Microbiota unbalance has been proven to affect chronic kidney disease (CKD) patients, and both microbiota composition and activity are implicated in CKD worsening. The kidney failure progression implies an exceeding accumulation of nitrogenous-derived waste compounds in both blood circulating system and intestinal milieu. Therefore, in the presence of an altered intestinal permeability and reduced kidney-based clearance, gut-derived uremic toxins – mainly indoxyl sulfate (IS) and p-cresyl sulfate (PCS) – accumulated. In a scenario facing the nutritional management as an adjuvant therapy, the present study investigated the effectiveness of an innovative synbiotics for its ability to modulate the patient gut microbiota and metabolome by setting a randomized, single-blind, placebo controlled, pilot trial and enrolling IIIb-IV stage CKD patients and healthy controls. The innovative synbiotics comprised a mixture of Bifidobacterium animalis BLC1 (109 cells), Lacticaseibacillus casei LC4P1 (109 cells), fructo-oligosaccharides (2.5 g), inulin (2.5 g), quercetin (640 mg), resveratrol (230 mg) and proanthocyanidins (13 mg). Fecal metataxonomics and volatilome were analyzed at the run-in, after two months of treatment, and after one month of wash out. Based on multivariate approaches, in CKD patients that were allocated in the synbiotics arm, the top-5 metataxonomics variables reaching significance accounted for Firmicutes, Lachnospiraceae and Blautia increase, while Bacteroidetes and Flavobacteriaceae decrease. Noteworthy, a carry-over effect till the end of the wash out was observed. In the same stool samples, acetic and propanoic acids, as well as 2-tridecanone and decane, increased while dimethyl trisulfide and nonanoic acid showed the opposite. In conclusion, the here analyzed data emphasized a selective efficacy of the innovative synbiotics on stage IIIb-IV CKD patients also considering the beneficial effects observed for some CKD-associated clinical parameters (i.e., reduced free circulating IS, improved small intestine barrier integrity, and ameliorated abdominal pain and constipation syndromes). Nonetheless, a further validation based on an increased patient number should be considered.
In vivo evaluation of an innovative synbiotics on stage IIIb-IV chronic kidney disease patients
Mirco Vacca;Giuseppe Celano;Francesco Maria Calabrese;Maria Teresa Rocchetti;Ilaria Iacobellis;Nadia Serale;Maria Calasso;Loreto Gesualdo;Maria De Angelis
2023-01-01
Abstract
Microbiota unbalance has been proven to affect chronic kidney disease (CKD) patients, and both microbiota composition and activity are implicated in CKD worsening. The kidney failure progression implies an exceeding accumulation of nitrogenous-derived waste compounds in both blood circulating system and intestinal milieu. Therefore, in the presence of an altered intestinal permeability and reduced kidney-based clearance, gut-derived uremic toxins – mainly indoxyl sulfate (IS) and p-cresyl sulfate (PCS) – accumulated. In a scenario facing the nutritional management as an adjuvant therapy, the present study investigated the effectiveness of an innovative synbiotics for its ability to modulate the patient gut microbiota and metabolome by setting a randomized, single-blind, placebo controlled, pilot trial and enrolling IIIb-IV stage CKD patients and healthy controls. The innovative synbiotics comprised a mixture of Bifidobacterium animalis BLC1 (109 cells), Lacticaseibacillus casei LC4P1 (109 cells), fructo-oligosaccharides (2.5 g), inulin (2.5 g), quercetin (640 mg), resveratrol (230 mg) and proanthocyanidins (13 mg). Fecal metataxonomics and volatilome were analyzed at the run-in, after two months of treatment, and after one month of wash out. Based on multivariate approaches, in CKD patients that were allocated in the synbiotics arm, the top-5 metataxonomics variables reaching significance accounted for Firmicutes, Lachnospiraceae and Blautia increase, while Bacteroidetes and Flavobacteriaceae decrease. Noteworthy, a carry-over effect till the end of the wash out was observed. In the same stool samples, acetic and propanoic acids, as well as 2-tridecanone and decane, increased while dimethyl trisulfide and nonanoic acid showed the opposite. In conclusion, the here analyzed data emphasized a selective efficacy of the innovative synbiotics on stage IIIb-IV CKD patients also considering the beneficial effects observed for some CKD-associated clinical parameters (i.e., reduced free circulating IS, improved small intestine barrier integrity, and ameliorated abdominal pain and constipation syndromes). Nonetheless, a further validation based on an increased patient number should be considered.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
