Randomised, double-blind, placebo-controlled trial of fructo-oligosaccharides in active Crohn's disease

IntroductionThe commensal intestinal microbiota drive the inflammation associated with Crohn's disease. However, bacteria such as bifidobacteria and Faecalibacterium prausnitzii appear to be immunoregulatory. In healthy subjects the intestinal microbiota are influenced by prebiotic carbohydrate...

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Published inGut Vol. 60; no. 7; pp. 923 - 929
Main Authors Benjamin, Jane L, Hedin, Charlotte R H, Koutsoumpas, Andreas, Ng, Siew C, McCarthy, Neil E, Hart, Ailsa L, Kamm, Michael A, Sanderson, Jeremy D, Knight, Stella C, Forbes, Alastair, Stagg, Andrew J, Whelan, Kevin, Lindsay, James O
Format Journal Article
LanguageEnglish
Published London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.07.2011
BMJ Publishing Group
BMJ Publishing Group LTD
Subjects
Online AccessGet full text
ISSN0017-5749
1468-3288
1468-3288
DOI10.1136/gut.2010.232025

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Abstract IntroductionThe commensal intestinal microbiota drive the inflammation associated with Crohn's disease. However, bacteria such as bifidobacteria and Faecalibacterium prausnitzii appear to be immunoregulatory. In healthy subjects the intestinal microbiota are influenced by prebiotic carbohydrates such as fructo-oligosaccharides (FOS). Preliminary data suggest that FOS increase faecal bifidobacteria, induce immunoregulatory dendritic cell (DC) responses and reduce disease activity in patients with Crohn's disease.Aims and methodsTo assess the impact of FOS in patients with active Crohn's disease using an adequately powered randomised double-blind placebo-controlled trial with predefined clinical, microbiological and immunological end points. Patients with active Crohn's disease were randomised to 15 g/day FOS or non-prebiotic placebo for 4 weeks. The primary end point was clinical response at week 4 (fall in Crohn's Disease Activity Index of ≥70 points) in the intention-to-treat (ITT) population.Results103 patients were randomised to receive FOS (n=54) or placebo (n=49). More patients receiving FOS (14 (26%) vs 4 (8%); p=0.018) withdrew before the 4-week end point. There was no significant difference in the number of patients achieving a clinical response between the FOS and placebo groups in the ITT analysis (12 (22%) vs 19 (39%), p=0.067). Patients receiving FOS had reduced proportions of interleukin (IL)-6-positive lamina propria DC and increased DC staining of IL-10 (p<0.05) but no change in IL-12p40 production. There were no significant differences in the faecal concentration of bifidobacteria and F prausnitzii between the groups at baseline or after the 4-week intervention.ConclusionAn adequately powered placebo-controlled trial of FOS showed no clinical benefit in patients with active Crohn's disease, despite impacting on DC function. ISRCTN50422530.
AbstractList The commensal intestinal microbiota drive the inflammation associated with Crohn's disease. However, bacteria such as bifidobacteria and Faecalibacterium prausnitzii appear to be immunoregulatory. In healthy subjects the intestinal microbiota are influenced by prebiotic carbohydrates such as fructo-oligosaccharides (FOS). Preliminary data suggest that FOS increase faecal bifidobacteria, induce immunoregulatory dendritic cell (DC) responses and reduce disease activity in patients with Crohn's disease. To assess the impact of FOS in patients with active Crohn's disease using an adequately powered randomised double-blind placebo-controlled trial with predefined clinical, microbiological and immunological end points. Patients with active Crohn's disease were randomised to 15 g/day FOS or non-prebiotic placebo for 4 weeks. The primary end point was clinical response at week 4 (fall in Crohn's Disease Activity Index of ≥ 70 points) in the intention-to-treat (ITT) population. 103 patients were randomised to receive FOS (n = 54) or placebo (n = 49). More patients receiving FOS (14 (26%) vs 4 (8%); p = 0.018) withdrew before the 4-week end point. There was no significant difference in the number of patients achieving a clinical response between the FOS and placebo groups in the ITT analysis (12 (22%) vs 19 (39%), p = 0.067). Patients receiving FOS had reduced proportions of interleukin (IL)-6-positive lamina propria DC and increased DC staining of IL-10 (p < 0.05) but no change in IL-12p40 production. There were no significant differences in the faecal concentration of bifidobacteria and F prausnitzii between the groups at baseline or after the 4-week intervention. An adequately powered placebo-controlled trial of FOS showed no clinical benefit in patients with active Crohn's disease, despite impacting on DC function. ISRCTN50422530.
The commensal intestinal microbiota drive the inflammation associated with Crohn's disease. However, bacteria such as bifidobacteria and Faecalibacterium prausnitzii appear to be immunoregulatory. In healthy subjects the intestinal microbiota are influenced by prebiotic carbohydrates such as fructo-oligosaccharides (FOS). Preliminary data suggest that FOS increase faecal bifidobacteria, induce immunoregulatory dendritic cell (DC) responses and reduce disease activity in patients with Crohn's disease.INTRODUCTIONThe commensal intestinal microbiota drive the inflammation associated with Crohn's disease. However, bacteria such as bifidobacteria and Faecalibacterium prausnitzii appear to be immunoregulatory. In healthy subjects the intestinal microbiota are influenced by prebiotic carbohydrates such as fructo-oligosaccharides (FOS). Preliminary data suggest that FOS increase faecal bifidobacteria, induce immunoregulatory dendritic cell (DC) responses and reduce disease activity in patients with Crohn's disease.To assess the impact of FOS in patients with active Crohn's disease using an adequately powered randomised double-blind placebo-controlled trial with predefined clinical, microbiological and immunological end points. Patients with active Crohn's disease were randomised to 15 g/day FOS or non-prebiotic placebo for 4 weeks. The primary end point was clinical response at week 4 (fall in Crohn's Disease Activity Index of ≥ 70 points) in the intention-to-treat (ITT) population.AIMS AND METHODSTo assess the impact of FOS in patients with active Crohn's disease using an adequately powered randomised double-blind placebo-controlled trial with predefined clinical, microbiological and immunological end points. Patients with active Crohn's disease were randomised to 15 g/day FOS or non-prebiotic placebo for 4 weeks. The primary end point was clinical response at week 4 (fall in Crohn's Disease Activity Index of ≥ 70 points) in the intention-to-treat (ITT) population.103 patients were randomised to receive FOS (n = 54) or placebo (n = 49). More patients receiving FOS (14 (26%) vs 4 (8%); p = 0.018) withdrew before the 4-week end point. There was no significant difference in the number of patients achieving a clinical response between the FOS and placebo groups in the ITT analysis (12 (22%) vs 19 (39%), p = 0.067). Patients receiving FOS had reduced proportions of interleukin (IL)-6-positive lamina propria DC and increased DC staining of IL-10 (p < 0.05) but no change in IL-12p40 production. There were no significant differences in the faecal concentration of bifidobacteria and F prausnitzii between the groups at baseline or after the 4-week intervention.RESULTS103 patients were randomised to receive FOS (n = 54) or placebo (n = 49). More patients receiving FOS (14 (26%) vs 4 (8%); p = 0.018) withdrew before the 4-week end point. There was no significant difference in the number of patients achieving a clinical response between the FOS and placebo groups in the ITT analysis (12 (22%) vs 19 (39%), p = 0.067). Patients receiving FOS had reduced proportions of interleukin (IL)-6-positive lamina propria DC and increased DC staining of IL-10 (p < 0.05) but no change in IL-12p40 production. There were no significant differences in the faecal concentration of bifidobacteria and F prausnitzii between the groups at baseline or after the 4-week intervention.An adequately powered placebo-controlled trial of FOS showed no clinical benefit in patients with active Crohn's disease, despite impacting on DC function. ISRCTN50422530.CONCLUSIONAn adequately powered placebo-controlled trial of FOS showed no clinical benefit in patients with active Crohn's disease, despite impacting on DC function. ISRCTN50422530.
IntroductionThe commensal intestinal microbiota drive the inflammation associated with Crohn's disease. However, bacteria such as bifidobacteria and Faecalibacterium prausnitzii appear to be immunoregulatory. In healthy subjects the intestinal microbiota are influenced by prebiotic carbohydrates such as fructo-oligosaccharides (FOS). Preliminary data suggest that FOS increase faecal bifidobacteria, induce immunoregulatory dendritic cell (DC) responses and reduce disease activity in patients with Crohn's disease.Aims and methodsTo assess the impact of FOS in patients with active Crohn's disease using an adequately powered randomised double-blind placebo-controlled trial with predefined clinical, microbiological and immunological end points. Patients with active Crohn's disease were randomised to 15 g/day FOS or non-prebiotic placebo for 4 weeks. The primary end point was clinical response at week 4 (fall in Crohn's Disease Activity Index of ≥70 points) in the intention-to-treat (ITT) population.Results103 patients were randomised to receive FOS (n=54) or placebo (n=49). More patients receiving FOS (14 (26%) vs 4 (8%); p=0.018) withdrew before the 4-week end point. There was no significant difference in the number of patients achieving a clinical response between the FOS and placebo groups in the ITT analysis (12 (22%) vs 19 (39%), p=0.067). Patients receiving FOS had reduced proportions of interleukin (IL)-6-positive lamina propria DC and increased DC staining of IL-10 (p<0.05) but no change in IL-12p40 production. There were no significant differences in the faecal concentration of bifidobacteria and F prausnitzii between the groups at baseline or after the 4-week intervention.ConclusionAn adequately powered placebo-controlled trial of FOS showed no clinical benefit in patients with active Crohn's disease, despite impacting on DC function. ISRCTN50422530.
INTRODUCTION: The commensal intestinal microbiota drive the inflammation associated with Crohn's disease. However, bacteria such as bifidobacteria and Faecalibacterium prausnitzii appear to be immunoregulatory. In healthy subjects the intestinal microbiota are influenced by prebiotic carbohydrates such as fructo-oligosaccharides (FOS). Preliminary data suggest that FOS increase faecal bifidobacteria, induce immunoregulatory dendritic cell (DC) responses and reduce disease activity in patients with Crohn's disease. AIMS AND METHODS: To assess the impact of FOS in patients with active Crohn's disease using an adequately powered randomised double-blind placebo-controlled trial with predefined clinical, microbiological and immunological end points. Patients with active Crohn's disease were randomised to 15 g/day FOS or non-prebiotic placebo for 4 weeks. The primary end point was clinical response at week 4 (fall in Crohn's Disease Activity Index of greater than or equal to 70 points) in the intention-to-treat (ITT) population. RESULTS: 103 patients were randomised to receive FOS (n=54) or placebo (n=49). More patients receiving FOS (14 (26%) vs 4 (8%); p=0.018) withdrew before the 4-week end point. There was no significant difference in the number of patients achieving a clinical response between the FOS and placebo groups in the ITT analysis (12 (22%) vs 19 (39%), p=0.067). Patients receiving FOS had reduced proportions of interleukin (IL)-6-positive lamina propria DC and increased DC staining of IL-10 (p<0.05) but no change in IL-12p40 production. There were no significant differences in the faecal concentration of bifidobacteria and F prausnitzii between the groups at baseline or after the 4-week intervention. CONCLUSION: An adequately powered placebo-controlled trial of FOS showed no clinical benefit in patients with active Crohn's disease, despite impacting on DC function. ISRCTN50422530.
Introduction The commensal intestinal microbiota drive the inflammation associated with Crohn's disease. However, bacteria such as bifidobacteria and Faecalibacterium prausnitzii appear to be immunoregulatory. In healthy subjects the intestinal microbiota are influenced by prebiotic carbohydrates such as fructo-oligosaccharides (FOS). Preliminary data suggest that FOS increase faecal bifidobacteria, induce immunoregulatory dendritic cell (DC) responses and reduce disease activity in patients with Crohn's disease. Aims and methods To assess the impact of FOS in patients with active Crohn's disease using an adequately powered randomised double-blind placebo-controlled trial with predefined clinical, microbiological and immunological end points. Patients with active Crohn's disease were randomised to 15 g/day FOS or non-prebiotic placebo for 4 weeks. The primary end point was clinical response at week 4 (fall in Crohn's Disease Activity Index of ≥70 points) in the intention-to-treat (ITT) population. Results 103 patients were randomised to receive FOS (n=54) or placebo (n=49). More patients receiving FOS (14 (26%) vs 4 (8%); p=0.018) withdrew before the 4-week end point. There was no significant difference in the number of patients achieving a clinical response between the FOS and placebo groups in the ITT analysis (12 (22%) vs 19 (39%), p=0.067). Patients receiving FOS had reduced proportions of interleukin (IL)-6-positive lamina propria DC and increased DC staining of IL-10 (p<0.05) but no change in IL-12p40 production. There were no significant differences in the faecal concentration of bifidobacteria and F prausnitzii between the groups at baseline or after the 4-week intervention. Conclusion An adequately powered placebo-controlled trial of FOS showed no clinical benefit in patients with active Crohn's disease, despite impacting on DC function. ISRCTN50422530.
Author Benjamin, Jane L
Ng, Siew C
Stagg, Andrew J
Kamm, Michael A
Sanderson, Jeremy D
McCarthy, Neil E
Hart, Ailsa L
Lindsay, James O
Koutsoumpas, Andreas
Whelan, Kevin
Forbes, Alastair
Hedin, Charlotte R H
Knight, Stella C
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  surname: Benjamin
  fullname: Benjamin, Jane L
  organization: Nutritional Sciences Division, King's College London, London, UK
– sequence: 2
  givenname: Charlotte R H
  surname: Hedin
  fullname: Hedin, Charlotte R H
  organization: Nutritional Sciences Division, King's College London, London, UK
– sequence: 3
  givenname: Andreas
  surname: Koutsoumpas
  fullname: Koutsoumpas, Andreas
  organization: Nutritional Sciences Division, King's College London, London, UK
– sequence: 4
  givenname: Siew C
  surname: Ng
  fullname: Ng, Siew C
  organization: Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong
– sequence: 5
  givenname: Neil E
  surname: McCarthy
  fullname: McCarthy, Neil E
  organization: Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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  givenname: Ailsa L
  surname: Hart
  fullname: Hart, Ailsa L
  organization: Antigen Presenting Research Group, Imperial College, London, UK
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  givenname: Michael A
  surname: Kamm
  fullname: Kamm, Michael A
  organization: Departments of Medicine and Gastroenterology, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
– sequence: 8
  givenname: Jeremy D
  surname: Sanderson
  fullname: Sanderson, Jeremy D
  organization: Nutritional Sciences Division, King's College London, London, UK
– sequence: 9
  givenname: Stella C
  surname: Knight
  fullname: Knight, Stella C
  organization: Antigen Presenting Research Group, Imperial College, London, UK
– sequence: 10
  givenname: Alastair
  surname: Forbes
  fullname: Forbes, Alastair
  organization: Centre for Gastroenterology and Nutrition, University College, London, UK
– sequence: 11
  givenname: Andrew J
  surname: Stagg
  fullname: Stagg, Andrew J
  organization: Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
– sequence: 12
  givenname: Kevin
  surname: Whelan
  fullname: Whelan, Kevin
  organization: Nutritional Sciences Division, King's College London, London, UK
– sequence: 13
  givenname: James O
  surname: Lindsay
  fullname: Lindsay, James O
  email: james.lindsay@bartsandthelondon.nhs.uk
  organization: Digestive Diseases Clinical Academic Unit, Barts and the London NHS Trust, London, UK
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https://www.ncbi.nlm.nih.gov/pubmed/21262918$$D View this record in MEDLINE/PubMed
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Keywords Crohn disease
Digestive diseases
Intestinal disease
Gastroenterology
Inflammatory disease
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Snippet IntroductionThe commensal intestinal microbiota drive the inflammation associated with Crohn's disease. However, bacteria such as bifidobacteria and...
Introduction The commensal intestinal microbiota drive the inflammation associated with Crohn's disease. However, bacteria such as bifidobacteria and...
The commensal intestinal microbiota drive the inflammation associated with Crohn's disease. However, bacteria such as bifidobacteria and Faecalibacterium...
INTRODUCTION: The commensal intestinal microbiota drive the inflammation associated with Crohn's disease. However, bacteria such as bifidobacteria and...
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SubjectTerms Adult
Bifidobacterium - isolation & purification
Biological and medical sciences
Biomedical research
Carbohydrates
clinical trials
Crohn Disease - drug therapy
Crohn Disease - immunology
Crohn Disease - microbiology
Crohn's disease
Cytokines
Dendritic cells
Dendritic Cells - immunology
Double-Blind Method
Endoscopy
Faecalibacterium prausnitzii
Feces - microbiology
Female
Fermentation
Fructo-oligosaccharide
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Immunity, Mucosal
Immunology
Inflammation
Inflammatory bowel disease
Intestinal Mucosa - immunology
inulin
Male
Medical sciences
Medication Adherence
Middle Aged
molecular immunology
oligofructose
Oligosaccharides - adverse effects
Oligosaccharides - therapeutic use
Other diseases. Semiology
prebiotic
Prebiotics
Prebiotics - adverse effects
Probiotics
Rectum - immunology
Rodents
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
Studies
Treatment Outcome
University colleges
Title Randomised, double-blind, placebo-controlled trial of fructo-oligosaccharides in active Crohn's disease
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