Oral versus intravenous iron replacement therapy distinctly alters the gut microbiota and metabolome in patients with IBD
ObjectiveIron deficiency is a common complication in patients with IBD and oral iron therapy is suggested to exacerbate IBD symptoms. We performed an open-labelled clinical trial to compare the effects of per oral (PO) versus intravenous (IV) iron replacement therapy (IRT).DesignThe study population...
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| Published in | Gut Vol. 66; no. 5; pp. 863 - 871 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
BMJ Publishing Group LTD
01.05.2017
BMJ Publishing Group |
| Series | Original article |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0017-5749 1468-3288 1468-3288 |
| DOI | 10.1136/gutjnl-2015-309940 |
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| Abstract | ObjectiveIron deficiency is a common complication in patients with IBD and oral iron therapy is suggested to exacerbate IBD symptoms. We performed an open-labelled clinical trial to compare the effects of per oral (PO) versus intravenous (IV) iron replacement therapy (IRT).DesignThe study population included patients with Crohn's disease (CD; N=31), UC (N=22) and control subjects with iron deficiency (non-inflamed, NI=19). After randomisation, participants received iron sulfate (PO) or iron sucrose (IV) over 3 months. Clinical parameters, faecal bacterial communities and metabolomes were assessed before and after intervention.ResultsBoth PO and IV treatments ameliorated iron deficiency, but higher ferritin levels were observed with IV. Changes in disease activity were independent of iron treatment types. Faecal samples in IBD were characterised by marked interindividual differences, lower phylotype richness and proportions of Clostridiales. Metabolite analysis also showed separation of both UC and CD from control anaemic participants. Major shifts in bacterial diversity occurred in approximately half of all participants after IRT, but patients with CD were most susceptible. Despite individual-specific changes in phylotypes due to IRT, PO treatment was associated with decreased abundances of operational taxonomic units assigned to the species Faecalibacterium prausnitzii, Ruminococcus bromii, Dorea sp. and Collinsella aerofaciens. Clear IV-specific and PO-specific fingerprints were evident at the level of metabolomes, with changes affecting cholesterol-derived host substrates.ConclusionsShifts in gut bacterial diversity and composition associated with iron treatment are pronounced in IBD participants. Despite similar clinical outcome, oral administration differentially affects bacterial phylotypes and faecal metabolites compared with IV therapy.Trial registration numberclinicaltrial.gov (NCT01067547). |
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| AbstractList | Iron deficiency is a common complication in patients with IBD and oral iron therapy is suggested to exacerbate IBD symptoms. We performed an open-labelled clinical trial to compare the effects of per oral (PO) versus intravenous (IV) iron replacement therapy (IRT).
The study population included patients with Crohn's disease (CD; N=31), UC (N=22) and control subjects with iron deficiency (non-inflamed, NI=19). After randomisation, participants received iron sulfate (PO) or iron sucrose (IV) over 3 months. Clinical parameters, faecal bacterial communities and metabolomes were assessed before and after intervention.
Both PO and IV treatments ameliorated iron deficiency, but higher ferritin levels were observed with IV. Changes in disease activity were independent of iron treatment types. Faecal samples in IBD were characterised by marked interindividual differences, lower phylotype richness and proportions of Clostridiales. Metabolite analysis also showed separation of both UC and CD from control anaemic participants. Major shifts in bacterial diversity occurred in approximately half of all participants after IRT, but patients with CD were most susceptible. Despite individual-specific changes in phylotypes due to IRT, PO treatment was associated with decreased abundances of operational taxonomic units assigned to the species
,
,
sp. and
. Clear IV-specific and PO-specific fingerprints were evident at the level of metabolomes, with changes affecting cholesterol-derived host substrates.
Shifts in gut bacterial diversity and composition associated with iron treatment are pronounced in IBD participants. Despite similar clinical outcome, oral administration differentially affects bacterial phylotypes and faecal metabolites compared with IV therapy.
clinicaltrial.gov (NCT01067547). Iron deficiency is a common complication in patients with IBD and oral iron therapy is suggested to exacerbate IBD symptoms. We performed an open-labelled clinical trial to compare the effects of per oral (PO) versus intravenous (IV) iron replacement therapy (IRT).OBJECTIVEIron deficiency is a common complication in patients with IBD and oral iron therapy is suggested to exacerbate IBD symptoms. We performed an open-labelled clinical trial to compare the effects of per oral (PO) versus intravenous (IV) iron replacement therapy (IRT).The study population included patients with Crohn's disease (CD; N=31), UC (N=22) and control subjects with iron deficiency (non-inflamed, NI=19). After randomisation, participants received iron sulfate (PO) or iron sucrose (IV) over 3 months. Clinical parameters, faecal bacterial communities and metabolomes were assessed before and after intervention.DESIGNThe study population included patients with Crohn's disease (CD; N=31), UC (N=22) and control subjects with iron deficiency (non-inflamed, NI=19). After randomisation, participants received iron sulfate (PO) or iron sucrose (IV) over 3 months. Clinical parameters, faecal bacterial communities and metabolomes were assessed before and after intervention.Both PO and IV treatments ameliorated iron deficiency, but higher ferritin levels were observed with IV. Changes in disease activity were independent of iron treatment types. Faecal samples in IBD were characterised by marked interindividual differences, lower phylotype richness and proportions of Clostridiales. Metabolite analysis also showed separation of both UC and CD from control anaemic participants. Major shifts in bacterial diversity occurred in approximately half of all participants after IRT, but patients with CD were most susceptible. Despite individual-specific changes in phylotypes due to IRT, PO treatment was associated with decreased abundances of operational taxonomic units assigned to the species Faecalibacterium prausnitzii, Ruminococcus bromii, Dorea sp. and Collinsella aerofaciens. Clear IV-specific and PO-specific fingerprints were evident at the level of metabolomes, with changes affecting cholesterol-derived host substrates.RESULTSBoth PO and IV treatments ameliorated iron deficiency, but higher ferritin levels were observed with IV. Changes in disease activity were independent of iron treatment types. Faecal samples in IBD were characterised by marked interindividual differences, lower phylotype richness and proportions of Clostridiales. Metabolite analysis also showed separation of both UC and CD from control anaemic participants. Major shifts in bacterial diversity occurred in approximately half of all participants after IRT, but patients with CD were most susceptible. Despite individual-specific changes in phylotypes due to IRT, PO treatment was associated with decreased abundances of operational taxonomic units assigned to the species Faecalibacterium prausnitzii, Ruminococcus bromii, Dorea sp. and Collinsella aerofaciens. Clear IV-specific and PO-specific fingerprints were evident at the level of metabolomes, with changes affecting cholesterol-derived host substrates.Shifts in gut bacterial diversity and composition associated with iron treatment are pronounced in IBD participants. Despite similar clinical outcome, oral administration differentially affects bacterial phylotypes and faecal metabolites compared with IV therapy.CONCLUSIONSShifts in gut bacterial diversity and composition associated with iron treatment are pronounced in IBD participants. Despite similar clinical outcome, oral administration differentially affects bacterial phylotypes and faecal metabolites compared with IV therapy.clinicaltrial.gov (NCT01067547).TRIAL REGISTRATION NUMBERclinicaltrial.gov (NCT01067547). ObjectiveIron deficiency is a common complication in patients with IBD and oral iron therapy is suggested to exacerbate IBD symptoms. We performed an open-labelled clinical trial to compare the effects of per oral (PO) versus intravenous (IV) iron replacement therapy (IRT).DesignThe study population included patients with Crohn's disease (CD; N=31), UC (N=22) and control subjects with iron deficiency (non-inflamed, NI=19). After randomisation, participants received iron sulfate (PO) or iron sucrose (IV) over 3 months. Clinical parameters, faecal bacterial communities and metabolomes were assessed before and after intervention.ResultsBoth PO and IV treatments ameliorated iron deficiency, but higher ferritin levels were observed with IV. Changes in disease activity were independent of iron treatment types. Faecal samples in IBD were characterised by marked interindividual differences, lower phylotype richness and proportions of Clostridiales. Metabolite analysis also showed separation of both UC and CD from control anaemic participants. Major shifts in bacterial diversity occurred in approximately half of all participants after IRT, but patients with CD were most susceptible. Despite individual-specific changes in phylotypes due to IRT, PO treatment was associated with decreased abundances of operational taxonomic units assigned to the species Faecalibacterium prausnitzii, Ruminococcus bromii, Dorea sp. and Collinsella aerofaciens. Clear IV-specific and PO-specific fingerprints were evident at the level of metabolomes, with changes affecting cholesterol-derived host substrates.ConclusionsShifts in gut bacterial diversity and composition associated with iron treatment are pronounced in IBD participants. Despite similar clinical outcome, oral administration differentially affects bacterial phylotypes and faecal metabolites compared with IV therapy.Trial registration numberclinicaltrial.gov (NCT01067547). Objective Iron deficiency is a common complication in patients with IBD and oral iron therapy is suggested to exacerbate IBD symptoms. We performed an open-labelled clinical trial to compare the effects of per oral (PO) versus intravenous (IV) iron replacement therapy (IRT). Design The study population included patients with Crohn's disease (CD; N=31), UC (N=22) and control subjects with iron deficiency (non-inflamed, NI=19). After randomisation, participants received iron sulfate (PO) or iron sucrose (IV) over 3 months. Clinical parameters, faecal bacterial communities and metabolomes were assessed before and after intervention. Results Both PO and IV treatments ameliorated iron deficiency, but higher ferritin levels were observed with IV. Changes in disease activity were independent of iron treatment types. Faecal samples in IBD were characterised by marked interindividual differences, lower phylotype richness and proportions of Clostridiales. Metabolite analysis also showed separation of both UC and CD from control anaemic participants. Major shifts in bacterial diversity occurred in approximately half of all participants after IRT, but patients with CD were most susceptible. Despite individual-specific changes in phylotypes due to IRT, PO treatment was associated with decreased abundances of operational taxonomic units assigned to the species Faecalibacterium prausnitzii, Ruminococcus bromii, Dorea sp. and Collinsella aerofaciens. Clear IV-specific and PO-specific fingerprints were evident at the level of metabolomes, with changes affecting cholesterol-derived host substrates. Conclusions Shifts in gut bacterial diversity and composition associated with iron treatment are pronounced in IBD participants. Despite similar clinical outcome, oral administration differentially affects bacterial phylotypes and faecal metabolites compared with IV therapy. Trial registration number clinicaltrial.gov ( NCT01067547 ). ObjectiveIron deficiency is a common complication in patients with IBD and oral iron therapy is suggested to exacerbate IBD symptoms. We performed an open-labelled clinical trial to compare the effects of per oral (PO) versus intravenous (IV) iron replacement therapy (IRT).DesignThe study population included patients with Crohn's disease (CD; N=31), UC (N=22) and control subjects with iron deficiency (non-inflamed, NI=19). After randomisation, participants received iron sulfate (PO) or iron sucrose (IV) over 3months. Clinical parameters, faecal bacterial communities and metabolomes were assessed before and after intervention.ResultsBoth PO and IV treatments ameliorated iron deficiency, but higher ferritin levels were observed with IV. Changes in disease activity were independent of iron treatment types. Faecal samples in IBD were characterised by marked interindividual differences, lower phylotype richness and proportions of Clostridiales. Metabolite analysis also showed separation of both UC and CD from control anaemic participants. Major shifts in bacterial diversity occurred in approximately half of all participants after IRT, but patients with CD were most susceptible. Despite individual-specific changes in phylotypes due to IRT, PO treatment was associated with decreased abundances of operational taxonomic units assigned to the species Faecalibacterium prausnitzii, Ruminococcus bromii, Dorea sp. and Collinsella aerofaciens. Clear IV-specific and PO-specific fingerprints were evident at the level of metabolomes, with changes affecting cholesterol-derived host substrates.ConclusionsShifts in gut bacterial diversity and composition associated with iron treatment are pronounced in IBD participants. Despite similar clinical outcome, oral administration differentially affects bacterial phylotypes and faecal metabolites compared with IV therapy.Trial registration numberclinicaltrial.gov (NCT01067547). |
| Author | Walker, Alesia Lagkouvardos, Ilias Schmitt-Kopplin, Philippe Fedorak, Richard Haller, Dirk Clavel, Thomas Lee, Thomas Lucio, Marianna Smirnov, Kirill Schmidt, Annemarie Michalke, Bernhard |
| AuthorAffiliation | 1 Division of Gastroenterology, Department of Medicine , University of Alberta , Edmonton , Canada 2 Department of Gastroenterology , Wollongong Hospital, Wollongong , NSW , Australia 5 Chair of Nutrition and Immunology, Technische Universität München , Freising , Germany 3 ZIEL Institute for Food and Health, Technische Universität München , Freising , Germany 4 Research Unit Analytical BioGeoChemistry, German Research Center for Environmental Health , Neuherberg , Germany |
| AuthorAffiliation_xml | – name: 1 Division of Gastroenterology, Department of Medicine , University of Alberta , Edmonton , Canada – name: 3 ZIEL Institute for Food and Health, Technische Universität München , Freising , Germany – name: 2 Department of Gastroenterology , Wollongong Hospital, Wollongong , NSW , Australia – name: 4 Research Unit Analytical BioGeoChemistry, German Research Center for Environmental Health , Neuherberg , Germany – name: 5 Chair of Nutrition and Immunology, Technische Universität München , Freising , Germany |
| Author_xml | – sequence: 1 givenname: Thomas surname: Lee fullname: Lee, Thomas email: dirk.haller@tum.de organization: Department of Gastroenterology, Wollongong Hospital, Wollongong, NSW, Australia – sequence: 2 givenname: Thomas surname: Clavel fullname: Clavel, Thomas email: dirk.haller@tum.de organization: ZIEL Institute for Food and Health, Technische Universität München, Freising, Germany – sequence: 3 givenname: Kirill surname: Smirnov fullname: Smirnov, Kirill email: dirk.haller@tum.de organization: Research Unit Analytical BioGeoChemistry, German Research Center for Environmental Health, Neuherberg, Germany – sequence: 4 givenname: Annemarie surname: Schmidt fullname: Schmidt, Annemarie email: dirk.haller@tum.de organization: Chair of Nutrition and Immunology, Technische Universität München, Freising, Germany – sequence: 5 givenname: Ilias surname: Lagkouvardos fullname: Lagkouvardos, Ilias email: dirk.haller@tum.de organization: ZIEL Institute for Food and Health, Technische Universität München, Freising, Germany – sequence: 6 givenname: Alesia surname: Walker fullname: Walker, Alesia email: dirk.haller@tum.de organization: Research Unit Analytical BioGeoChemistry, German Research Center for Environmental Health, Neuherberg, Germany – sequence: 7 givenname: Marianna surname: Lucio fullname: Lucio, Marianna email: dirk.haller@tum.de organization: Research Unit Analytical BioGeoChemistry, German Research Center for Environmental Health, Neuherberg, Germany – sequence: 8 givenname: Bernhard surname: Michalke fullname: Michalke, Bernhard email: dirk.haller@tum.de organization: Research Unit Analytical BioGeoChemistry, German Research Center for Environmental Health, Neuherberg, Germany – sequence: 9 givenname: Philippe surname: Schmitt-Kopplin fullname: Schmitt-Kopplin, Philippe email: dirk.haller@tum.de organization: Research Unit Analytical BioGeoChemistry, German Research Center for Environmental Health, Neuherberg, Germany – sequence: 10 givenname: Richard surname: Fedorak fullname: Fedorak, Richard email: dirk.haller@tum.de organization: Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada – sequence: 11 givenname: Dirk surname: Haller fullname: Haller, Dirk email: dirk.haller@tum.de organization: Chair of Nutrition and Immunology, Technische Universität München, Freising, Germany |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/26848182$$D View this record in MEDLINE/PubMed |
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| Copyright | Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/. Copyright: 2016 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ 2016 |
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| Keywords | IRON DEFICIENCY ANEMIA INFLAMMATORY BOWEL DISEASE IBD CLINICAL INTESTINAL BACTERIA |
| Language | English |
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| Snippet | ObjectiveIron deficiency is a common complication in patients with IBD and oral iron therapy is suggested to exacerbate IBD symptoms. We performed an... Iron deficiency is a common complication in patients with IBD and oral iron therapy is suggested to exacerbate IBD symptoms. We performed an open-labelled... Objective Iron deficiency is a common complication in patients with IBD and oral iron therapy is suggested to exacerbate IBD symptoms. We performed an... |
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| SubjectTerms | Administration, Intravenous Administration, Oral Anemia Anemia, Iron-Deficiency - drug therapy Anemia, Iron-Deficiency - etiology Bacteria Cholesterol Clostridiales Colitis, Ulcerative - complications Colitis, Ulcerative - metabolism Colitis, Ulcerative - microbiology Collinsella aerofaciens Crohn Disease - complications Crohn Disease - metabolism Crohn Disease - microbiology Crohn's disease Faecalibacterium prausnitzii Fatty acids Feces - chemistry Feces - microbiology Ferric Compounds - administration & dosage Ferritin Ferritins - blood Fourier transforms Gastrointestinal Microbiome - drug effects Glucaric Acid - administration & dosage Hematinics - administration & dosage Humans Inflammation Inflammatory Bowel Disease Intestinal microflora Intravenous administration Iron Iron - deficiency Mass spectrometry Melatonin Metabolism Metabolites Metabolome - drug effects Microbiota Nutrient deficiency Oral administration Ostomy Pathogenesis Pathogens Patients Population studies Quality of Life RNA, Ribosomal, 16S - analysis Ruminococcus Scientific imaging Sucrose Sulfates |
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| Title | Oral versus intravenous iron replacement therapy distinctly alters the gut microbiota and metabolome in patients with IBD |
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