NEW research has shed light on the potential of the gut microbiota in predicting recurrence of Crohn’s disease following surgical remission.
Lead author Cristian Hernández Rocha, University of Toronto, Canada, and colleagues, aimed to investigate the mechanisms behind the re-emergence of intestinal inflammation in Crohn’s disease by examining tissue-associated microbiota. Conducted across six academic centres, the study enrolled 262 patients with Crohn’s disease undergoing ileocolic resection. Post-operative colonoscopies yielded 944 biopsy samples from the neoterminal ileum, colon, and rectosigmoid, which were analysed using 16S ribosomal RNA gene sequencing to assess microbial diversity and composition.
The team analysed microbial diversity and taxonomic differential relative abundance, and applied a random forest model to assess the performance of clinical and microbial features to predict recurrence. A Rutgeerts score ≥i2 was deemed as endoscopic recurrence.
Key findings revealed that ileal inflammation significantly influenced the microbiota of both the ileal and colonic mucosa. Notably, 97 patients who initially were in remission, but later experienced endoscopic recurrence, exhibited lower microbial diversity and significant microbial deviations compared to those who remained in remission. Specifically, a depletion of the genus Anaerostipes, and an increase in several genera from the class Gammaproteobacteria, were observed across all biopsy sites, indicating a higher risk of recurrence.
The study’s findings suggest that deviations in the ileal and colonic mucosa-associated microbiome can precede new onset ileal inflammation after surgical remission, offering a robust predictive tool for future disease recurrence. The ability to predict and potentially prevent Crohn’s disease flare-ups through microbiome analysis represents a significant advancement in the management of this complex condition. Future research and clinical applications may focus on microbiota-targeted therapies, with the potential to enhance post-operative care for patients with Crohn’s disease.
Ada Enesco, EMJ
Reference
Rocha CH et al. After surgically induced remission, ileal and colonic mucosa-associated microbiota predicts Crohn’s disease recurrence. Clin Gastroenterol Hepatol. 2024; DOI:10.1016/j.cgh.2024.06.022.
