A Randomized, Controlled Trial of Lactic Acid Bacteria for Idiopathic Hyperoxaluria

Abstract

Background: Urinary oxalate excretion is an important contributor to calcium oxalate stone formation. Methods of reducing oxalate excretion are not wholly satisfactory, and no controlled trials using them have been performed to prevent stone recurrence. Some lactic acid bacteria can degrade oxalate in vitro. This study sought to reduce urinary oxalate excretion in calcium stone formers with idiopathic hyperoxaluria.Design, setting, participants, and measurements: A randomized, double-blind, placebo-controlled trial was performed of Oxadrop, a mix of four lactic acid bacterium species. This preparation previously reduced oxalate excretion in stone formers with idiopathic and enteric hyperoxaluria. Patients were selected from two stone prevention clinics. Twenty people with calcium stones and idiopathic hyperoxaluria (>40 mg/d) were enrolled and randomly assigned 1:1 in placebo and active preparation arms. Both groups took 3.6 g of granulate each day: Either placebo or the experimental preparation. Participants performed two consecutive 24-h urine collections at baseline, at 28 d of therapy, and at 56 d, after being off the preparation for 4 wk. Diet was replicated at each point.Results: There was no effect of the study preparation: Mean 24-h urinary oxalate excretion in placebo-treated patients was 73.9 mg at baseline and 72.7 mg after treatment, whereas the Oxadrop-treated patients had 59.1 mg at baseline and 55.4 mg after treatment. The preparation was well tolerated; three participants on active treatment experienced mild constipation.Conclusions: In this randomized, placebo-controlled trial, Oxadrop did not reduce urinary oxalate excretion in participants with idiopathic hyperoxaluria.

Pediatric primary urolithiasis: Symptoms, medical management and prevention strategies

“…New approaches such as the use of probiotics like Oxalobacter formigenes, which act as oxalatedegraders, appear to be promising in calcium oxalate stone formers. However, the results are not consistent [114,115] . Future alternative treatments of hyperoxaluria involve upregulation of intestinal secretion through the increase of the anion transporter activity (S1c26a6) [118] .…”

“…However, in vivo results are contradictory. Goldfarb et al [114] found that lactic acid bacteria are ineffective in patients with absorptive hypercalciuria. Effective reduction in urine oxalate excretion was described by Lieske et al [115] in patients with secondary absorptive hyperoxaluria associated with fat malabsorption.…”

Hyperoxaluria Is Reduced and Nephrocalcinosis Prevented with an Oxalate-Degrading Enzyme in Mice with Hyperoxaluria

“…Recently it has been shown that the gastrointestinal tract presents an alternative route of oxalate elimination, especially under conditions of renal insufficiency [4]. It has also been recognized that an endogenous component of intestinal microflora potentially limits oxalate absorption or enhances its colonic excretion [5,6,7]. Such data open new horizons for pharmacological manipulation of oxalate in the intestine that may affect its systemic balance [3, 5, 7].…”

Oxalate-Degrading Activity in Bifidobacterium animalis subsp. lactis : Impact of Acidic Conditions on the Transcriptional Levels of the Oxalyl Coenzyme A (CoA) Decarboxylase and Formyl-CoA Transferase Genes

“…Unfortunately, an oxalate-free diet is difficult to achieve and would probably be deficient in essential nutrients. Hence, other approaches to reducing urinary oxalate for management of stone disease have been explored.The discovery of oxalate-degrading bacteria within the human gastrointestinal tract has opened the way to a flurry of research regarding their potential role in reducing urinary excretion of oxalic acid (12,20,21,25,26,30,31,35,40,44,45). The first intestinal oxalate-degrading bacterium to be described was Oxalobacter formigenes, an obligate anaerobe which relies exclusively on oxalate metabolism for energy (2).…”