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Tatur J, Lipiński M, Sznurkowska M, Józefik E, Rydzewska G. Rifaximin in gut microbiota modification in acute pancreatitis: 15 years of retrospective clinical study. ADV CLIN EXP MED 2022; 31:399-405. [PMID: 35467085 DOI: 10.17219/acem/144993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Gut decontamination could have some benefits in preventing infectious complications in acute pancreatitis (AP). OBJECTIVES To investigate whether the administration of rifaximin could have an impact on the outcomes of AP. MATERIAL AND METHODS We conducted a retrospective study on 373 patients with a median age of 50 years that were admitted to our Department of Gastroenterology in the years 2001-2016 with a diagnosis of AP. Patients were subclassified according to the revised Atlanta criteria: mild acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP). Thereafter, all the patients were divided into 2 groups: in the 1st group (R0) with MSAP and SAP, patients did not receive rifaximin, and in the 2nd group (R1), in the cases of MSAP and SAP, rifaximin was administered to patients at a dose of 3 × 400 mg (for at least 5 days and up to 7 days). There was no other difference in the treatment between the groups. The median duration of hospital stay, the number of infectious complications and the mortality rate were recorded for both groups. RESULTS A significant difference was observed between median durations of hospitalization between the groups with (R1) and without (R0) rifaximin treatment (14 days compared to 24 days, p = 0.001) and in the number of patients infected with pancreatic necrosis (7 compared to 1, p = 0.0487). However, there was no statistically significant difference between the R1 and R0 group in terms of mortality rate. CONCLUSIONS The results indicate that rifaximin seems to be a promising novel therapeutic option in MSAP and SAP.
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Affiliation(s)
- Jacek Tatur
- Department of Gastroenterology, Central Clinical Hospital of The Ministry of Interior and Administration, Warsaw, Poland
| | - Michał Lipiński
- Department of Gastroenterology, Central Clinical Hospital of The Ministry of Interior and Administration, Warsaw, Poland
| | - Marta Sznurkowska
- Department of Gastroenterology, Central Clinical Hospital of The Ministry of Interior and Administration, Warsaw, Poland
- Collegium Medicum, Jan Kochanowski University of Kielce, Poland
| | - Ewa Józefik
- Department of Gastroenterology, Central Clinical Hospital of The Ministry of Interior and Administration, Warsaw, Poland
| | - Grażyna Rydzewska
- Department of Gastroenterology, Central Clinical Hospital of The Ministry of Interior and Administration, Warsaw, Poland
- Collegium Medicum, Jan Kochanowski University of Kielce, Poland
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Amorim N, McGovern E, Raposo A, Khatiwada S, Shen S, Koentgen S, Hold G, Behary J, El-Omar E, Zekry A. Refining a Protocol for Faecal Microbiota Engraftment in Animal Models After Successful Antibiotic-Induced Gut Decontamination. Front Med (Lausanne) 2022; 9:770017. [PMID: 35223890 PMCID: PMC8864074 DOI: 10.3389/fmed.2022.770017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/17/2022] [Indexed: 12/23/2022] Open
Abstract
Background There is mounting evidence for the therapeutic use of faecal microbiota transplant (FMT) in numerous chronic inflammatory diseases. Germ free mice are not always accessible for FMT research and hence alternative approaches using antibiotic depletion prior to FMT in animal studies are often used. Hence, there is a need for standardising gut microbiota depletion and FMT methodologies in animal studies. The aim of this study was to refine gut decontamination protocols prior to FMT engraftment and determine efficiency and stability of FMT engraftment over time. Methods Male C57BL/6J mice received an antibiotic cocktail consisting of ampicillin, vancomycin, neomycin, and metronidazole in drinking water for 21 days ad libitum. After antibiotic treatment, animals received either FMT or saline by weekly oral gavage for 3 weeks (FMT group or Sham group, respectively), and followed up for a further 5 weeks. At multiple timepoints throughout the model, stool samples were collected and subjected to bacterial culture, qPCR of bacterial DNA, and fluorescent in-situ hybridisation (FISH) to determine bacterial presence and load. Additionally, 16S rRNA sequencing of stool was used to confirm gut decontamination and subsequent FMT engraftment. Results Antibiotic treatment for 7 days was most effective in gut decontamination, as evidenced by absence of bacteria observed in culture, and reduced bacterial concentration, as determined by FISH as well as qPCR. Continued antibiotic administration had no further efficacy on gut decontamination from days 7 to 21. Following gut decontamination, 3 weekly doses of FMT was sufficient for the successful engraftment of donor microbiota in animals. The recolonised animal gut microbiota was similar in composition to the donor sample, and significantly different from the Sham controls as assessed by 16S rRNA sequencing. Importantly, this similarity in composition to the donor sample persisted for 5 weeks following the final FMT dose. Conclusions Our results showed that 7 days of broad-spectrum antibiotics in drinking water followed by 3 weekly doses of FMT provides a simple, reliable, and cost-effective methodology for FMT in animal research.
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Affiliation(s)
- Nadia Amorim
- Microbiome Research Centre, St. George and Sutherland Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Emily McGovern
- Microbiome Research Centre, St. George and Sutherland Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Anita Raposo
- Microbiome Research Centre, St. George and Sutherland Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Saroj Khatiwada
- Microbiome Research Centre, St. George and Sutherland Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Sj Shen
- Microbiome Research Centre, St. George and Sutherland Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Sabrina Koentgen
- Microbiome Research Centre, St. George and Sutherland Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Georgina Hold
- Microbiome Research Centre, St. George and Sutherland Clinical School, UNSW Sydney, Sydney, NSW, Australia
| | - Jason Behary
- Microbiome Research Centre, St. George and Sutherland Clinical School, UNSW Sydney, Sydney, NSW, Australia.,Department of Gastroenterology and Hepatology, St. George Hospital, Sydney, NSW, Australia
| | - Emad El-Omar
- Microbiome Research Centre, St. George and Sutherland Clinical School, UNSW Sydney, Sydney, NSW, Australia.,Department of Gastroenterology and Hepatology, St. George Hospital, Sydney, NSW, Australia
| | - Amany Zekry
- Microbiome Research Centre, St. George and Sutherland Clinical School, UNSW Sydney, Sydney, NSW, Australia.,Department of Gastroenterology and Hepatology, St. George Hospital, Sydney, NSW, Australia
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Routy B, Letendre C, Enot D, Chénard-Poirier M, Mehraj V, Séguin NC, Guenda K, Gagnon K, Woerther PL, Ghez D, Lachance S. The influence of gut-decontamination prophylactic antibiotics on acute graft-versus-host disease and survival following allogeneic hematopoietic stem cell transplantation. Oncoimmunology 2016; 6:e1258506. [PMID: 28197380 DOI: 10.1080/2162402x.2016.1258506] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 02/08/2023] Open
Abstract
The intestinal microbiota plays a key role in the pathogenesis of acute graft-versus-host disease (aGVHD). High-dose conditioning regimens given prior to allogeneic hematopoietic stem cell transplantation (aHSCT) modulate the composition of gut microbiota and damage the gut epithelial barrier, resulting in increased systemic inflammation. We assessed whether gut decontamination with antibiotics (ATB) prior to aHSCT influenced the frequency of aGVHD and mortality in 500 patients from two Canadian centers between 2005 and 2012. The rate of grade II-IV aGVHD was higher in the ATB arm compared with the arm without ATB (42% vs 28%; p < 0.001). This difference was mainly driven by a 2-fold higher rate of grade II-IV gastrointestinal aGVHD (GI-GVHD) in the ATB arm compared with the arm without ATB (20.7% vs 10.8%; p = 0.003). Multivariate analyses adjusted for known aGVHD risk factors revealed that more patients in the ATB group developed clinically significant GI-GVHD and liver aGVHD; adjusted odds ratio (aOR) = 1.83; p = 0.023 and aOR = 3.56; p = 0.047, respectively. Importantly, median overall survival (OS) was significantly lower in the group receiving ATB and the OS at 10 y remained decreased in the ATB group; adjusted hazard ratio (aHR) = 1.61 (p < 0.001). Without undermining the role of ATB prophylaxis to prevent infection in aHSCT, we have shown that the use of ATB that targets intestinal bacteria is associated with a more severe aGVHD that involves the GI organs and impacts OS. Prospective studies that evaluate the contribution of bacterial decontamination to aGVHD are warranted.
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Affiliation(s)
- Bertrand Routy
- Gustave Roussy Comprehensive Cancer Center, Villejuif, France; Department of Hematology and Stem Cell Transplant Program, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, QC, Canada
| | - Caroline Letendre
- Department of Hematology and Stem Cell Transplant Program, Hôpital Maisonneuve-Rosemont, University of Montreal , Montreal, QC, Canada
| | - David Enot
- Gustave Roussy Comprehensive Cancer Center , Villejuif, France
| | - Maxime Chénard-Poirier
- Department of Medicine, Division of Hematology and Oncology, Centre Hospitalier Universitaire de Québec , QC, Canada
| | - Vikram Mehraj
- Research Institute, McGill University Health Centre , Montreal, QC, Canada
| | - Noémie Charbonneau Séguin
- Department of Hematology and Stem Cell Transplant Program, Hôpital Maisonneuve-Rosemont, University of Montreal , Montreal, QC, Canada
| | - Khaled Guenda
- Department of Hematology and Stem Cell Transplant Program, Hôpital Maisonneuve-Rosemont, University of Montreal , Montreal, QC, Canada
| | - Kathia Gagnon
- Department of Hematology and Stem Cell Transplant Program, Hôpital Maisonneuve-Rosemont, University of Montreal , Montreal, QC, Canada
| | - Paul-Louis Woerther
- Gustave Roussy Comprehensive Cancer Center, Villejuif, France; Laboratory of Medical Microbiology, GRCC, Villejuif, France
| | - David Ghez
- Gustave Roussy Comprehensive Cancer Center , Villejuif, France
| | - Silvy Lachance
- Department of Hematology and Stem Cell Transplant Program, Hôpital Maisonneuve-Rosemont, University of Montreal , Montreal, QC, Canada
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Abstract
Graft-versus-host disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplant (AHSCT) associated with significant morbidity and mortality. This review focuses on the pathophysiology, prevention, and treatment of acute GVHD. Specifically, we explain how new discoveries in immunology have expanded our understanding of GVHD, in which tissue damage from chemotherapy or radiation results in cytokine release, activating T cells, resulting in proliferation and differentiation, trafficking to target organs, and tissue destruction and inflammation. Insights into the mechanisms of this disease relate directly to the development of preventive strategies and therapies, such as immunosuppression, calcineurin inhibitors, T-cell depletion, CCR5 antagonists, gut decontamination, extracorporeal photopheresis, and more. Understanding the immunobiology of GVHD and developing effective preventions and treatments are critical to the continuing success of AHSCT.
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Affiliation(s)
- Anthony D Sung
- Duke University Medical Center, Division of Hematologic Malignancies and Cellular Therapy, 2400 Pratt St, Suite 9100, Box 3961, Durham, NC 27710, USA.
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