1
|
Cook L, Wong MQ, Rees WD, Schick A, Lisko DJ, Lunken GR, Wang X, Peters H, Oliveira L, Lau T, Mah R, Bressler B, Levings MK, Steiner TS. Dysregulated Immunity to Clostridioides difficile in IBD Patients Without a History of Recognized Infection. Inflamm Bowel Dis 2024; 30:820-828. [PMID: 37874904 PMCID: PMC11063544 DOI: 10.1093/ibd/izad238] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND & AIMS Clostridioides difficile is a toxin-secreting bacteria that is an urgent antimicrobial resistance threat, with approximately 25% of patients developing recurrent infections. Inflammatory bowel disease (IBD) patients are at increased risk of severe, recurrent C. difficile infection. METHODS To investigate a role for C. difficile infection in IBD pathogenesis, we collected peripheral blood and stool from 20 each of ulcerative colitis patients, Crohn's disease patients, and healthy control subjects. We used a flow cytometric activation induced marker assay to quantify C. difficile toxin-specific CD4+ T cells and 16S ribosomal RNA sequencing to study microbiome diversity. RESULTS We found IBD patients had significantly increased levels of C. difficile toxin B-specific CD4+ T cells, but not immunoglobulin G or immunoglobulin A, compared with healthy control subjects. Within antigen-specific CD4+ T cells, T helper type 17 cells and cells expressing the gut homing receptor integrin β7 were reduced compared with healthy control subjects, similar to our previous study of non-IBD patients with recurrent C. difficile infection. Stool microbiome analysis revealed that gut homing, toxin-specific CD4+ T cells negatively associated with microbial diversity and, along with T helper type 17 cells, positively associated with bacteria enriched in healthy control subjects. CONCLUSIONS These data suggest that IBD patients, potentially due to underlying intestinal dysbiosis, experience undiagnosed C. difficile infections that result in impaired toxin-specific immunity. This may contribute to the development of inflammatory T cell responses toward commensal bacteria and provide a rationale for C. difficile testing in IBD patients.
Collapse
Affiliation(s)
- Laura Cook
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Microbiology and Immunology, University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - May Q Wong
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - William D Rees
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Alana Schick
- Gut4Health, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Daniel J Lisko
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Genelle R Lunken
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Xiaojiao Wang
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Hannah Peters
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laura Oliveira
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Torey Lau
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Regan Mah
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brian Bressler
- Gastrointestinal Research Institute, Vancouver, BC, Canada
| | - Megan K Levings
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Theodore S Steiner
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| |
Collapse
|
2
|
Evans S, Olive L, Dober M, Knowles S, Fuller-Tyszkiewicz M, O E, Gibson P, Raven L, Gearry R, McCombie A, van Niekerk L, Chesterman S, Romano D, Mikocka-Walus A. Acceptance commitment therapy (ACT) for psychological distress associated with inflammatory bowel disease (IBD): protocol for a feasibility trial of the ACTforIBD programme. BMJ Open 2022; 12:e060272. [PMID: 35688593 PMCID: PMC9189839 DOI: 10.1136/bmjopen-2021-060272] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) involves an abnormal immune response to healthy gut bacteria. When a person develops IBD, their susceptibility to anxiety and/or depression increases. The ACTforIBD programme, specifically designed for people with IBD and comorbid psychological distress, draws on acceptance and commitment therapy (ACT), which promotes acceptance of situations that cannot be solved such as persistent physical symptoms. There are no ACT trials for IBD using an active control group or a telemedicine approach, which is important to improve accessibility, particularly in the context of the ongoing COVID-19 pandemic. The ACTforIBD programme is administered online with a 4-hour therapist involvement per participant only; if successful it can be widely implemented to improve the well-being of many individuals with IBD. METHODS AND ANALYSIS Our team have codesigned with consumers the ACTforIBD programme, an 8-week intervention of 1-hour sessions, with the first three sessions and the last session delivered one-to-one by a psychologist, and the other sessions self-directed online. This study aims to evaluate the feasibility and preliminary efficacy of ACTforIBD to reduce psychological distress in patients with IBD. Using a randomised controlled trial, 25 participants will be randomised to ACTforIBD, and 25 patients to an active control condition. ETHICS AND DISSEMINATION This protocol has been approved by Deakin University Research Ethics Committee in September 2021 (Ref. 2021-263) and the New Zealand Central Health and Disability Ethics Committee in December 2021 (Ref. 2021 EXP 11384). The results of this research will be published in peer-reviewed journals and shared with various stakeholders, including community members, policy-makers and researchers, through local and international conferences. TRIAL REGISTRATION NUMBER ACTRN12621001316897.
Collapse
Affiliation(s)
- Subhadra Evans
- Psychology, Deakin University Faculty of Health, Burwood, Victoria, Australia
| | - Lisa Olive
- School of Pyschology, Deakin, Geelong, Victoria, Australia
| | - Madeleine Dober
- School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Simon Knowles
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | | | - Eric O
- Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Peter Gibson
- Gastroenterology, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Leanne Raven
- Crohn's and Colitis Australia, Camberwell, Victoria, Australia
| | - Richard Gearry
- Department of Medicine, Christchurch School of Medicine and Health Sciences, Medicine, Christchurch, New Zealand
| | - Andrew McCombie
- Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Leesa van Niekerk
- School of Psychological Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Daniel Romano
- School of Pyschology, Deakin, Geelong, Victoria, Australia
| | | |
Collapse
|