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P655 Microencapsulated Sodium Butyrate significantly modifies the microbiota in patients with inflammatory bowel disease mimicking prebiotic activity and proving effects on the treatment of the disease

S. Facchin*1, N. Vitulo2, B. Perini1, A. Buda3, F. Zingone4, C. Romualdi5, R. D'Incà4, E. Savarino4

1University of Padua, Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, Padova, Italy, 2University of Padua, Department of Biotechnology, Verona, Italy, 3S.Maria del Prato Hospital, Department of Oncological Gastrointestinal Surgery, Feltre( BL), Italy, 4University of Padua, Department of Oncological Gastrointestinal Surgery, Padova, Italy, 5University of Padua, Department of Biology, Padova, Italy

Background

Inflammatory bowel disease (IBD) is characterised by severe inflammation of the small bowel and/or the colon leading to recurrent diarrhoea and abdominal pain. Butyrate represents one of the final product of saccharolytic fermentation of complex and non-digestible polysaccharides by anaerobic bacteria and has shown anti-inflammatory and regenerative properties, providing symptomatic relief when orally supplemented in patients suffering from a various range of colonic diseases.1 We investigate the effect of a microencapsulated form of sodium Butyrate (MSB, ButyroseR, SILA, Noale, Italy) on the faecal microbiota of patients with IBD

Methods

In this prospective-randomised-placebo-controlled study, 49 IBD patients, 19 CD and 30 UC with mild-to-moderate clinical activity were enrolled (Figure 1)

Figure 1.

Patients with extensive surgery were excluded. After stratification by clinical assessment, colonoscopy, and faecal calprotectin (FC) levels, patients were randomised to oral administration of MSB (1800 mg/die) or placebo for 2 months, in addition to conventional therapy. Clinical activity was defined according to HBI in case of Crohn’s disease (CD) and Mayo score in case of ulcerative colitis (UC). Before (T0) and after (T1) butyrate-treatment, stool samples were collected for faecal microbiota assessment analysis by 16S ribosomal RNA Illumina MiSeq sequencing. Patients completed the quality of life questionnaire in IBD (IBDQ) on T = 0 and T = 1.

Results

MSB induced similar changes in the microbiota of IBD patients by increasing the bacteria able to produce short-chain fatty acids (SFCA). However, an increased abundance of butyrogenic colonic bacteria (including genera Butyricicoccus and Subdoligranulum) were observed in CD patients, whereas in UC patients we observed a major increase of Lachnospiraceae (sPLS-DA analysis). Clinically, when only patients with calprotectin levels above 250 μg/g1 for CD and 150 μg/g2 for UC were considered, a 30% decrease of calprotectin levels were observed in 67% of CD patients treated with MSB vs. 33.3% in those treated with placebo. Subjective improvement in QoL based on IBDQ was significantly observed either in the treatment (p = 0.0046) and in placebo (p = 0.039) group. However, a greater effect was observed among the UC patients.

Conclusion

MSB supplementation showed a mimicking prebiotic effect increasing the production of endogenous and physiological SCFAs with a marked improvement of QoL and reduction of the level of inflammatory markers

References

1. Louis P, Duncan SH, McCrae SI, et al. Restricted distribution of the butyrate kinase pathway among butyrate-producing bacteria from the human colon. J Bacteriol 2004;186:2099–106.

2. Lin JF, Chen JM, Zuo JH, et al. Meta-analysis: fecal calprotectin for assessment of inflammatory bowel disease activity. Inflamm Bowel Dis 2014;20:1407–15.

3. Costa F, Mumolo MG, Ceccarelli L, et al. Calprotectin is a stronger predictive marker of relapse in ulcerative colitis than in Crohn’s disease. , Gut. 2005;54:364–8.