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Horvath A, Rainer F, Bashir M, Leber B, Schmerboeck B, Klymiuk I, Groselj-Strele A, Durdevic M, Freedberg DE, Abrams JA, Fickert P, Stiegler P, Stadlbauer V. Biomarkers for oralization during long-term proton pump inhibitor therapy predict survival in cirrhosis. Sci Rep 2019; 9:12000. [PMID: 31427714 PMCID: PMC6700098 DOI: 10.1038/s41598-019-48352-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/31/2019] [Indexed: 02/07/2023] Open
Abstract
Proton pump inhibitors (PPI) are an invaluable therapy option for acid related diseases; however, PPI therapy is also linked to a series of side effects in cirrhosis, such as microbiome alterations, spontaneous bacterial peritonitis and hepatic encephalopathy. Decision tools to balance benefits and risks of PPI therapy are largely missing. In this study, we tested gut-derived biomarkers to identify PPI-associated dysbiosis, its association with gut barrier function and liver-related mortality. In this observational study, faecal microbiome composition data obtained from 16S rDNA sequencing of 90 cirrhotic patients with and without long-term PPI use and additional potential biomarkers identified from the literature were evaluated for their predictive value regarding PPI-associated dysbiosis and liver-related three-year mortality. In addition, faecal calprotectin, faecal zonulin and serum lipopolysaccharides were assessed as markers for intestinal inflammation, gut permeability and bacterial translocation. Streptococcus salivarius, Veillonella parvula and the genus Streptococcus were significantly increased in patients with long-term PPI therapy and performed well as biomarkers for PPI-associated dysbiosis (accuracy: 74%, 72% and 74%, respectively). The abundance of Streptococcus salivarius was linked to intestinal inflammation and gut barrier dysfunction, whereas the abundance of Veillonella parvula showed associations with liver disease severity; both were independent predictors for liver-related three-year mortality. Gut-derived biomarkers of PPI-associated dysbiosis are linked to worse outcome and a potential option to evaluate the risks of adverse events during long-term PPI therapy.
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Affiliation(s)
- Angela Horvath
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria. .,Center for Biomarker Research in Medicine (CBmed), Graz, Austria.
| | - Florian Rainer
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Mina Bashir
- Department of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Bettina Leber
- Department of Transplantation Surgery, Medical University of Graz, Graz, Austria
| | - Bianca Schmerboeck
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.,Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Ingeborg Klymiuk
- Center for Medical Research, Core Facility Molecular Biology, Medical University of Graz, Graz, Austria
| | - Andrea Groselj-Strele
- Center for Medical Research, Core Facility Computational Bioanalytics, Medical University of Graz, Graz, Austria
| | - Marija Durdevic
- Center for Medical Research, Core Facility Computational Bioanalytics, Medical University of Graz, Graz, Austria
| | - Daniel E Freedberg
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, USA
| | - Julian A Abrams
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, USA
| | - Peter Fickert
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Philipp Stiegler
- Department of Transplantation Surgery, Medical University of Graz, Graz, Austria
| | - Vanessa Stadlbauer
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
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Stadlbauer V, Horvath A, Komarova I, Schmerboeck B, Feldbacher N, Wurm S, Klymiuk I, Durdevic M, Rainer F, Blesl A, Stryeck S, Madl T, Stiegler P, Leber B. A single alcohol binge impacts on neutrophil function without changes in gut barrier function and gut microbiome composition in healthy volunteers. PLoS One 2019; 14:e0211703. [PMID: 30707717 PMCID: PMC6358085 DOI: 10.1371/journal.pone.0211703] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/15/2019] [Indexed: 12/31/2022] Open
Abstract
Alcohol binge drinking is a dangerous drinking habit, associated with neurological problems and inflammation. The impact of a single alcohol binge on innate immunity, gut barrier and gut microbiome was studied. In this cohort study 15 healthy volunteers received 2 ml vodka 40% v/v ethanol/kg body weight. Neutrophil function was studied by flow cytometry; markers of gut permeability and inflammation (lactulose/mannitol/sucrose test, zonulin, calprotectin, diamino-oxidase) were studied with NMR spectroscopy and enzyme-linked immunosorbent assay in urine, stool and serum respectively. Bacterial products in serum were quantified using different reporter cell lines. Gut microbiome composition was studied by 16S rDNA sequencing and bioinformatics analysis. After a single alcohol binge, neutrophils were transiently primed and the response to E.coli stimulation with reactive oxygen species (ROS) production was transiently increased, on the other hand the percentage of neutrophils that did not perform phagocytosis increased. No changes in gut permeability, inflammatory biomarker, bacterial translocation and microbiome composition could be detected up to 4 hours after a single alcohol binge or on the next day. A single alcohol binge in young, healthy volunteers transiently impacts on neutrophil function. Although the exact biological consequence of this finding is not clear yet, we believe that this strengthens the importance to avoid any alcohol binge drinking, even in young, otherwise healthy persons.
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Affiliation(s)
- Vanessa Stadlbauer
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Angela Horvath
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Irina Komarova
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Bianca Schmerboeck
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Nicole Feldbacher
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Sonja Wurm
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Ingeborg Klymiuk
- Center for Medical Research, Core Facility Molecular Biology, Medical University of Graz, Graz, Austria
| | - Marija Durdevic
- Core Facility Computational Bioanalytics, Medical University of Graz, Graz, Austria
| | - Florian Rainer
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Andreas Blesl
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Sarah Stryeck
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Graz, Austria
- BioTechMed, Graz, Austria
| | - Tobias Madl
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Molecular Biology and Biochemistry, Medical University of Graz, Graz, Graz, Austria
- BioTechMed, Graz, Austria
| | - Philipp Stiegler
- Department of Transplantation Surgery, Medical University of Graz, Graz, Austria
| | - Bettina Leber
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
- Department of Transplantation Surgery, Medical University of Graz, Graz, Austria
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Stadlbauer V, Horvath A, Komarova I, Schmerboeck B, Feldbacher N, Klymiuk I, Durdevic M, Rainer F, Blesl A, Stiegler P, Leber B. Dysbiosis in early sepsis can be modulated by a multispecies probiotic: a randomised controlled pilot trial. Benef Microbes 2019; 10:265-278. [PMID: 30694100 DOI: 10.3920/bm2018.0067] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The gut is hypothesised to play an important role in the development and progression of sepsis. It is however unknown whether the gut microbiome and the gut barrier function is already altered early in sepsis development and whether it is possible to modulate the microbiome in early sepsis. Therefore, a randomised, double blind, placebo-controlled pilot study to examine the alterations of the microbiome and the gut barrier in early sepsis and the influence of a concomitant probiotic intervention on dysbiosis at this early stage of the disease was conducted. Patients with early sepsis, defined as fulfilling the sepsis definition from the 2012 Surviving Sepsis Campaign guidelines but without signs of organ failure, received multispecies probiotic (Winclove 607 based on Omnibiotic® 10 AAD) for 28 days. Gut microbiome composition, function, gut barrier and bacterial translocation were studied. Patients with early sepsis had a significantly lower structural and functional alpha diversity, clustered differently and showed structural alterations on all taxonomic levels. Gut permeability was unaltered but endotoxin, endotoxin binding proteins and peptidoglycans were elevated in early sepsis patients compared to controls. Probiotic intervention successfully increased probiotic strains in stool and led to an improvement of functional diversity. Microbiome composition and function are altered in early sepsis. Probiotic intervention successfully modulates the microbiome and is therefore a promising tool for early intervention in sepsis.
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Affiliation(s)
- V Stadlbauer
- 1 Department of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - A Horvath
- 1 Department of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.,2 Center for Biomarker Research in Medicine (CBmed), Stiftingtalstrasse 5, 8010 Graz, Austria
| | - I Komarova
- 1 Department of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - B Schmerboeck
- 1 Department of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.,2 Center for Biomarker Research in Medicine (CBmed), Stiftingtalstrasse 5, 8010 Graz, Austria
| | - N Feldbacher
- 1 Department of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - I Klymiuk
- 3 Center for Medical Research, Core Facility Molecular Biology, Medical University of Graz, Graz, Austria
| | - M Durdevic
- 4 Core Facility Computational Bioanalytics, Medical University of Graz, Graz, Austria
| | - F Rainer
- 1 Department of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - A Blesl
- 1 Department of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - P Stiegler
- 5 Department of Transplantation Surgery, Medical University Graz, Auenbruggerplatz 29/E, 8036 Graz, Austria
| | - B Leber
- 2 Center for Biomarker Research in Medicine (CBmed), Stiftingtalstrasse 5, 8010 Graz, Austria.,5 Department of Transplantation Surgery, Medical University Graz, Auenbruggerplatz 29/E, 8036 Graz, Austria
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Rainer F, Horvath A, Sandahl TD, Leber B, Schmerboeck B, Blesl A, Groselj-Strele A, Stauber RE, Fickert P, Stiegler P, Møller HJ, Grønbæk H, Stadlbauer V. Soluble CD163 and soluble mannose receptor predict survival and decompensation in patients with liver cirrhosis, and correlate with gut permeability and bacterial translocation. Aliment Pharmacol Ther 2018; 47:657-664. [PMID: 29266346 PMCID: PMC6333289 DOI: 10.1111/apt.14474] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 10/13/2017] [Accepted: 11/27/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Activated hepatic macrophages play a key role in inflammation and fibrosis progression in chronic liver disease. AIM To assess the prognostic value of soluble (s)CD163 and mannose receptor (sMR) in cirrhotic patients and explore associations with markers of intestinal permeability (lactulose-mannitol ratio, diamine oxidase), bacterial translocation (endotoxin, lipopolysaccharide-binding protein) and markers of systemic immune activation (interleukin-6, interleukin-8, sCD14). METHODS We prospectively investigated 101 cirrhotic patients (Child-Pugh class A: n = 72, Child-Pugh classes B and C: n = 29) and 31 healthy controls. Patients were observed for a median follow-up of 37 months. RESULTS Median plasma levels of sCD163 and soluble mannose receptor were significantly elevated in cirrhotic patients (P < .001) and increased with disease severity (sCD163 in healthy controls = 1.3, Child-Pugh class A = 4.2, Child-Pugh classes B and C = 8.4 mg/L; sMR in healthy controls = 15.8, Child-Pugh class A = 36.5, Child-Pugh classes B and C = 66.3 μg/dL). A total of 21 patients died during the observation period. Patients with sCD163 levels above 5.9 mg/L showed significantly reduced survival (survival rate after 36 months: 71% versus 98%, P < .001). Patients with soluble mannose receptor levels above 45.5 μg/dL developed significantly more complications of cirrhosis within 12 months (73% versus 9%, P < .001). Furthermore, both variables correlated with the lactulose-mannitol ratio, diamine oxidase, lipopolysaccharide and interleukin-8. CONCLUSION Our data demonstrate the prognostic value of sCD163 in predicting long-term survival in patients with liver cirrhosis and identify soluble mannose receptor as a prognostic marker for occurrence of cirrhosis-associated complications. The correlation between gut barrier dysfunction and activation of macrophages points towards a link between them.
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Affiliation(s)
- F. Rainer
- Department of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | - A. Horvath
- Department of Gastroenterology and Hepatology, Medical University of Graz, Austria,Department of Transplantation Surgery, Medical University of Graz, Austria,Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - T. D. Sandahl
- Departments of Hepatology and Gastroenterology, and Clinical Biochemistry, Denmark
| | - B. Leber
- Department of Transplantation Surgery, Medical University of Graz, Austria,Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - B. Schmerboeck
- Department of Transplantation Surgery, Medical University of Graz, Austria,Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - A. Blesl
- Department of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | - A. Groselj-Strele
- Core Facility Computational Bioanalytics, Medical University of Graz, Austria
| | - R. E. Stauber
- Department of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | - P. Fickert
- Department of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | - P. Stiegler
- Department of Transplantation Surgery, Medical University of Graz, Austria
| | - H. J. Møller
- Departments of Hepatology and Gastroenterology, and Clinical Biochemistry, Denmark
| | - H. Grønbæk
- Departments of Hepatology and Gastroenterology, and Clinical Biochemistry, Denmark
| | - V. Stadlbauer
- Department of Gastroenterology and Hepatology, Medical University of Graz, Austria
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5
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Horvath A, Leber B, Schmerboeck B, Tawdrous M, Zettel G, Hartl A, Madl T, Stryeck S, Fuchs D, Lemesch S, Douschan P, Krones E, Spindelboeck W, Durchschein F, Rainer F, Zollner G, Stauber RE, Fickert P, Stiegler P, Stadlbauer V. Randomised clinical trial: the effects of a multispecies probiotic vs. placebo on innate immune function, bacterial translocation and gut permeability in patients with cirrhosis. Aliment Pharmacol Ther 2016; 44:926-935. [PMID: 27593544 PMCID: PMC5053220 DOI: 10.1111/apt.13788] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/12/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Probiotics may correct intestinal dysbiosis and proinflammatory conditions in patients with liver cirrhosis. AIM To test the effects of a multispecies probiotic on innate immune function, bacterial translocation and gut permeability. METHODS In a randomised, double blind, placebo-controlled study, stable cirrhotic out-patients either received a daily dose of a probiotic powder containing eight different bacterial strains (Ecologic Barrier, Winclove, Amsterdam, The Netherlands) (n = 44) or a placebo (n = 36) for 6 months and were followed up for another 6 months. RESULTS We found a significant but subclinical increase in neutrophil resting burst (2.6-3.2%, P = 0.0134) and neopterin levels (7.7-8.4 nmol/L, P = 0.001) with probiotics but not with placebo. Probiotic supplementation did not have a significant influence on neutrophil phagocytosis, endotoxin load, gut permeability or inflammatory markers. Ten severe infections occurred in total; one during intervention in the placebo group, and five and four after the intervention has ended in the probiotic and placebo group, respectively. Liver function showed some improvement with probiotics but not with placebo. CONCLUSIONS Probiotic supplementation significantly increased serum neopterin levels and the production of reactive oxygen species by neutrophils. These findings might explain the beneficial effects of probiotics on immune function. Furthermore, probiotic supplementation may be a well-tolerated method to maintain or even improve liver function in stable cirrhosis. However, its influence on gut barrier function and bacterial translocation in cirrhotic patients is minimal.
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Affiliation(s)
- A. Horvath
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - B. Leber
- Department of Transplantation SurgeryMedical University of GrazGrazAustria,Centre for Biomarker Research in Medicine (CBmed)GrazAustria
| | - B. Schmerboeck
- Department of Transplantation SurgeryMedical University of GrazGrazAustria
| | - M. Tawdrous
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - G. Zettel
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - A. Hartl
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - T. Madl
- Institute of Molecular Biology and BiochemistryMedical University of GrazGrazAustria
| | - S. Stryeck
- Institute of Molecular Biology and BiochemistryMedical University of GrazGrazAustria
| | - D. Fuchs
- Division of Biological ChemistryBiocentreMedical University of InnsbruckInnsbruckAustria
| | - S. Lemesch
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - P. Douschan
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - E. Krones
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - W. Spindelboeck
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - F. Durchschein
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - F. Rainer
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - G. Zollner
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - R. E. Stauber
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - P. Fickert
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
| | - P. Stiegler
- Department of Transplantation SurgeryMedical University of GrazGrazAustria
| | - V. Stadlbauer
- Department of Gastroenterology and HepatologyMedical University of GrazGrazAustria
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