Treatment of active Crohn's disease with an ordinary food-based diet that replicates exclusive enteral nutrition

V. Svolos, R. Hansen, B. Nichols, C. Quince, U.Z. Ijaz, R.T. Papadopoulou, C.A. Edwards, D. Watson, A. Alghamdi, A. Brejnrod, C. Ansalone, H. Duncan, L. Gervais, R. Tayler, J. Salmond, D. Bolognini, R. Klopfleisch, D.R. Gaya, S. Milling, R.K. Russell & 1 others K. Gerasimidis

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background & Aims Exclusive enteral nutrition (EEN) is the only established dietary treatment for Crohn’s disease (CD), but its acceptability is limited. There is a need for novel dietary treatments for CD. Methods We evaluated the effects of an individualized, food-based diet (CD-TREAT), with similar composition to EEN, on the gut microbiome, inflammation and clinical response in a rat model, healthy adults, and children with relapsing CD. Twenty-five healthy adults randomly received EEN or CD-TREAT for 7 days, followed by a 14-day washout period, followed by the alternate diet. Fecal microbiome and metabolome were assessed before and after each diet. HLA-B7 and HLA-B27 transgenic rats with gut inflammation received EEN, CD-TREAT, or standard chow for 4 weeks. Fecal, luminal and tissue microbiome, fecal metabolites and gut inflammation were assessed. Five children received CD-TREAT with clinical activity and fecal calprotectin evaluated after 8-week treatment. 
Results Among healthy adults, CD-TREAT was easier to comply with and more acceptable than EEN. CD-TREAT induced similar effects to EEN (EEN vs CD-TREAT) on fecal microbiome composition, metabolome, mean total sulfide (increase 133.0±80.5 vs 54.3±47.0 nmol/g), pH (increase 1.3±0.5 vs 0.9±0.6), the short-chain fatty acids (μmol/g) acetate (decrease 27.4±22.6 vs 21.6±20.4), propionate (decrease 5.7±7.8 vs 5.2±7.9), and butyrate (decrease 7.0±7.4 vs 10.2±8.5). In the rat model, CD-TREAT and EEN produced similar changes in bacterial load (decrease 0.3±0.3 log10 16S rRNA gene copies/g), short-chain fatty acids, microbiome, and ileitis severity (mean histopathology score reductions 1.25 for EEN (P=.015) and 1.0 for CD-TREAT (P=.044) vs chow). Among the children receiving CD-TREAT, 4 (80%) had a clinical response and 3 (60%) entered remission, with significant concurrent reductions in fecal calprotectin (mean decrease 918±555 mg/kg, (P=.002)). 
Conclusion CD-TREAT replicates EEN changes in the microbiome, reduces gut inflammation, is well-tolerated and is potentially effective in patients with active CD.
LanguageEnglish
JournalGastroenterology
Early online date11 Dec 2018
DOIs
Publication statusE-pub ahead of print - 11 Dec 2018

Fingerprint

Enteral Nutrition
Crohn Disease
Diet
Food
Microbiota
Therapeutics
Leukocyte L1 Antigen Complex
Inflammation
Metabolome
Volatile Fatty Acids
HLA-B7 Antigen
Ileitis
Transgenic Rats
HLA-B27 Antigen
Bacterial Load
Butyrates
Propionates
Sulfides
rRNA Genes
Acetates

Keywords

  • IBD
  • microbiota
  • pediatric trial
  • carbohydrate

Cite this

Svolos, V., Hansen, R., Nichols, B., Quince, C., Ijaz, U. Z., Papadopoulou, R. T., ... Gerasimidis, K. (2018). Treatment of active Crohn's disease with an ordinary food-based diet that replicates exclusive enteral nutrition. Gastroenterology. https://doi.org/10.1053/j.gastro.2018.12.002
Svolos, V. ; Hansen, R. ; Nichols, B. ; Quince, C. ; Ijaz, U.Z. ; Papadopoulou, R.T. ; Edwards, C.A. ; Watson, D. ; Alghamdi, A. ; Brejnrod, A. ; Ansalone, C. ; Duncan, H. ; Gervais, L. ; Tayler, R. ; Salmond, J. ; Bolognini, D. ; Klopfleisch, R. ; Gaya, D.R. ; Milling, S. ; Russell, R.K. ; Gerasimidis, K. / Treatment of active Crohn's disease with an ordinary food-based diet that replicates exclusive enteral nutrition. In: Gastroenterology. 2018.
@article{6015dd77f6a041b4a9137a19a187b89f,
title = "Treatment of active Crohn's disease with an ordinary food-based diet that replicates exclusive enteral nutrition",
abstract = "Background & Aims Exclusive enteral nutrition (EEN) is the only established dietary treatment for Crohn’s disease (CD), but its acceptability is limited. There is a need for novel dietary treatments for CD. Methods We evaluated the effects of an individualized, food-based diet (CD-TREAT), with similar composition to EEN, on the gut microbiome, inflammation and clinical response in a rat model, healthy adults, and children with relapsing CD. Twenty-five healthy adults randomly received EEN or CD-TREAT for 7 days, followed by a 14-day washout period, followed by the alternate diet. Fecal microbiome and metabolome were assessed before and after each diet. HLA-B7 and HLA-B27 transgenic rats with gut inflammation received EEN, CD-TREAT, or standard chow for 4 weeks. Fecal, luminal and tissue microbiome, fecal metabolites and gut inflammation were assessed. Five children received CD-TREAT with clinical activity and fecal calprotectin evaluated after 8-week treatment. Results Among healthy adults, CD-TREAT was easier to comply with and more acceptable than EEN. CD-TREAT induced similar effects to EEN (EEN vs CD-TREAT) on fecal microbiome composition, metabolome, mean total sulfide (increase 133.0±80.5 vs 54.3±47.0 nmol/g), pH (increase 1.3±0.5 vs 0.9±0.6), the short-chain fatty acids (μmol/g) acetate (decrease 27.4±22.6 vs 21.6±20.4), propionate (decrease 5.7±7.8 vs 5.2±7.9), and butyrate (decrease 7.0±7.4 vs 10.2±8.5). In the rat model, CD-TREAT and EEN produced similar changes in bacterial load (decrease 0.3±0.3 log10 16S rRNA gene copies/g), short-chain fatty acids, microbiome, and ileitis severity (mean histopathology score reductions 1.25 for EEN (P=.015) and 1.0 for CD-TREAT (P=.044) vs chow). Among the children receiving CD-TREAT, 4 (80{\%}) had a clinical response and 3 (60{\%}) entered remission, with significant concurrent reductions in fecal calprotectin (mean decrease 918±555 mg/kg, (P=.002)). Conclusion CD-TREAT replicates EEN changes in the microbiome, reduces gut inflammation, is well-tolerated and is potentially effective in patients with active CD.",
keywords = "IBD, microbiota, pediatric trial, carbohydrate",
author = "V. Svolos and R. Hansen and B. Nichols and C. Quince and U.Z. Ijaz and R.T. Papadopoulou and C.A. Edwards and D. Watson and A. Alghamdi and A. Brejnrod and C. Ansalone and H. Duncan and L. Gervais and R. Tayler and J. Salmond and D. Bolognini and R. Klopfleisch and D.R. Gaya and S. Milling and R.K. Russell and K. Gerasimidis",
year = "2018",
month = "12",
day = "11",
doi = "10.1053/j.gastro.2018.12.002",
language = "English",
journal = "Gastroenterology",
issn = "0016-5085",

}

Svolos, V, Hansen, R, Nichols, B, Quince, C, Ijaz, UZ, Papadopoulou, RT, Edwards, CA, Watson, D, Alghamdi, A, Brejnrod, A, Ansalone, C, Duncan, H, Gervais, L, Tayler, R, Salmond, J, Bolognini, D, Klopfleisch, R, Gaya, DR, Milling, S, Russell, RK & Gerasimidis, K 2018, 'Treatment of active Crohn's disease with an ordinary food-based diet that replicates exclusive enteral nutrition' Gastroenterology. https://doi.org/10.1053/j.gastro.2018.12.002

Treatment of active Crohn's disease with an ordinary food-based diet that replicates exclusive enteral nutrition. / Svolos, V.; Hansen, R.; Nichols, B.; Quince, C.; Ijaz, U.Z.; Papadopoulou, R.T.; Edwards, C.A.; Watson, D.; Alghamdi, A.; Brejnrod, A.; Ansalone, C.; Duncan, H.; Gervais, L.; Tayler, R.; Salmond, J.; Bolognini, D.; Klopfleisch, R.; Gaya, D.R.; Milling, S.; Russell, R.K.; Gerasimidis, K.

In: Gastroenterology, 11.12.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Treatment of active Crohn's disease with an ordinary food-based diet that replicates exclusive enteral nutrition

AU - Svolos, V.

AU - Hansen, R.

AU - Nichols, B.

AU - Quince, C.

AU - Ijaz, U.Z.

AU - Papadopoulou, R.T.

AU - Edwards, C.A.

AU - Watson, D.

AU - Alghamdi, A.

AU - Brejnrod, A.

AU - Ansalone, C.

AU - Duncan, H.

AU - Gervais, L.

AU - Tayler, R.

AU - Salmond, J.

AU - Bolognini, D.

AU - Klopfleisch, R.

AU - Gaya, D.R.

AU - Milling, S.

AU - Russell, R.K.

AU - Gerasimidis, K.

PY - 2018/12/11

Y1 - 2018/12/11

N2 - Background & Aims Exclusive enteral nutrition (EEN) is the only established dietary treatment for Crohn’s disease (CD), but its acceptability is limited. There is a need for novel dietary treatments for CD. Methods We evaluated the effects of an individualized, food-based diet (CD-TREAT), with similar composition to EEN, on the gut microbiome, inflammation and clinical response in a rat model, healthy adults, and children with relapsing CD. Twenty-five healthy adults randomly received EEN or CD-TREAT for 7 days, followed by a 14-day washout period, followed by the alternate diet. Fecal microbiome and metabolome were assessed before and after each diet. HLA-B7 and HLA-B27 transgenic rats with gut inflammation received EEN, CD-TREAT, or standard chow for 4 weeks. Fecal, luminal and tissue microbiome, fecal metabolites and gut inflammation were assessed. Five children received CD-TREAT with clinical activity and fecal calprotectin evaluated after 8-week treatment. Results Among healthy adults, CD-TREAT was easier to comply with and more acceptable than EEN. CD-TREAT induced similar effects to EEN (EEN vs CD-TREAT) on fecal microbiome composition, metabolome, mean total sulfide (increase 133.0±80.5 vs 54.3±47.0 nmol/g), pH (increase 1.3±0.5 vs 0.9±0.6), the short-chain fatty acids (μmol/g) acetate (decrease 27.4±22.6 vs 21.6±20.4), propionate (decrease 5.7±7.8 vs 5.2±7.9), and butyrate (decrease 7.0±7.4 vs 10.2±8.5). In the rat model, CD-TREAT and EEN produced similar changes in bacterial load (decrease 0.3±0.3 log10 16S rRNA gene copies/g), short-chain fatty acids, microbiome, and ileitis severity (mean histopathology score reductions 1.25 for EEN (P=.015) and 1.0 for CD-TREAT (P=.044) vs chow). Among the children receiving CD-TREAT, 4 (80%) had a clinical response and 3 (60%) entered remission, with significant concurrent reductions in fecal calprotectin (mean decrease 918±555 mg/kg, (P=.002)). Conclusion CD-TREAT replicates EEN changes in the microbiome, reduces gut inflammation, is well-tolerated and is potentially effective in patients with active CD.

AB - Background & Aims Exclusive enteral nutrition (EEN) is the only established dietary treatment for Crohn’s disease (CD), but its acceptability is limited. There is a need for novel dietary treatments for CD. Methods We evaluated the effects of an individualized, food-based diet (CD-TREAT), with similar composition to EEN, on the gut microbiome, inflammation and clinical response in a rat model, healthy adults, and children with relapsing CD. Twenty-five healthy adults randomly received EEN or CD-TREAT for 7 days, followed by a 14-day washout period, followed by the alternate diet. Fecal microbiome and metabolome were assessed before and after each diet. HLA-B7 and HLA-B27 transgenic rats with gut inflammation received EEN, CD-TREAT, or standard chow for 4 weeks. Fecal, luminal and tissue microbiome, fecal metabolites and gut inflammation were assessed. Five children received CD-TREAT with clinical activity and fecal calprotectin evaluated after 8-week treatment. Results Among healthy adults, CD-TREAT was easier to comply with and more acceptable than EEN. CD-TREAT induced similar effects to EEN (EEN vs CD-TREAT) on fecal microbiome composition, metabolome, mean total sulfide (increase 133.0±80.5 vs 54.3±47.0 nmol/g), pH (increase 1.3±0.5 vs 0.9±0.6), the short-chain fatty acids (μmol/g) acetate (decrease 27.4±22.6 vs 21.6±20.4), propionate (decrease 5.7±7.8 vs 5.2±7.9), and butyrate (decrease 7.0±7.4 vs 10.2±8.5). In the rat model, CD-TREAT and EEN produced similar changes in bacterial load (decrease 0.3±0.3 log10 16S rRNA gene copies/g), short-chain fatty acids, microbiome, and ileitis severity (mean histopathology score reductions 1.25 for EEN (P=.015) and 1.0 for CD-TREAT (P=.044) vs chow). Among the children receiving CD-TREAT, 4 (80%) had a clinical response and 3 (60%) entered remission, with significant concurrent reductions in fecal calprotectin (mean decrease 918±555 mg/kg, (P=.002)). Conclusion CD-TREAT replicates EEN changes in the microbiome, reduces gut inflammation, is well-tolerated and is potentially effective in patients with active CD.

KW - IBD

KW - microbiota

KW - pediatric trial

KW - carbohydrate

U2 - 10.1053/j.gastro.2018.12.002

DO - 10.1053/j.gastro.2018.12.002

M3 - Article

JO - Gastroenterology

T2 - Gastroenterology

JF - Gastroenterology

SN - 0016-5085

ER -