Our Top 5 Research updates: The latest Gastroenterology and Probiotic Science

Corrine Toyn RD

Welcome to the VSL# healthcare professional blog series where we dive into the latest and most intriguing research findings curated by VSL#. In a world inundated with information, it can be challenging to sift through the noise and find the most relevant and up to date gastroenterology and probiotic studies.

That's where the VSL# HCP team come in.

At VSL#, we're passionate about staying ahead of the curve and identifying the research that has the potential to make a real impact in gastroenterology and probiotic science.

Join us as we delve into the fascinating world of gastroenterology and probiotic research. Here are our top recent research picks.

1) The American Gastroenterological Association recommends Faecal Matter Transplant (FMT) for C.Diff

The American Gastroenterological Association has released the first evidence-based guideline on faecal microbiota-based therapies for gastrointestinal diseases, recommending faecal microbiota transplant (FMT) as a safe and effective treatment for most patients with recurrent Clostridioides difficile (C. diff) infection. Nearly half a million people in the U.S. annually experience C. diff, with one in six facing a recurrence. The guideline suggests FMT for high-risk patients after standard antibiotic treatment and for hospitalised patients with severe C. diff infection if there is no improvement. However, the guidance states that FMT is not recommended for inflammatory bowel diseases or irritable bowel syndrome, and interested patients are encouraged to participate in clinical trials. The guideline covers conventional FMT methods and recently FDA-approved therapies, concluding that FMT may provide hope for those with recurrent C. diff, allowing for shorter periods of suffering and a return to healthier lives.

Link to article here.

2) Opening a world of opportunity with human milk oligosaccharide (HMO)

The manipulation of the gut microbiome using live biotherapeutic products holds promise for clinical applications but faces challenges. In a study involving 56 healthy volunteers, dysbiosis was induced through antibiotics to test a synbiotic consisting of Bifidobacterium longum subspecies infantis (B. infantis) and human milk oligosaccharides (HMOs). B. infantis successfully engrafted in 76% of subjects in an HMO-dependent manner, reaching up to 81% relative abundance. The changes in microbiome composition and gut metabolites indicated altered recovery in engrafted subjects compared to controls. Engraftment correlated with increases in lactate-consuming Veillonella, accelerated acetate recovery, and alterations in indolelactate and p-cresol sulfate—metabolites influencing host inflammatory status. Additionally, in vitro and in vivo experiments revealed that Veillonella, when co-cultured with B. infantis and HMO, converted lactate produced by B. infantis into propionate, a crucial mediator of host physiology. These findings suggest that the synbiotic consistently and predictably modulates the recovery of a dysbiotic microbiome.

Therefore, colonisation of B. infantis, reliant on HMOs, amidst temporary dysbiosis, results in consistent alterations in both microbiome structure and metabolic production. In specific groups of patients or in dysbioses triggered by alternative types of antibiotics, dysbiosis might persist without intentional intervention. The findings mark a noteworthy stride towards targeted microbiome manipulation to tackle such situations, leveraging insights from the innate course of healthy microbiome establishment in infants.

Link to paper here.

3) Exploring the role of probiotics in non-alcoholic fatty liver disease (NAFLD)

Non-alcoholic fatty liver disease (NAFLD) and its advanced stage, non-alcoholic steatohepatitis (NASH), are increasingly prevalent global chronic liver conditions. Lifestyle changes, including weight loss, increased physical activity, and maintaining a healthy diet, are crucial for managing NAFLD/NASH. Recent research indicates a link between the gut microbiome and the development of NAFLD/NASH, leading to the emergence of microbiome-targeted therapy as a potential treatment. Through a systematic review and network meta-analysis following the PRISMA statement, this paper explores the impact of traditional probiotics and next-generation probiotics (NGPs) on NAFLD/NASH. Comparative analysis revealed that traditional probiotics primarily alleviate liver fat deposition and inflammation by improving gut microbiota composition, enhancing intestinal barrier function, and modulating immune responses. On the other hand, NGPs exhibit a more substantial therapeutic potential, directly inhibiting oxidative stress and promoting the production of short-chain fatty acids (SCFAs). NGPs present a promising strategy for managing NAFLD/NASH by simultaneously inhibiting oxidative stress and enhancing SCFA production, underscoring the significance of understanding and utilising both direct and indirect regulatory mechanisms of oxidative stress in disease management. 

Link to paper here.

4) Early dietary intervention in Scandanavian children reduces risk of inflammatory bowel disease (IBD)

The study investigated the link between early-life diet and inflammatory bowel disease (IBD) using data from two Scandinavian cohort studies. Higher diet quality at age 1 was associated with a reduced IBD risk, with adjusted hazard ratios of 0.75. High fish intake at age 1 was linked to lower IBD risk, particularly ulcerative colitis. Increased vegetable intake at age 1 also reduced IBD risk, while sugar-sweetened beverages raised the risk. Diet quality at age 3 did not show a significant association with IBD. In conclusion, high diet quality and early-life fish intake were connected to a lower IBD risk in this Scandinavian birth cohort. 

Link to paper here.

5) Is consumption of ultra processed foods linked to an increased risk of gut diseases?

Processed foods and additives are widely prevalent in the modern human diet, with an increasing body of evidence linking diets high in these substances to various gut-related conditions. Conditions such as IBD, colorectal cancer, and IBS have been associated with a high consumption of ultra-processed foods (UPFs). Moreover, many UPFs contain food additives have been demonstrated to impact gut health. For instance, certain emulsifiers, sweeteners, colours, as well as microparticles and nanoparticles have been shown to affect outcomes like the gut microbiome, intestinal permeability, and intestinal inflammation. Notably, research on the impact of UPFs on gut health primarily relies on observational epidemiological studies, while evidence for the effects of food additives is predominantly derived from preclinical studies conducted in vitro or with animal models. This paper reviews the effects of UPFs and food additives on gut health and disease to discuss the potential clinical implications of these findings.

Link to article here.

Stay tuned for the next VSL# healthcare professional newsletter! In the meantime, let us know if you have any thoughts on the research above by emailing hcp@vsl3.co.uk

References:

• American Gastroenterological Association. AGA now recommends fecal microbiota transplant for the majority of recurrent C. diff patients. 2024. Available online: https://gastro.org/press-releases/aga-recommends-fecal-transplant-for-recurrent-cdiff-patients/#:~:text=FMT%20offers%20hope%20to%20patients,FMT%20therapy%20to%20prevent%20recurrence. Accessed March 2024.
• Button JE, Cosetta CM, Reens AL, Brooker SL, Rowan-Nash AD, Lavin RC, Saur R, Zheng S, Autran CA, Lee ML, Sun AK, Alousi AM, Peterson CB, Koh AY, Rechtman DJ, Jenq RR, McKenzie GJ. Precision modulation of dysbiotic adult microbiomes with a human-milk-derived synbiotic reshapes gut microbial composition and metabolites. Cell Host Microbe. 2023 Sep 13;31(9):1523-1538.e10. doi: 10.1016/j.chom.2023.08.004. Epub 2023 Aug 31. PMID: 37657443.
• Zhu Y, Tan JK, Liu J, Goon JA. Roles of Traditional and Next-Generation Probiotics on Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH): A Systematic Review and Network Meta-Analysis. Antioxidants. 2024; 13(3):329. https://doi.org/10.3390/antiox13030329
• Guo A, Ludvigsson J, Brantsæter AL, Klingberg S, Östensson M, Størdal K, Mårild K. Early-life diet and risk of inflammatory bowel disease: a pooled study in two Scandinavian birth cohorts. Gut. 2024 Mar 7;73(4):590-600. doi: 10.1136/gutjnl-2023-330971. PMID: 38290832; PMCID: PMC10958293.
• Whelan, K., Bancil, A.S., Lindsay, J.O. et al. Ultra-processed foods and food additives in gut health and disease. Nat Rev Gastroenterol Hepatol (2024). https://doi.org/10.1038/s41575-024-00893-5.