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Mohan BP, Loganathan P, Khan SR, Garg G, Muthusamy A, Ponnada S, Pasam RT, Chandan S, Tuteja A. Fecal microbiota transplant delivered via invasive routes in irritable bowel syndrome: A systematic review and meta-analysis of randomized controlled trials. Indian J Gastroenterol 2023; 42:315-323. [PMID: 37247177 PMCID: PMC10225764 DOI: 10.1007/s12664-023-01373-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 04/15/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND AIMS Irritable bowel syndrome (IBS) results in significant loss of quality of life. Management guidelines do not recommend fecal microbiota transplant (FMT) for IBS based on weak evidence as refined data is lacking. We performed a systematic review and meta-analysis to ascertain the pooled clinical outcomes of FMT in IBS, delivered via invasive routes. METHODS Multiple databases were searched through January 2023 to identify studies that reported on FMT treatment in IBS by invasive routes. Standard meta-analysis methodology using the random-effects model was used. Heterogeneity was assessed by I2% and 95% predication interval. RESULTS Five studies were included. As many as 377 IBS patients were assessed, of which 238 received FMT and 139 received placebo. One study used nasojejunal tubes, one esophagogastroduodenoscopy and three colonoscopy for FMT delivery. FMT via colonoscopy was performed as a one-time procedure instilled into the cecum. Two studies used 30 g of stool from a single universal donor and one study used 50-80 g of pooled donor feces. The pooled odds ratio of improvement in IBS symptoms with FMT was significantly better as compared to that of placebo OR = 2.9 (95% CI [1.6-5.2, I2 = 62%, p < 0.001]). This was true for studies that exclusively used colonoscopy (OR = 2.1 [1.1-4.2, p = 0.04]). In the FMT arm, 10 patients (10.6%) reported abdomen pain and worsening of symptoms with bloating and six patients (6.3%) reported diarrhea. CONCLUSION FMT delivered via invasive routes, especially colonoscopy, demonstrated significant improvement in IBS symptoms. A single FMT consisting of 30 g or more of single universal donor feces instilled into the cecum is the predominant modality.
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Affiliation(s)
- Babu P Mohan
- Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Utah Health School of Medicine, 30 N 1900 E SOM 4R118, Salt Lake City, UT, 84132, USA.
| | | | - Shahab R Khan
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gauri Garg
- Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Utah Health School of Medicine, 30 N 1900 E SOM 4R118, Salt Lake City, UT, 84132, USA
| | | | - Suresh Ponnada
- Internal Medicine, Carilion Roanoke Medical Center, Roanoke, VA, USA
| | | | - Saurabh Chandan
- Gastroenterology and Hepatology, CHI Creighton School of Medicine, Omaha, NE, USA
| | - Ashok Tuteja
- Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Utah Health School of Medicine, 30 N 1900 E SOM 4R118, Salt Lake City, UT, 84132, USA
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Bose D, Stebliankin V, Cickovski T, Saha P, Trivedi A, Roy S, More M, Tuteja A, Mathee K, Narasimhan G, Chatterjee S. Microbiome Dysbiosis Shows Strong Association of Gut-Derived Altered Metabolomic Profile in Gulf War Chronic Multisymptom Illness Symptom Persistence Following Western Diet Feeding and Development of Obesity. Int J Mol Sci 2023; 24:4245. [PMID: 36835663 PMCID: PMC9962797 DOI: 10.3390/ijms24044245] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023] Open
Abstract
The pathophysiology of Gulf War Illness (GWI) remains elusive even after three decades. The persistence of multiple complex symptoms along with metabolic disorders such as obesity worsens the health of present Gulf War (GW) Veterans often by the interactions of the host gut microbiome and inflammatory mediators. In this study, we hypothesized that the administration of a Western diet might alter the host metabolomic profile, which is likely associated with the altered bacterial species. Using a five-month symptom persistence GWI model in mice and whole-genome sequencing, we characterized the species-level dysbiosis and global metabolomics, along with heterogenous co-occurrence network analysis, to study the bacteriome-metabolomic association. Microbial analysis at the species level showed a significant alteration of beneficial bacterial species. The beta diversity of the global metabolomic profile showed distinct clustering due to the Western diet, along with the alteration of metabolites associated with lipid, amino acid, nucleotide, vitamin, and xenobiotic metabolism pathways. Network analysis showed novel associations of gut bacterial species with metabolites and biochemical pathways that could be used as biomarkers or therapeutic targets to ameliorate symptom persistence in GW Veterans.
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Affiliation(s)
- Dipro Bose
- Environmental Health and Disease Laboratory, Department of Environmental and Occupational Health, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA 92697, USA
| | - Vitalli Stebliankin
- Knight Foundation School of Computing and Information Sciences, College of Engineering and Computing, Florida International University, Miami, FL 33199, USA
| | - Trevor Cickovski
- Knight Foundation School of Computing and Information Sciences, College of Engineering and Computing, Florida International University, Miami, FL 33199, USA
| | - Punnag Saha
- Environmental Health and Disease Laboratory, Department of Environmental and Occupational Health, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA 92697, USA
| | - Ayushi Trivedi
- Environmental Health and Disease Laboratory, Department of Environmental and Occupational Health, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA 92697, USA
| | - Subhajit Roy
- Environmental Health and Disease Laboratory, Department of Environmental and Occupational Health, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA 92697, USA
| | - Madhura More
- Environmental Health and Disease Laboratory, Department of Environmental and Occupational Health, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA 92697, USA
| | - Ashok Tuteja
- Division of Internal Medicine, University of Utah School of Medicine, Salt Lake City VAMC, Salt Lake City, UT 84132, USA
| | - Kalai Mathee
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
- Biomolecular Sciences Institute, Florida International University, Miami, FL 33199, USA
| | - Giri Narasimhan
- Knight Foundation School of Computing and Information Sciences, College of Engineering and Computing, Florida International University, Miami, FL 33199, USA
- Biomolecular Sciences Institute, Florida International University, Miami, FL 33199, USA
| | - Saurabh Chatterjee
- Environmental Health and Disease Laboratory, Department of Environmental and Occupational Health, Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA 92697, USA
- Department of Medicine, Infectious Disease, UCI School of Medicine, Irvine, CA 92697, USA
- VA Research and Development, VA Long Beach Health Care System, Long Beach, CA 90822, USA
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Abstract
Open-channel microfluidic devices have shown great potential in achieving a high degree of fluid control, at relatively low-cost, while enabling the opportunity for rapid fabrication. However, thus far, work in open channel microfluidics has largely focused on controlling the flow of water or other aqueous solutions. In this work we present new open channel microfluidic devices based on surfaces with patterned wettabilty that are capable of controlling the flow of virtually all high and low surface tension liquids. The fabricated open channel devices are capable of constraining a variety of low surface tension oils at high enough flow rates to enable, for the first time, water-in-oil microfluidic emulsification in an open channel device. By changing the flow rates for both the aqueous (dispersed) and organic (continuous) phases, we show that it is possible to vary the size of the emulsified droplets produced in the open channel device. Finally, we utilized the fabricated devices to synthesize relatively monodisperse, hydrogel microparticles that could incorporate a drug molecule. We also investigated the drug release characteristics of the fabricated particles.
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Affiliation(s)
- C Li
- Department of Materials Science and Engineering, University of Michigan, Ann Arbor, MI 48109, USA
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Abstract
Ingestion and digestion of food as well as expulsion of residual material from our gastrointestinal tract requires normal propulsive, i.e. motor, function. Hypomotility refers to inherited or acquired changes that come with decreased contractile forces or slower transit. It not only often causes symptoms but also may compromise nutritional status or lead to other complications. While severe forms, such as pseudo-obstruction or ileus, may have a tremendous functional impact, the less severe forms of hypomotility may well be more relevant, as they contribute to common disorders, such as functional dyspepsia, gastroparesis, chronic constipation, and irritable bowel syndrome (IBS). Clinical testing can identify changes in contractile activity, defined by lower amplitudes or abnormal patterns, and the related effects on transit. However, such biomarkers show a limited correlation with overall symptom severity as experienced by patients. Similarly, targeting hypomotility with pharmacological interventions often alters gut motor function but does not consistently improve symptoms. Novel diagnostic approaches may change this apparent paradox and enable us to obtain more comprehensive information by integrating data on electrical activity, mechanical forces, patterns, wall stiffness, and motions with information of the flow of luminal contents. New drugs with more selective effects or more specific delivery may improve benefits and limit adverse effects. Lastly, the complex regulation of gastrointestinal motility involves the brain-gut axis as a reciprocal pathway for afferent and efferent signaling. Considering the role of visceral input in emotion and the effects of emotion on visceral activity, understanding and managing hypomotility disorders requires an integrative approach based on the mind-body continuum or biopsychosocial model of diseases.
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Affiliation(s)
- Klaus Bielefeldt
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ashok Tuteja
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Salman Nusrat
- Department of Medicine, Oklahoma University Medical Center, Oklahoma City, OK, USA
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Verma P, Subodh S, Tiwari V, Rampal R, Tuteja A, Toteja GS, Gupta SD, Ahuja V. Correlation of Serum Vitamin A Levels with Disease Activity Indices and Colonic IL-23R and FOXP3 mRNA Expression in Ulcerative Colitis Patients. Scand J Immunol 2016; 84:110-7. [DOI: 10.1111/sji.12450] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 12/19/2022]
Affiliation(s)
- P. Verma
- Department of Gastroenterology and Human Nutrition; All India Institute of Medical Sciences; New Delhi India
| | - S. Subodh
- The Centre for Genomic Application (An IGIB-IMM collaboration); New Delhi India
| | - V. Tiwari
- Department of Gastroenterology and Human Nutrition; All India Institute of Medical Sciences; New Delhi India
| | - R. Rampal
- Department of Gastroenterology and Human Nutrition; All India Institute of Medical Sciences; New Delhi India
| | - A. Tuteja
- The Centre for Genomic Application (An IGIB-IMM collaboration); New Delhi India
| | - G. S. Toteja
- ICMR laboratory in Centre for Promotion of Nutrition Research and Training with Special Focus on North- East, Tribal and Inaccessible Population; New Delhi India
| | - S. D. Gupta
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - V. Ahuja
- Department of Gastroenterology and Human Nutrition; All India Institute of Medical Sciences; New Delhi India
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