Assessing the Relationship between the Gut Microbiota and Inflammatory Bowel Disease Therapeutics: A Systematic Review

Cassandra Mah; Thisun Jayawardana; Gary Leong; Sabrina Koentgen; Daniel Lemberg; Susan J Connor; Theodore Rokkas; Michael C Grimm; Steven T Leach; Georgina L Hold

doi:10.3390/pathogens12020262

Assessing the Relationship between the Gut Microbiota and Inflammatory Bowel Disease Therapeutics: A Systematic Review

Pathogens. 2023 Feb 6;12(2):262. doi: 10.3390/pathogens12020262.

Authors

Affiliations

¹ Microbiome Research Centre, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2217, Australia.
² Discipline of Paediatrics, School of Clinical Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
³ Gastroenterology, Sydney Children's Hospital Randwick, Randwick, NSW 2031, Australia.
⁴ Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia.
⁵ Department of Gastroenterology Hepatology, Liverpool Hospital, Sydney, NSW 2170, Australia.
⁶ Gastroenterology Clinic, Henry Dunant Hospital, 11526 Athens, Greece.

Abstract

Current inflammatory bowel disease (IBD) treatments including non-biological, biological, and nutritional therapies aim to achieve remission and mucosal healing. Treatment efficacy, however, is highly variable, and there is growing evidence that the gut microbiota influences therapeutic efficacy. The aim of this study was to conduct a systematic review and meta-analysis to define changes in the gut microbiota following IBD treatment and to identify microbial predictors of treatment response. A systematic search using MEDLINE/Embase and PubMed was performed in July 2022. The review was conducted based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Studies were included if they reported longitudinal microbiota analysis (>2 weeks) using next-generation sequencing or high-throughput sequencing of faecal/mucosal samples from IBD patients commencing treatment. Meta-analysis on alpha-diversity changes following infliximab treatment was conducted. Thirty-nine studies met the inclusion criteria, and four studies were included in the meta-analysis. An increase in alpha diversity was observed following treatment with 5-aminosalicylates, corticosteroids, and biological therapies in most studies. Characteristic signatures involving the enrichment of short-chain-fatty-acid-producing bacteria including Faecalibacterium prausnitzii and a reduction of pathogenic bacteria including various Proteobacteria were demonstrated following treatment with specific signatures identified based on treatment outcome. The meta-analysis demonstrated a statistically significant increase in bacterial richness following infliximab treatment (standardised mean difference -1.16 (-1.50, -0.83), p < 0.00001). Conclusion: Distinct microbial signatures are seen following treatment and are associated with treatment response. The interrogation of large longitudinal studies is needed to establish the link between the gut microbiota and IBD therapeutic outcomes.

Keywords: Crohn’s disease; gut micro-biota; inflammatory bowel disease; therapeutics; ulcerative colitis.

Publication types

Review

Grants and funding

This research received no external funding.