6th Annual BMRP Investigator Meeting - Abstract
Fructo-oligosaccharides in Crohn’s Disease: a Prospective Randomized, Double-Blind, Controlled Trial
Charlotte Hedin1, Andreas Koutsoumpos1, Andy Stagg2, Stella Knight3, Alastair Forbes4, Kevin Whelan1, James O. Lindsay2,a
1Nutritional Sciences Research Division, King’s College London (United Kingdom); 2Gastroenterology Clinical Academic Unit, Barts and The London, Queen Mary's School of Medicine and Dentistry (United Kingdom); 3The Antigen Presentation Research Group, Imperial College London, (United Kingdom); 4Department of Gastroenterology and Nutrition, University College London (United Kingdom)
The intestinal inflammation associated with Crohn’s disease results from an uncontrolled T cell mediated response to luminal antigen. Standard therapies such as corticosteroids act to suppress this inflammatory response but are only partially effective and associated with a significant morbidity. Specific bacteria within the commensal microbiota exhibit marked immunoregulatory effects and may suppress intestinal inflammation. However, trials of probiotic bacteria have not demonstrated significant benefit, perhaps due to heterogeneity in both the patients studied and the appropriate immunoregulatory bacteria for each individual. Fructo-oligosaccharides (FOS), are prebiotic carbohydrates that pass undigested through the small intestine and are fermented by commensal immunoregulatory bacteria in the colon resulting in a specific growth advantage to those bacteria and the release of short chain fatty acids. In an open label study in patients with moderately active Crohn’s disease, we have previously demonstrated that FOS reduces disease activity and is associated with an increase in both faecal / mucosal bifidobacteria and dendritic cell IL-10 release. We are conducting a prospective randomised double blind controlled trial of FOS in 110 patients with moderately active Crohn’s disease. The primary endpoint is clinical response at week four. Secondary endpoints include clinical remission, quality of life, changes in faecal and mucosal microbiota, faecal short chain fatty acid concentrations and alterations in mucosal dendritic cell phenotype after FOS.
aPrincipal Investigator
Charlotte Hedin1, Andreas Koutsoumpos1, Andy Stagg2, Stella Knight3, Alastair Forbes4, Kevin Whelan1, James O. Lindsay2,a
1Nutritional Sciences Research Division, King’s College London (United Kingdom); 2Gastroenterology Clinical Academic Unit, Barts and The London, Queen Mary's School of Medicine and Dentistry (United Kingdom); 3The Antigen Presentation Research Group, Imperial College London, (United Kingdom); 4Department of Gastroenterology and Nutrition, University College London (United Kingdom)
The intestinal inflammation associated with Crohn’s disease results from an uncontrolled T cell mediated response to luminal antigen. Standard therapies such as corticosteroids act to suppress this inflammatory response but are only partially effective and associated with a significant morbidity. Specific bacteria within the commensal microbiota exhibit marked immunoregulatory effects and may suppress intestinal inflammation. However, trials of probiotic bacteria have not demonstrated significant benefit, perhaps due to heterogeneity in both the patients studied and the appropriate immunoregulatory bacteria for each individual. Fructo-oligosaccharides (FOS), are prebiotic carbohydrates that pass undigested through the small intestine and are fermented by commensal immunoregulatory bacteria in the colon resulting in a specific growth advantage to those bacteria and the release of short chain fatty acids. In an open label study in patients with moderately active Crohn’s disease, we have previously demonstrated that FOS reduces disease activity and is associated with an increase in both faecal / mucosal bifidobacteria and dendritic cell IL-10 release. We are conducting a prospective randomised double blind controlled trial of FOS in 110 patients with moderately active Crohn’s disease. The primary endpoint is clinical response at week four. Secondary endpoints include clinical remission, quality of life, changes in faecal and mucosal microbiota, faecal short chain fatty acid concentrations and alterations in mucosal dendritic cell phenotype after FOS.
aPrincipal Investigator