Rifaximin has minor effects on bacterial composition, inflammation and bacterial translocation in cirrhosis: a randomized trial

Nina Kimer; Julie S. Pedersen; Juliette Tavenier; Jeffrey E. Christensen; Troels M. Busk; Lise Hobolth; Aleksander Krag; Waleed Abu Al-Soud; Martin Steen Mortensen; Søren Johannes Sørensen; Søren Møller; Flemming Bendtsen

doi:10.1111/jgh.13852

Rifaximin has minor effects on bacterial composition, inflammation and bacterial translocation in cirrhosis: a randomized trial

Nina Kimer, Julie S. Pedersen, Juliette Tavenier, Jeffrey E. Christensen, Troels M. Busk, Lise Hobolth, Aleksander Krag, Waleed Abu Al-Soud, Martin Steen Mortensen, Søren Johannes Sørensen, Søren Møller, Flemming Bendtsen

28 Citations (Scopus)

Abstract

Background and Aim: Decompensated cirrhosis is characterized by disturbed hemodynamics, immune dysfunction, and high risk of infections. Translocation of viable bacteria and bacterial products from the gut to the blood is considered a key driver in this process. Intestinal decontamination with rifaximin may reduce bacterial translocation (BT) and decrease inflammation. A randomized, placebo-controlled trial investigated the effects of rifaximin on inflammation and BT in decompensated cirrhosis. Methods: Fifty-four out-patients with cirrhosis and ascites were randomized, mean age 56 years (± 8.4), and model for end-stage liver disease score 12 (± 3.9). Patients received rifaximin 550-mg BD (n = 36) or placebo BD (n = 18). Blood and fecal (n = 15) sampling were conducted at baseline and after 4 weeks. Bacterial DNA in blood was determined by real-time qPCR 16S rRNA gene quantification. Bacterial composition in feces was analyzed by 16S rRNA gene sequencing. Results: Circulating markers of inflammation, including tumor necrosis factor alpha, interleukins 6, 10, and 18, stromal cell-derived factor 1-α, transforming growth factor β-1, and high sensitivity C-reactive protein, were unaltered by rifaximin treatment. Rifaximin altered abundance of bacterial taxa in blood marginally, only a decrease in Pseudomonadales was observed. In feces, rifaximin decreased bacterial richness, but effect on particular species was not observed. Subgroup analyses on patients with severely disturbed hemodynamics (n = 34) or activated lipopolysaccharide binding protein (n = 37) revealed no effect of rifaximin. Conclusion: Four weeks of treatment with rifaximin had no impact on the inflammatory state and only minor effects on BT and intestinal bacterial composition in stable, decompensated cirrhosis (NCT01769040).

Original language	English
Journal	Journal of Gastroenterology and Hepatology
Volume	33
Issue number	1
Pages (from-to)	307-314
Number of pages	8
ISSN	0815-9319
DOIs	https://doi.org/10.1111/jgh.13852
Publication status	Published - Jan 2018

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Kimer, N., Pedersen, J. S., Tavenier, J., Christensen, J. E., Busk, T. M., Hobolth, L., Krag, A., Abu Al-Soud, W., Mortensen, M. S., Sørensen, S. J., Møller, S., & Bendtsen, F. (2018). Rifaximin has minor effects on bacterial composition, inflammation and bacterial translocation in cirrhosis: a randomized trial. Journal of Gastroenterology and Hepatology, 33(1), 307-314. https://doi.org/10.1111/jgh.13852

Kimer, N, Pedersen, JS, Tavenier, J, Christensen, JE, Busk, TM, Hobolth, L, Krag, A, Abu Al-Soud, W, Mortensen, MS, Sørensen, SJ , Møller, S & Bendtsen, F 2018, 'Rifaximin has minor effects on bacterial composition, inflammation and bacterial translocation in cirrhosis: a randomized trial', Journal of Gastroenterology and Hepatology, vol. 33, no. 1, pp. 307-314. https://doi.org/10.1111/jgh.13852

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title = "Rifaximin has minor effects on bacterial composition, inflammation and bacterial translocation in cirrhosis: a randomized trial",

abstract = "Background and Aim: Decompensated cirrhosis is characterized by disturbed hemodynamics, immune dysfunction, and high risk of infections. Translocation of viable bacteria and bacterial products from the gut to the blood is considered a key driver in this process. Intestinal decontamination with rifaximin may reduce bacterial translocation (BT) and decrease inflammation. A randomized, placebo-controlled trial investigated the effects of rifaximin on inflammation and BT in decompensated cirrhosis. Methods: Fifty-four out-patients with cirrhosis and ascites were randomized, mean age 56 years (± 8.4), and model for end-stage liver disease score 12 (± 3.9). Patients received rifaximin 550-mg BD (n = 36) or placebo BD (n = 18). Blood and fecal (n = 15) sampling were conducted at baseline and after 4 weeks. Bacterial DNA in blood was determined by real-time qPCR 16S rRNA gene quantification. Bacterial composition in feces was analyzed by 16S rRNA gene sequencing. Results: Circulating markers of inflammation, including tumor necrosis factor alpha, interleukins 6, 10, and 18, stromal cell-derived factor 1-α, transforming growth factor β-1, and high sensitivity C-reactive protein, were unaltered by rifaximin treatment. Rifaximin altered abundance of bacterial taxa in blood marginally, only a decrease in Pseudomonadales was observed. In feces, rifaximin decreased bacterial richness, but effect on particular species was not observed. Subgroup analyses on patients with severely disturbed hemodynamics (n = 34) or activated lipopolysaccharide binding protein (n = 37) revealed no effect of rifaximin. Conclusion: Four weeks of treatment with rifaximin had no impact on the inflammatory state and only minor effects on BT and intestinal bacterial composition in stable, decompensated cirrhosis (NCT01769040).",

author = "Nina Kimer and Pedersen, {Julie S.} and Juliette Tavenier and Christensen, {Jeffrey E.} and Busk, {Troels M.} and Lise Hobolth and Aleksander Krag and {Abu Al-Soud}, Waleed and Mortensen, {Martin Steen} and S{\o}rensen, {S{\o}ren Johannes} and S{\o}ren M{\o}ller and Flemming Bendtsen",

year = "2018",

month = jan,

doi = "10.1111/jgh.13852",

language = "English",

volume = "33",

pages = "307--314",

journal = "Journal of Gastroenterology and Hepatology",

issn = "0815-9319",

publisher = "Wiley-Blackwell Publishing Asia",

number = "1",

}

TY - JOUR

T1 - Rifaximin has minor effects on bacterial composition, inflammation and bacterial translocation in cirrhosis

T2 - a randomized trial

AU - Kimer, Nina

AU - Pedersen, Julie S.

AU - Tavenier, Juliette

AU - Christensen, Jeffrey E.

AU - Busk, Troels M.

AU - Hobolth, Lise

AU - Krag, Aleksander

AU - Abu Al-Soud, Waleed

AU - Mortensen, Martin Steen

AU - Sørensen, Søren Johannes

AU - Møller, Søren

AU - Bendtsen, Flemming

PY - 2018/1

Y1 - 2018/1

N2 - Background and Aim: Decompensated cirrhosis is characterized by disturbed hemodynamics, immune dysfunction, and high risk of infections. Translocation of viable bacteria and bacterial products from the gut to the blood is considered a key driver in this process. Intestinal decontamination with rifaximin may reduce bacterial translocation (BT) and decrease inflammation. A randomized, placebo-controlled trial investigated the effects of rifaximin on inflammation and BT in decompensated cirrhosis. Methods: Fifty-four out-patients with cirrhosis and ascites were randomized, mean age 56 years (± 8.4), and model for end-stage liver disease score 12 (± 3.9). Patients received rifaximin 550-mg BD (n = 36) or placebo BD (n = 18). Blood and fecal (n = 15) sampling were conducted at baseline and after 4 weeks. Bacterial DNA in blood was determined by real-time qPCR 16S rRNA gene quantification. Bacterial composition in feces was analyzed by 16S rRNA gene sequencing. Results: Circulating markers of inflammation, including tumor necrosis factor alpha, interleukins 6, 10, and 18, stromal cell-derived factor 1-α, transforming growth factor β-1, and high sensitivity C-reactive protein, were unaltered by rifaximin treatment. Rifaximin altered abundance of bacterial taxa in blood marginally, only a decrease in Pseudomonadales was observed. In feces, rifaximin decreased bacterial richness, but effect on particular species was not observed. Subgroup analyses on patients with severely disturbed hemodynamics (n = 34) or activated lipopolysaccharide binding protein (n = 37) revealed no effect of rifaximin. Conclusion: Four weeks of treatment with rifaximin had no impact on the inflammatory state and only minor effects on BT and intestinal bacterial composition in stable, decompensated cirrhosis (NCT01769040).

AB - Background and Aim: Decompensated cirrhosis is characterized by disturbed hemodynamics, immune dysfunction, and high risk of infections. Translocation of viable bacteria and bacterial products from the gut to the blood is considered a key driver in this process. Intestinal decontamination with rifaximin may reduce bacterial translocation (BT) and decrease inflammation. A randomized, placebo-controlled trial investigated the effects of rifaximin on inflammation and BT in decompensated cirrhosis. Methods: Fifty-four out-patients with cirrhosis and ascites were randomized, mean age 56 years (± 8.4), and model for end-stage liver disease score 12 (± 3.9). Patients received rifaximin 550-mg BD (n = 36) or placebo BD (n = 18). Blood and fecal (n = 15) sampling were conducted at baseline and after 4 weeks. Bacterial DNA in blood was determined by real-time qPCR 16S rRNA gene quantification. Bacterial composition in feces was analyzed by 16S rRNA gene sequencing. Results: Circulating markers of inflammation, including tumor necrosis factor alpha, interleukins 6, 10, and 18, stromal cell-derived factor 1-α, transforming growth factor β-1, and high sensitivity C-reactive protein, were unaltered by rifaximin treatment. Rifaximin altered abundance of bacterial taxa in blood marginally, only a decrease in Pseudomonadales was observed. In feces, rifaximin decreased bacterial richness, but effect on particular species was not observed. Subgroup analyses on patients with severely disturbed hemodynamics (n = 34) or activated lipopolysaccharide binding protein (n = 37) revealed no effect of rifaximin. Conclusion: Four weeks of treatment with rifaximin had no impact on the inflammatory state and only minor effects on BT and intestinal bacterial composition in stable, decompensated cirrhosis (NCT01769040).

U2 - 10.1111/jgh.13852

DO - 10.1111/jgh.13852

M3 - Journal article

C2 - 28671712

SN - 0815-9319

VL - 33

SP - 307

EP - 314

JO - Journal of Gastroenterology and Hepatology

JF - Journal of Gastroenterology and Hepatology

IS - 1

ER -

Rifaximin has minor effects on bacterial composition, inflammation and bacterial translocation in cirrhosis: a randomized trial

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