You are here

  • Home
  • Online First
  • Basal levels of microbiota-driven subclinical inflammation are associated with anastomotic leak in patients with colorectal cancer

Article Text

Article menu
Download PDFPDF
Letter
Basal levels of microbiota-driven subclinical inflammation are associated with anastomotic leak in patients with colorectal cancer
  1. Roy Hajjar1,2,3,4,
  2. Gabriela Fragoso1,
  3. Manon Oliero1,
  4. Ahmed Amine Alaoui1,2,3,4,
  5. Annie Calvé1,
  6. Hervé Vennin Rendos1,
  7. Thibault Cuisiniere1,
  8. Nassima Taleb2,
  9. Sophie Thérien2,
  10. François Dagbert2,5,
  11. Rasmy Loungnarath2,5,
  12. Herawaty Sebajang2,5,
  13. Frank Schwenter2,5,
  14. Ramses Wassef2,5,
  15. Richard Ratelle2,5,
  16. Eric Debroux2,5,
  17. Carole Richard2,5,
  18. Manuela M Santos1,4,6
  1. 1Nutrition and Microbiome Laboratory, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
  2. 2Digestive Surgery Service, Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
  3. 3Department of Surgery, Université de Montréal, Montréal, Québec, Canada
  4. 4Institut du cancer de Montréal, Montréal, Canada, Canada
  5. 5Division of General Surgery, Université de Montréal, Montréal, Québec, Canada
  6. 6Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
  1. Correspondence to Dr Roy Hajjar, Nutrition and Microbiome Laboratory, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada; roy.hajjar{at}umontreal.ca

http://dx.doi.org/10.1136/gutjnl-2023-329929

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    In our recent publication in Gut,1 we showed that preoperative gut microbiota was causally linked to the development of anastomotic leak (AL) after colorectal cancer (CRC) surgery. AL results from impaired healing of the colonic wound and leads to the leakage of intestinal content into the abdomen. Using faecal microbiota transplantation (FMT) in mice with faecal samples from 18 patients with CRC, we established that preanastomosis expression of mucosal proinflammatory cytokines, namely macrophage inflammatory protein-1 alpha (MIP-1α), monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein 2 (MIP-2) and interleukin-17A/F (IL-17A/F), was increased in patients who later developed AL. Most importantly, these higher basal cytokine levels were driven by gut microbiota, as FMT from these patients led to higher cytokine levels in mice.

    To corroborate these findings, we now expanded the analysis to our cohort of 77 patients with CRC who underwent a bowel resection with anastomosis (table 1): 13 were diagnosed with poor anastomotic healing and AL after surgery or at follow-up, while 64 did not. Colonic mucosal biopsies were collected during surgery from all patients and the levels of nine cytokines were measured (online supplemental material), confirming higher levels of MIP-1α, MIP-2, MCP-1 and IL-17A/F in patients who later developed AL (figure 1A). This larger cohort also revealed that the basal levels of IL-1β and tumour necrosis factor alpha, which we have previously shown to be increased after surgery in patients with AL,1 …

    View Full Text

    Footnotes

    • Contributors Conceptualisation: RH, CR and MMS. Methodology: RH, GF, MO, AAA, AC, HVR, TC, NT, ST, FD, RL, HS, FS, RW, RR, ED, CR and MMS. Visualisation and original draft: RH, MMS. Supervision: CR and MMS. Review and editing: RH, GF, MO, AAA, AC, HVR, TC, NT, ST, FD, RL, HS, FS, RW, RR, ED, CR and MMS. Guarantor and overall supervision: MMS.

    • Funding Canadian Institutes of Health Research grant FRN-159775 and PJT-175181 (MMS). New Frontiers in Research Fund – Exploration grant NFRFE-2020-00991 (MMS, CR). Canadian Society of Colon and Rectal Surgeons operating grant 2019 (CR, RH). Fonds de recherche du Québec – Santé (FRQ-S) and Ministère de la Santé et des Services sociaux Resident Physician Health Research Career Training Program (RH). Canadian Institutes of Health Research Graduate Scholarships program (RH). Institut du Cancer de Montréal (Canderel scholarship) (MO, TC).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.