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Hirschsprung's Associated Enterocolitis (HAEC) Personalized Treatment with Probiotics Based on Gene Sequencing
Georg Singer1, Karl Kashofer2, Christoph Castellani1
1Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.
Insights
Probiotic treatment altered the gut microbiome in a child with Hirschsprung
Area of Science:
- Microbiology and Gastroenterology: Focuses on the gut microbiome's role in pediatric gastrointestinal disorders.
- Pediatric Surgery and Immunology: Investigates the interplay between surgical outcomes and immune responses in Hirschsprung's disease.
Background:
- Hirschsprung's disease (HD) affects approximately 40% of children with Hirschsprung's-associated enterocolitis (HAEC) post-surgery.
- The role of intestinal microbiome disturbances in HAEC pathogenesis remains incompletely understood.
- No published studies have investigated probiotic treatment based on individual fecal microbiome analysis for recurrent HAEC in HD patients.
Observation:
- A case study of a boy with trisomy 21 and rectosigmoid HD who developed recurrent HAEC at age four.
- Fecal microbiome analysis was performed during healthy and HAEC episodes using next-generation sequencing.
- Weekly microbiome measurements were taken during a 3-month probiotic treatment period.
Findings:
- Significant differences in fecal microbiome composition were observed between healthy and HAEC episodes.
- HAEC episodes were characterized by decreased Actinobacteria and increased Bacteroidetes and Proteobacteria.
- Probiotic treatment increased overall gut microbial diversity (alpha diversity) and modulated specific bacterial populations, including increases in Bifidobacterium and Streptococcus, and decreases in Rikenellaceae, Pseudobutyrivibrio, Blautia, and Lachnospiraceae.
Implications:
- This study provides the first longitudinal observation of the fecal microbiome in an HD patient following surgical correction.
- Probiotic intervention significantly altered the gut microbiome composition, suggesting a potential therapeutic avenue for HAEC.
- The observed microbiome alterations extended beyond the strains present in the administered probiotics, indicating broader systemic effects.
Abstract:
Approximately 40% of children with Hirschsprung's disease (HD) suffer from Hirschsprung's associated enterocolitis (HAEC) despite correct surgery. Disturbances of the intestinal microbiome may play a role. Treatment with probiotics based on individual analyses of the fecal microbiome has not been published for HD patients with recurrent HAEC yet. A boy with trisomy 21 received transanal pull-through at the age of 6 months for rectosigmoid HD. With four years, he suffered from recurrent episodes of HAEC. The fecal microbiome was measured during three healthy and three HAEC episodes by next-generation sequencing. The patient was started on daily probiotics for 3 months; the fecal microbiome was measured weekly. The fecal microbiome differed significantly between healthy and HAEC episodes. HAEC episodes were associated with significant decreases of Actinobacteria and significant increases of Bacteroidetes and Proteobacteria. Probiotic treatment led to a significant increase of alpha diversity and a significant increase of Bifidobacterium and Streptococcus as well as decreases of Rikenellaceae, Pseudobutyrivibrio, Blautia, and Lachnospiraceae. A longitudinal observation of the microbiome has never been performed following correction of Hirschsprung's disease. Probiotic treatment significantly changed the fecal microbiome; the alterations were not limited to strains contained in the administered probiotics.