Intrinsic properties of the intestinal ecosystem may delay or prevent remission from ulcerative colitis (UC), according to a study in Gastroenterology.

Researchers sought to determine whether alternative stable states exist in the intestinal ecosystem and if they could affect remission from UC. Data were analyzed from 428 pediatric patients with new-onset, treatment-naïve UC from 29 centers in the United States and Canada. The patients were aged 4 to 17 years (mean age, 12.8±3.3 years) and 48% were girls.

The participants received 5-aminosalicylic acid (mesalamine) or oral/intravenous corticosteroids (CS) followed by mesalamine and were monitored for 1 year. The investigators collected stool samples at baseline and approximately 4, 12, or 52 weeks after initial treatment initiation that were used for microbiome profiling (16S rRNA gene sequencing) and fecal calprotectin measurement.


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The study authors identified 4 alternative microbiota states and 4 alternative host states, with at least 3 of each also being observed among treatment-naïve patients, suggesting that the alternative states are not created by anti-inflammatory treatment. Improvement in inflammatory status is related to improvement in microbiota status, and both may be retarded or blocked by alternative states barriers, according to the researchers.

“We provide the first formal proof for the existence of alternative stable states of the human intestinal ecosystem,” stated the investigators. “Our analyses strongly suggest that the stability of these states interferes with remission from UC under standard of care. They may also explain the variable success of fecal microbiota transplantation in the treatment of UC.”

The researchers noted that their study considers intrinsic properties of the intestinal ecosystem — microbiota and host inflammatory status — and that for disease remediation, external factors such as diet are needed to support a healthy ecosystem state.

“New insights from this study provide a strong rationale for the application of combinatorial therapeutic strategies, combining anti-inflammatory treatments and microbiota management, in UC,” the study authors commented.

Reference

van de Guchte M, Mondot S, Doré J. Dynamic properties of the intestinal ecosystem call for combination therapies, targeting inflammation and microbiota, in ulcerative colitis. Gastroenterol. Published online September 6, 2021. doi: 10.1053/j.gastro.2021.08.057

This article originally appeared on Gastroenterology Advisor