Gut microbiota reveals whether drug therapies work in inflammatory bowel diseases
The prevalence of inflammatory bowel diseases has increased considerably, both in Finland and worldwide. These diseases cannot be fully cured. Instead, they are treated with anti-inflammatory drugs and sometimes surgery.
An indicator in the intestines
If conventional drug treatments based on anti-inflammatory drugs are ineffective, these diseases can be treated with infliximab, a biological blocker of TNF-α administered intravenously. Infliximab is an antibody that prevents TNF-α, a pro-inflammatory factor, from binding to inflammatory cells in the gut. It is effective in reducing inflammation and improving a patient's condition, while maintaining good disease control.
Although infliximab therapy is often effective, approximately 30-40% of patients do not respond to treatment, or lose their response over time. To date, there is no reliable test to predict patient response to this treatment.
"A test that predicts responses would help in the selection of drug therapies and avoid unnecessary drug use, thereby reducing potential adverse effects and saving money on drug expenditures in the healthcare system," says postdoctoral researcher Eija Nissilä.
In a collaborative project, the University of Helsinki and the Department of Gastroenterology at Helsinki University Hospital conducted research to see if predictors associated with infliximab therapy could be identified in the intestinal microbiota.
The intestinal microbiota was different
This study revealed that even before treatment, the intestinal microbiota of patients with inflammatory bowel disease differed in the types of bacteria and fungi. These differences were related to the response to infliximab treatment.
The changes that occurred in the gut microbiota during treatment also differed between patients who had a response to treatment and those who did not. The intestines of patients who did not respond to treatment contained fewer anti-inflammatory bacteria of the Clostridia family and more pro-inflammatory bacteria and fungi, such as Candida. Certain bacteria found in the gut predicted a good response to Infliximab treatment.
Choosing the appropriate therapy
On the basis of these results, intestinal bacteria and fungi could possibly serve as indicators to assess whether or not treatment should be initiated. "Such a predictive test would allow the selection of appropriate therapy, which would save on drug therapy costs in health care," Nissilä notes.
