Sequential laxative-probiotic usage for treatment of irritable bowel syndrome: a novel method inspired by mathematical modelling of the microbiome

Abstract

The gut microbiome plays an important role in human health. However, its response to external intervention is complex. A previous study showed that the response to Clostridium butyricum (CB) treatment of irritable bowel syndrome (IBS) is heterogeneous. We proposed that mathematical model simulation of the microbiota may help to optimize the management of IBS-associated microbiota. In this study, a novel mathematical non-extinction and defecation normalized (NEDN) model was generated for stable simulation of the dynamic nature of gut microbiota. In silico simulation revealed that a laxative may create a favourable opportunity for Clostridium cluster XIVa to shift the microbiota. An explorative clinical trial was conducted to compare three CB regimens in an IBS cohort: laxative, interval of 2 weeks and CB administration for 2 weeks (L2P); laxative immediately followed by CB administration (LP) for 2 weeks; and CB administration for 2 weeks (P). The LP regimen optimally relieved the IBS symptoms and shifted the microbiota closer to those of the healthy subjects during 2 weeks of CB intake. These results indicate that integration of biological/mathematical approaches and clinical scenarios is a promising method for management of microbiota. Additionally, the optimal effect of sequential laxative-CB usage for IBS treatment warrants further validation. Clinical trial registration numbers: NCT02254629. Date of registration: October 2, 2014.

Looking into key bacterial proteins involved in gut dysbiosis

“…The transplanted probiotics met indigenous microbiome-mediated mucosal colonization resistance in mice and even a specific colonization resistance in a person-, strain-, and region- dependent manner in humans[ 113 ]. Our recent mathematical model studies also suggested intriguing behavior of microbiome in response to probiotic supplement[ 114 ]. For FMT, the risk of unknown infections is still inevitable even after rigorous tests on the donors.…”

Randomized clinical trial: the effects of pregabalin for centrally mediated abdominal pain syndrome

“…The pain severity was scored on a seven-point Likert scale (0 = no pain; 1 = very little; 2 = slight; 3 = moderate; 4 = relatively severe; 5 = severe; and 6 = as severe as it could be, insufferable pain) and the frequency was shown as pain onset days per week. 13 …”

“…The pain severity was scored on a seven-point Likert scale (0 = no pain; 1 = very little; 2 = slight; 3 = moderate; 4 = relatively severe; 5 = severe; and 6 = as severe as it could be, insufferable pain) and the frequency was shown as pain onset days per week. 13 Common mental disorder questionnaires comprising Somatic Self-rating Scale (SSS), Patient Health Questionnaire-15 (PHQ-15), and sevenitem Generalized Anxiety Disorder Scale (GAD-7) were also administered at baseline and week 4. SSS is a highly valid and reliable self-report questionnaire that is primarily used to evaluate emotional responses and somatic symptoms, consisting of 20 items divided into four domains.…”

Utilization of Probiotics in Relieving Post-Colonoscopy Gastrointestinal Symptoms: A Systematic Review and Meta-Analysis.

“…There is a possibility that using a laxative in bowel cleaning process may induce a significant increase in colonic motility as well as small intestine and colonic volume clearance, thus dissimulating the benefits of probiotics used before colonoscopy. Consequently, it was recommended to utilize probiotics after the colonoscopy procedure, as reported by Li et al, which observed a significant benefit in adding probiotics immediately after the laxative course to IBS patients, rather than using the medications separately [38].…”