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ACCEPTABILITY OF INNOVATIVE MICROBIOME-DERIVED THERAPIES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES: A QUESTIONNAIRE-BASED CROSS-SECTIONAL STUDY

Nathan Grellier 1, Clotilde Policar 2, Anne Bourrier 3, Cécilia Landman 4, Isabelle Nion larmurier 4, Paul McLellan 4, Julien Kirchgesner 5, Harry Sokol 1, Nicolas Delsuc 2, Enguerran Macia 6, Philippe Seksik 5

Affiliations

1 Saint-Antoine Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France|||Sorbonne Université, INSERM, Paris, France|||Gut, Liver & Microbiome Research FHU (GLIMMER), Paris, France

2 Ecole Normale Supérieure, PSL University, Sorbonne Université, CNRS, Paris, France

3 Gut, Liver & Microbiome Research FHU (GLIMMER), Paris, France|||Saint-Antoine Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France

4 Saint-Antoine Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France|||Gut, Liver & Microbiome Research FHU (GLIMMER), Paris, France

5 Saint-Antoine Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France|||Gut, Liver & Microbiome Research FHU (GLIMMER), Paris, France|||Sorbonne Université, INSERM, Paris, France

6 Faculté de Médecine Nord Marseille, Marseille, France

Summary

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A survey of 324 inflammatory bowel disease patients found that 76.5% were willing to try chemically modified bacteria and 65% genetically modified bacteria, with probiotics ranking as most acceptable (35.5%) followed by chemically modified bacteria (24.1%).

Among 324 IBD patients surveyed at Saint-Antoine Hospital from April to July 2024, 76.5% were willing to try chemically modified bacteria (CMB) delivering antioxidant enzymes, while 65% were open to genetically modified bacteria (GMB).
When ranking four microbiome-based treatments by acceptability, probiotics ranked first (35.5%), followed by CMB (24.1%), fecal microbiota transplant (12.3%), and GMB (6.5%), with 22% unable to give an opinion.
The majority of surveyed patients (83.0%) found their current IBD treatment effective; 63.9% had Crohn's disease and 36.1% ulcerative colitis.
Qualitative responses revealed that safety concerns, satisfaction with current treatments, and unfamiliarity with newer approaches were the main reasons for reluctance, while probiotics were preferred for their perceived naturalness and simplicity.
This study provides insight for clinicians and researchers developing microbiome-based IBD therapies regarding patient perspectives on novel bacterial modification approaches.

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Abstract

Introduction

New approaches based on the gut microbiome emerge trying to control gut inflammation in inflammatory bowel diseases (IBD). The MOBIDIC project (Modified Bacteria for Manganese-based antioxIdants Production and Delivery for Gut Inflammation Control, NCT06189599) aims to develop innovative microbiome-based therapies to treat inflammatory bowel diseases (IBD), focusing on reducing oxidative stress in intestinal epithelial cells. These approaches include the use of (a) chemically modified bacteria delivering antioxidant enzymes and (b) genetically engineered bacteria expressing similar antioxidant compounds. Besides promising preclinical results (1–3), the acceptability of these novel treatments by patients remains largely unexplored. This study aimed to assess and compare the acceptability of such strategies among IBD patients.

Aims & Methods

A mixed-method cross-sectional survey was conducted from April to July 2024 among 324 consecutive patients diagnosed with Crohn’s disease (CD) or Ulcerative colitis (UC) seen at Saint-Antoine Hospital (Paris, France) in day hospital. The questionnaire combined closed-ended items to assess perceptions and acceptability of four therapeutic compounds : chemically modified bacteria (CMB), genetically modified bacteria (GMB), probiotics, fecal microbiota transplant (FMT). Participants were invited to provide open-ended responses to gain insight into the underlying reasons for their choices. Descriptive and inferential statistics were complemented by thematic analysis of qualitative data.

Results

Among the 324 respondents, 48.5% were female and 51.5% male. The mean age was 41.6 years (SD 13.3 years) and the type of IBD was CD for 63.9% and UC for 36.1%. The majority of patients found their current treatment to be effective (83.0%), a minority found their treatment to be ineffective (13.9%), and 10 patients (3.1%) did not express an opinion. When patients were asked if they would be willing to try CMB or GMB, 76.5% were willing to try CMB and only 65% were open to GMB. When patients were asked which of the four innovative microbiome-derived treatments would be most acceptable, probiotics ranked first (35.5%), followed by CMB (24.1%), FMT (12.3%), and GMB (6.5%). Twenty-two percent of patients were unable to give an opinion. Qualitative responses revealed that safety concerns, satisfaction with current treatments, and unfamiliarity with newer approaches were the main reasons for reluctance. Probiotics were preferred because of their perceived naturalness and simplicity, while FMT caused discomfort because of its perceived invasiveness and terminology.

Conclusion

Despite the innovative potential of microbiome-based therapies, patient acceptability varies considerably. CMB may offer a promising alternative to conventional approaches, provided they are accompanied by strong clinical validation and clear communication. Understanding patient perceptions is critical to ensure the successful integration of novel therapies into IBD care pathways.

References

1. Schanne G, Zoumpoulaki M, Gazzah G, Vincent A, Preud’homme H, Lobinski R, et al. Inertness of Superoxide Dismutase Mimics Mn(II) Complexes Based on an Open-Chain Ligand, Bioactivity, and Detection in Intestinal Epithelial Cells. Oxid Med Cell Longev. 2022;2022:3858122.
2. Schanne G, Vincent ,Amandine, Chain ,Florian, Ruffié ,Pauline, Carbonne ,Célia, Quévrain ,Elodie, et al. SOD mimics delivered to the gut using lactic acid bacteria mitigate the colitis symptoms in a mouse model of inflammatory bowel diseases. Free Radic Res. 4 march 2025;59(3):262‑73.
3. Zoumpoulaki M, Chiappetta G, Bouvet J, John NR, Schanne G, Gehan P, et al. Kinetic Redox Shotgun Proteomics Reveals Specific Lipopolysaccharide Effects on Intestinal Epithelial Cells, Mitigated by a Mn Superoxide Dismutase Mimic. Angew Chem Int Ed Engl. 25 feb 2025;e202422644.

Conference

UEG Week Berlin 2025

Topics

IBD

Submission format

Abstract

Session

Microbiome in IBD: From bench to bedside (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Johanna Arola

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DOES ELF PREDICT PROGRESSION BILE DUCT CHANGES BASED ON SEQUENTIAL ERC EXAMINATIONS AND DISEASE OUTCOME IN PSC?

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DOES ELF PREDICT PROGRESSION BILE DUCT CHANGES BASED ON SEQUENTIAL ERC EXAMINATIONS AND DISEASE OUTCOME IN PSC?

Martti A. Färkkilä 1, Hannu Kautiainen 2, Mette Vesterhus 3, Andrea Tenca 4, Johanna Arola 5

Affiliations

1 Helsinki University Hospital, Helsinki, Finland

2 University of Eastern Finland, Kuopio, Finland

3 Haraldsplass Deaconess Hospital, Bergen, Norway

4 Clinic of Gastroenterology - Helsinki University Hospital, Helsinki, Finland

5 University of Helsinki, Helsinki, Finland

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Abstract

Introduction

Primary sclerosing cholangitis (PSC) is a chronic inflammatory disease affecting the biliary epithelium, leading to bile duct strictures and eventually cirrhosis. Liver fibrosis is a well-established predictor of disease outcome in PSC. The Enhanced Liver Fibrosis (ELF) test, which combines three direct serum markers—hyaluronic acid (HA), tissue inhibitor of metalloproteinases-1 (TIMP-1), and amino-terminal pro-peptide of type III pro-collagen (PIIINP)—has been shown to correlate with the Ishak staging of liver histology in PSC. Both the ELF score and its individual components demonstrate moderate diagnostic accuracy in distinguishing advanced fibrosis (AUROC 0.73–0.78) and cirrhosis (AUROC 0.73–0.81) [1].
However, liver fibrosis and cirrhosis in PSC develop as secondary consequences of bile duct strictures and therefore represent late-stage indicators of disease progression. We have previously shown that biliary levels of calprotectin and interleukin-8 (IL-8) can help identify patients at higher risk of developing bile duct strictures. Moreover, our findings indicated that commonly used liver function tests, particularly plasma alkaline phosphatase (P-ALP), lack both sensitivity and specificity for effectively monitoring PSC progression [2].

Aims & Methods

To study: 1) the association of ELF with ERC-score, 2) the predictive value of ELF for bile duct disease progressio assessed by ≥2 increase in ERC score or need for dilatation, 3) the role of ELF-test to predict the overall disease outcome.
We included patients from Helsinki PSC-registry with ELF determined at least once, and ≥2 ERC examinations. End of f/u was 31.12.23. ERC -score was determined as described earlier [3]. ELF ≥9.8 was used as a marker for advanced liver fibrosis.

Results

In total, we included 397 patients. Demographics, laboratory results, and outcomes stratified by ELF levels, are presented in the table. Increase of ERC-score did not differ between groups, but the score at baseline associated with ELF-test (p<0.001). Progression of PSC assessed by increase of ERC score≥2 or dilatation did not correlated with ELF-levels (p=0.11), but ln[P-hyaluronic acid] showed close association with progression of bile duct changes (p<0.001). The probability for LTx increased in a linear way with the increase of ELF-level. (<0.001).

Variables	ELF ≤9.8 N=310	ELF 9.8-11.2 N=62	ELF ≥11.3 N=25	p for linearity
Person years. [Median (IQR) of person years]	2181 [5.6(3.5,11.8)]	414 [5.6(3.5,11.8)]	82 [2.5(1.3,3.8)]	-
PSC duration, mean (SD), years	6.9(5.8)	8.8(6.0)	11.2(8.1)	<0.001
AOM, mean (SD)	1.39(0.46)	1.83(0.56)	2.49(0.67)	<0.001
P-ALP, U/l, median (IQR)	94(74,135)	168(107,250)	317(203,438)	<0.001
P-Bil, µmol/l, median (IQR)	11(8,17)	13(9,18)	29(17,48)	<0.001
Biliary calprotectin, mg/l, median (IQR)	1.3(0.2,15.8)	13.4(0.9,71.0)	22.4(9.1,133.0)	<0.001
Increase of ERC score ≥2, n(%)*	35(11)	9(15)	4(16)	0.35
Increase of ERC score≥2 or dilatation, n(%)*	142(46)	40(65)	20(80)	<0.001
CCA, HCC, GBCA, Death, LTx (Incidence (95% CI), [no])**	15(10 to 21), [32]	60(39 to 89), [25]	220(30 to 347), [18]	<0.001

* Adjusted linearity for age, sex, PSC duration, intra-and extrahepatic disease,and ERC-score at baseline
** per 1000 pyrs. Adjusted for age, sex, PSC duration, intra-and extrahepatic disease.
Abbreviations: AOM, Amsterdam-Oxford model; CCA, cholangiocarcinoma, GB-CA, gallbladder carcinoma; LTx, liver transplantation.

Conclusion

The ELF test correlates with the severity of bile duct disease and the risk of liver transplantation, but it is not suitable for assessing the progression of bile duct changes based on sequential ERC examinations. The role of hyaluronic acid as a surrogate marker of bile duct changes deserves further studies.

References

[1] Thorburn DT et al. Hepatology Communications 2024;8(7):e0467, [2] Färkkilä M et al. JHEP Rep. 2024 Jul 2;6(10):101161, [3] Boyd S, et al. Endoscopy. 2016;48:432-9.

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Immunology Mechanisms & Personalised Medicine

Submission format

Abstract

Session

Advances in management of immune-mediated biliary disease

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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UEG Presentation

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Drug management in necrotising pancreatitis

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Drug management in necrotising pancreatitis

Jacob Hamm 1

Affiliations

1 University Medical Center Goettingen, Goettingen, Germany

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Abstract

Event

UEG Week Berlin 2025

Topics

Endoscopy Pancreas

Session

Therapy update: Acute severe pancreatitis – It's all about timing!

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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UEG Presentation

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Summary: Autoimmune disease of liver and bile ducts

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Summary: Autoimmune disease of liver and bile ducts

Christian Lange 1

Affiliations

1 Klinikum rechts der Isar, München, Germany

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Abstract

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Hepatobiliary Immunology

Session

Autoimmune disease of liver and bile ducts

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Can we harmonise methods of microbiological surveillance

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Can we harmonise methods of microbiological surveillance

Heike Martiny, Prof. Dr. 1

Affiliations

1 Charité - Universitätsmedizin Campus Benjamin Franklin, CC 5, Berlin, Germany

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Abstract

Event

UEG Week Berlin 2025

Topics

Nurses

Session

Hygiene: Update 2025

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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DOES ELF PREDICT PROGRESSION BILE DUCT CHANGES BASED ON SEQUENTIAL ERC EXAMINATIONS AND DISEASE OUTCOME IN PSC?

Johanna Arola

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Jacob Hamm

Summary: Autoimmune disease of liver and bile ducts

Christian Lange

Can we harmonise methods of microbiological surveillance

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Ilhami Yuksel

Impact of New Treatment Guidelines in the Region: Is It Time to Treat Everyone?

Oscar Beltrán Galvis

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INNOVATIVE ERCP TRAINING: BRIDGING EDUCATIONAL GAPS WITH NEXT-GENERATION 3D-PRINTED SIMULATORS

Oguz Ozturk 1, Mucahit Ergul 1, Yavuz Cagir 2, Ali Atay 1, Muhammed bahaddin Durak 3, Ilhami Yuksel 4

Affiliations

1 Ankara Bilkent City Hospital, Ankara, Türkiye

2 Ankara Yildirim Beyazit University Yenimahalle Training and Research Hospital, Ankara, Türkiye

3 Ankara Hacettepe University, Ankara, Türkiye

4 Ankara Bilkent City Hospital, Ankara, Türkiye|||Ankara Yildirim Beyazit University School of Medicine, Ankara, Türkiye

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Abstract

Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) is recognized as a foundational procedure within the realm of interventional gastroenterology. Nevertheless, a significant amount of hands-on experience is required to achieve proficiency in this procedure, particularly with regard to the performance of sophisticated therapeutic maneuvers. Access to authentic training cases remains limited, while the use of cadaveric or live animal models presents distinct ethical, logistical and financial challenges (1). The advent of 3D printing technology paved the way for the development of advanced medical simulators. This study utilized computer-aided design and fused deposition modeling techniques to engineer an ERCP simulator that is both anatomically accurate and enables the training of trainee physicians in the intricate procedures of their chosen discipline (2). The simulator's modular design allows it to replicate a spectrum of papillary conditions, enabling targeted training in anatomies that are resistant to cannulation, as well as high-risk procedures like precut sphincterotomy and fistulotomy.

Aims & Methods

The design process for the ERCP simulator employed accessible parametric modeling software. Fabrication of the primary structural components, including the pancreas, the duodenum, and the bile ducts, were undertaken using polylactic acid (PLA) filament, a material that is both widely accessible and economical, thereby ensuring adequate rigidity and durability. The interchangeable papillary components were produced using flexible thermoplastic polyurethane (TPU) 95A filament, selected for its elasticity and capacity to be readily incised during procedures such as endoscopic sphincterotomy (EST). This allowed for easy exchangeability and facilitated the acquisition of skills by novice endoscopists. This process were selected on the basis of accessibility, user-friendly interface and cost-effectiveness, enabling replication in diverse settings. The biliary and pancreatic ductal lumens were meticulously calibrated to represent a range of procedural difficulty, with internal diameters that closely mirrored real anatomical variations.

Results

The simulator exhibited a high degree of anatomical and biomechanical fidelity, featuring a structurally stable duodenal framework and a flexible papillary interface. The simulator accurately reproduced tactile feedback experienced by gastroenterologists during ERCP, thereby validating its efficacy as a training tool. Furthermore, the simulator was enabled meticulous rehearsal of EST through sphincterotomy incisions and facilitated fistulotomy simulation using an elastomeric papilla structure. The simulator's design is both cost-effective and easily replicable, making it a valuable asset for continuing education and training in this field (3,4).

Conclusion

The ERCP simulator, fabricated using 3D printing technology, can be regarded as both technologically advanced and economically efficient for a number of complex procedures. These encompass endoscopic sphincterotomy, precut techniques, fistulotomy and stent placement. The simulator's design, featuring a modular papillary system, was crafted to provide a structured and progressive learning environment for novice users as well as experienced endoscopists. The simulator's cost-effectiveness, ease of scaling up and potential for wide dissemination signify a paradigm shift in ERCP education, facilitating proficiency acquisition in complex interventional endoscopy with greater efficiency and safety. Further investigations are needed for the simulator in ERCP training.

References

1. Lee S, Ahn JY, Han M, Lee GH, Na HK, Jung KW, et al. Efficacy of a three-dimensional-printed training simulator for endoscopic biopsy in the stomach. Gut and liver. 2017;12(2):149.
2. Zhang Y, Chen L, Hu B. Advances of 3D printing in gastroenterology and where it might be going. International Journal of Bioprinting. 2023;9(6):0149.
3. Lee DS, Ahn JY, Lee GH. A newly designed 3-dimensional printer-based gastric hemostasis simulator with two modules for endoscopic trainees (with video). Gut and Liver. 2019;13(4):415.
4. Bundy JJ, Weadock WJ, Chick JFB, Srinivasa RN, Patel N, Johnson E, et al. Three-dimensional printing facilitates creation of a biliary endoscopy phantom for interventional radiology-operated endoscopy training. Current Problems in Diagnostic Radiology. 2019;48(5):456-61.

Conference

UEG Week Berlin 2025

Topics

Hepatobiliary

Submission format

Abstract

Session

BILIARY (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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DOES ELF PREDICT PROGRESSION BILE DUCT CHANGES BASED ON SEQUENTIAL ERC EXAMINATIONS AND DISEASE OUTCOME IN PSC?

Johanna Arola

Drug management in necrotising pancreatitis

Jacob Hamm

Summary: Autoimmune disease of liver and bile ducts

Christian Lange

Can we harmonise methods of microbiological surveillance

Heike Martiny, Prof. Dr.

INNOVATIVE ERCP TRAINING: BRIDGING EDUCATIONAL GAPS WITH NEXT-GENERATION 3D-PRINTED SIMULATORS

Ilhami Yuksel

Impact of New Treatment Guidelines in the Region: Is It Time to Treat Everyone?

Oscar Beltrán Galvis

UEG Presentation

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Impact of New Treatment Guidelines in the Region: Is It Time to Treat Everyone?

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Impact of New Treatment Guidelines in the Region: Is It Time to Treat Everyone?

Oscar Beltrán Galvis 1

Affiliations

1 Universidad del Rosario., Bogota, Colombia

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Abstract

Event

UEG Week Berlin 2025

Session

Hot topics from Pan America: Hepatitis B in Latin America - Situation and management by 2025

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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DOES ELF PREDICT PROGRESSION BILE DUCT CHANGES BASED ON SEQUENTIAL ERC EXAMINATIONS AND DISEASE OUTCOME IN PSC?

Johanna Arola

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Jacob Hamm

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