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Inflammatory Bowel Diseases:
doi: 10.1097/MIB.0000000000000071
Online Only: Letters to the Editor

Beneficial Effects of Exclusive Enteral Nutrition in Crohn's Disease Are not Mediated by Faecalibacterium prausnitzii

Sokol, Harry MD, PhD*,†,‡; Langella, Philippe PhD

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*Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris and Paris VI University, Paris, France

AVENIR Team, Gut Microbiota and Immunity, INSERM U1057/UMR CNRS 7203, Université Pierre et Marie Curie 6, Paris, France

Commensal and Probiotics-Host Interactions Laboratory, UMR 1319 Micalis, Jouy-en-Josas, France

The authors have no conflicts of interest to disclose.

To the Editor:

We read with high interest the study by Gerasimidis et al1 that investigated the effects of exclusive enteral nutrition (EEN) on gut microbiota and fecal metabolites in pediatric patients with Crohn's disease (CD).

In this study, enteral nutrition was associated with alterations of several parameters usually considered to be biomarkers of health status. This is the case for the decrease of butyric acid concentration and of bacterial biodiversity and conversely the increase of total fecal sulfides concentration. Moreover, the authors observed a decrease of Faecalibacterium prausnitzii after EEN. The authors then claimed that these results are not in accordance with the beneficial effects of F. prausnitzii in CD that we were first to show in our landmark publication.2

As the authors explain themselves, the lack of fibers in the EEN product used in the study has direct suppressive effects on activity of butyrate producing bacteria, such as F. prausnitzii. Actually, this effect of EEN has also been described in non-IBD patients supporting an unspecific effect of EEN, unrelated to CD. Bacterial biodiversity has been clearly shown to be a biomarker of health in IBD3 but also in many other settings. Butyrate has been clearly shown to play major role in intestinal homeostasis, particularly by inducing regulatory T cells in colon.4 F. prausnitzii has been shown consistently to be decreased in the microbiota of patients with IBD and in several other intestinal and extraintestinal diseases.5 Moreover, a low level of F. prausnitzii has been associated with a higher risk of relapse in IBD.6 These data support the role of F. prausnitzii as a biomarker of health with potential beneficial effects in CD.

We think that the results of Gerasimidis et al underline the fact that, (1) as expected, EEN induces a nonphysiological functioning of the gastrointestinal tract and (2) the mechanisms of EEN beneficial effects in CD are still not understood. However, these results cannot be extrapolated to non-EEN settings and do not question the beneficial role of F. prausnitzii and bacterial biodiversity or butyrate level in gut homeostasis.

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1. Gerasimidis K, Bertz M, Hanske L, et al.. Decline in presumptively protective gut bacterial species and metabolites are paradoxically associated with disease improvement in pediatric Crohn's disease during enteral nutrition. Inflamm Bowel Dis. 2014;20:861–871.

2. Sokol H, Pigneur B, Watterlot L, et al.. Faecalibacterium prausnitzii is an anti-inflammatory commensal bacterium identified by gut microbiota analysis of Crohn disease patients. Proc Natl Acad Sci U S A. 2008;105:16731–16736.

3. Sokol H, Lay C, Seksik P, et al.. Analysis of bacterial bowel communities of IBD patients: what has it revealed? Inflamm Bowel Dis. 2008;14:858–867.

4. Furusawa Y, Obata Y, Fukuda S, et al.. Commensal microbe-derived butyrate induces the differentiation of colonic regulatory T cells. Nature. 2013;504:446–450.

5. Miquel S, Martin R, Rossi O, et al.. Faecalibacterium prausnitzii and human intestinal health. Curr Opin Microbiol. 2013;16:255–261.

6. Varela E, Manichanh C, Gallart M, et al.. Colonisation by Faecalibacterium prausnitzii and maintenance of clinical remission in patients with ulcerative colitis. Aliment Pharmacol Ther. 2013;38:151–161.

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