortium GIT 2.0 2.0 questionnaire. The trial includes three parts. In part A1 (induction phase) lasting from week 0 to week 12, participants will be randomised 1:1 to repeat infusions of 30 mL ACHIM or placebo at week 0 and 2 by gastroduodenoscopy. In part A2, which is an 8-week subsequent maintenance phase, all study participants will receive 30 mL ACHIM at week 12 and followed until week 20 on continued blind. In part B, which will last until the last participant completes part A2, the participants will be followed through a maximum 16-week extended monitoring period, for longer-term data on safety and intervention effects. Primary endpoint is change from baseline to week 12 in UCLA GIT subscale scores of diarrhoea or bloating, depending on the worst symptom at baseline evaluated separately for each patient. Secondary endpoints are safety measures and changes in UCLA GIT scores (total, diarrhoea and bloating). ETHICS AND DISSEMINATION This protocol was approved by the Northern Norwegian Committee for Medical Ethics. Study findings will be published. TRIAL REGISTRATION NUMBER NCT04300426; Pre-results. PROTOCOL VERSION V.3.1.
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Affiliation(s)
- Anna-Maria Hoffmann-Vold
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Faculty of medicine, University of Oslo, Oslo, Norway
| | - Håvard H Fretheim
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Faculty of medicine, University of Oslo, Oslo, Norway
| | - Vikas K Sarna
- Department of gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Imon Barua
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Faculty of medicine, University of Oslo, Oslo, Norway
| | | | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Dinesh Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth R Volkmann
- Division of Rheumatology, David Geffen School of Medicine, Los Angeles, California, USA
| | - Øyvind Midtvedt
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Henriette Didriksen
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Faculty of medicine, University of Oslo, Oslo, Norway
| | - Alvilde Dhainaut
- Department of Rheumatology, St Olavs Hospital Universitetssykehuset i Trondheim, Trondheim, Norway
| | | | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of North Norway, Tromso, Troms, Norway
| | - Maiju Pesonen
- Oslo Centre for Biostatistics & Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Inge Olsen
- Oslo Centre for Biostatistics & Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Øyvind Molberg
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Faculty of medicine, University of Oslo, Oslo, Norway
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Tan TC, Noviani M, Leung YY, Low AHL. The microbiome and systemic sclerosis: A review of current evidence. Best Pract Res Clin Rheumatol 2021; 35:101687. [PMID: 33849778 DOI: 10.1016/j.berh.2021.101687] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Systemic sclerosis (SSc) is characterized by immune dysregulation, vasculopathy, and fibrosis of multiple organs. The gastrointestinal (GI) tract is the most common internal organ manifestation, which contributes to significant morbidity and mortality in patients with SSc. Emerging reports have identified unique microbial taxa alterations in the GI microbiome of patients with SSc as compared to healthy controls (HC). These taxa alterations include differences at the phyla (e.g., Bacteroidetes) and genera (e.g., Bacteroides, Clostridium, Faecalibacterium, and Lactobacillus) level. In addition, some genera have been associated with more severe GI symptoms (e.g., Prevotella and Akkermansia). This review summarizes the current evidence on factors influencing the GI microbiome, GI microbiome alterations in SSc as compared to HC, and in SSc subgroups according to disease manifestations. Current exploration in therapeutic interventions that target the GI microbiome is discussed.
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Affiliation(s)
- Tze Chin Tan
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
| | - Maria Noviani
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
| | - Ying Ying Leung
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
| | - Andrea Hsiu Ling Low
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
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4
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Jin CY, Hu Y, Jin B. Faecal microbiota transplantation: Application in treatment of some digestive diseases and safety concerns. Shijie Huaren Xiaohua Zazhi 2020; 28:135-143. [DOI: 10.11569/wcjd.v28.i4.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Intestinal microbiota is an essential part of the body, and it closely relates to normal functioning of the host as well as the onset of a variety of diseases. Faecal microbiota transplantation (FMT) is the major method to modify the intestinal dysbiosis. Currently, it has been approved for treatment of refractory/recurrent Clostridium difficile infection by the US Food and Drug Administration. Clinical trials also suggested that FMT may have effects on a variety of systemic diseases. In this paper, we briefly reviewed the current status of FMT application in most studied digestive diseases such as inflammatory bowel diseases, hepatic encephalopathy, irritable bowel syndrome, and cancer. The adverse effects and complications disclosed in these studies are analyzed in the context of current administrative rules, and safety concerns are discussed.
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Affiliation(s)
- Cheng-Yue Jin
- Beijing Zhongyan Chinese Medicine Hospital, Beijing 102401, China
| | - Ying Hu
- Beijing Zhongyan Chinese Medicine Hospital, Beijing 102401, China
| | - Bo Jin
- The 8th Medical Center, Chinese PLA General Hospital, Beijing 100091, China
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5
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Hoffmann-Vold AM, Fretheim H, Didriksen H, Molberg Ø. The potential of fecal microbiota transplantation in systemic sclerosis. Expert Rev Clin Immunol 2020; 16:117-118. [PMID: 31858856 DOI: 10.1080/1744666x.2019.1707665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Anna-Maria Hoffmann-Vold
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Håvard Fretheim
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Henriette Didriksen
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Øyvind Molberg
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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