Articles You Don’t Wanna Miss (June 2017 Issue)

Siew Ng - The Chinese University of Hong Kong, Hong Kong
Grace Wong - The Chinese University of Hong Kong, Hong Kong

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If you're wondering what good articles to read while you're waiting to board the plane or for your phone to charge, you’re in luck! IDDF’s OC members who are themselves editors of prestigious journals have handpicked a list of recent articles that make a good read. 

 


   

 

"Sterile Fecal Filtrate for Treating Clostridium Difficile Infection?"

Ott SJ, Waetzig GH, Rehman A, et al.  Gastroenterology. 2017 Mar;152(4):799-811.e7

 

Recommended by SIEW NG, Editorial Board Member of Gastroenterology

 

Fecal microbiota transplantation (FMT) is a highly effective therapy for recurrent Clostridium difficile infection (CDI). However, transferring undefined living bacteria entails uncontrollable risks for infectious and metabolic or malignant diseases, particularly in immunocompromised patients. Sterile fecal filtrates (containing bacterial debris, proteins, antimicrobial compounds, metabolic products and oligonucleotides/DNA), rather than intact microorganisms, may be effective in patients with CDI.

 

A clinical case series was performed to investigate the effects of fecal filtrate transfer (FFT) in 5 patients with symptomatic chronic-relapsing CDI. Patients were followed for at least 6 months and up to 33 months. Stool was sterile-filtered to remove small particles and bacteria, and then transferred to patients in a single administration via nasojejunal tube. In all 5 patients, FFT restored normal stool habits and eliminated symptoms of CDI for a minimum period of 6 months. 16S rRNA gene sequencing detected diverse bacterial DNA signatures in the filtrates. Analysis of virus-like particles from a filtrate found to reduce symptoms of CDI revealed a complex signature of bacteriophages. This finding indicates that bacterial components, metabolites or bacteriophages mediate many of the effects of FMT, and that FFT might be an alternative approach, particularly for immunocompromised patients.

 


 

“Randomised Clinical Trial: the Efficacy and Safety of Oltipraz, a Liver X Receptor Alpha-Inhibitory Dithiolethione in Patients with Non-Alcoholic Fatty Liver Disease”

Kim W, Kim BG, Lee JS, et al. Aliment Pharmacol Ther. 2017; 45:1073-1083. 

 

Recommended by GRACE WONG, Associate Editor of Alimentary Pharmacology and Therapeutics, Editor-in-Chief of Hepatology (Hong Kong Edition)

 

A recently published phase II randomized controlled trial (RCT) from South Korea provided new evidence that 24-week treatment of oltipraz, a synthetic dithiolethione with an antisteatotic effect by inhibiting the activity of liver X receptor alpha (LXR-α), significantly reduced the NAFLD patients’ liver fat content. 68 subjects with a liver fat >20% and raised alanine aminotransferase were randomised to either placebo (n = 22), 30 mg of oltipraz (n = 22) or 60 mg of oltipraz (n = 24) twice daily for 24 weeks. The primary outcome was the change in the liver fat from baseline to 24 weeks quantified using magnetic resonance spectroscopy. The investigators observed absolute changes in the liver fat content increased in a dose-dependent manner: −7.7 ± 7.0% and −13.9 ± 10.7% for the low-dose and high-dose groups (P = 0.13 and P < 0.01), compared to the placebo group (−3.2 ± 11.1%). The early safety profile of oltipraz was favorable.

 

Non-alcoholic fatty liver disease (NAFLD) is an increasingly critical liver disease worldwide. Currently there are dozens of clinical trials at different phases evaluating different pharmacological treatments for NAFLD. Most studies target necroinflammation and fibrosis, whereas this recently published RCT only target liver fat, which is the prerequisite rather than prognostic histological feature in NAFLD. Studies using necroinflammation, fibrosis or even hard clinical outcomes should be carried out to define the role of oltipraz.