Research by Dibyendu Dutta, PhD and Seah H. Lim, MD, PhD indicate that reducing gut bacteria significantly improves the health of people living with sickle cell anaemia…
SCD patients not only have altered bacterial population, they also have higher bacterial density in the gut. They also have leakier gut lining
Research demonstrates healthy eating and other regimes crucial to good gut health
Sickle Cell Disease (SCD) affects millions of people worldwide and causes anaemia, recurrent episodes of severe pain (painful crisis), and multi-organ damage, resulting in poor quality of life.
Although SCD affects the red blood cells, white blood cells contribute to the development of painful crisis. The white blood cells, neutrophils, are the most numerous and are the first line of defense against infection. They have the shortest life span (8-12 hours) in the human body. When an infection strikes, neutrophils become activated, become stickier to the lining of the blood vessels. Some are retained for longer duration in the body to fight infection. These neutrophils are called activated and aged neutrophils, respectively. In SCD, the number of activated and aged neutrophils are higher in the absence of any overt infection. The numbers of these neutrophil populations rise even higher during painful crisis. It is now known that, because they are stickier, activated and aged neutrophils are essential for the development of multicellular aggregates that obstruct blood flow and cause painful crisis in SCD.
Interestingly, the process of neutrophil production, activation and aging is driven by bacteria that live in the gut. A lot of good bacteria reside in a healthy gut. They help in digestion, production of essential compounds such as vitamins and short-chain fatty acids, help in maintenance and repair of gut architecture, and protect against harmful gut infection.
SCD patients not only have altered bacterial population, they also have higher bacterial density in the gut. They also have leakier gut lining. Due to this disturbed bacterial ratio and overgrowth, in the presence of leaky gut lining, increased number of intestinal bacteria enter into the circulating blood. This triggers neutrophil activation and aging, and cause aggregate formation in the blood vessels resulting in painful crisis.
Based on these observations, we hypothesized that if the gut of SCD patients can be kept clean, may be less bacteria will enter the circulating blood to reduce activation and aging of the neutrophils. Thus, this might reduce the number of episodes of painful crisis in SCD patients. We therefore, conducted a human study of an oral antibiotic (rifaximin) that is minimally absorbed in the intestine to reduce the number of bacteria in the gut of twelve SCD patients.
We found that rifaximin dramatically improved gut health in SCD patients. Six months of rifaximin therapy resulted in a significant reduction in the leakage of bacteria from the gut into the circulating blood and decreased the numbers of activated and aged neutrophils in the blood. As a result, the median number of painful crisis decreased from the expected 2.25 per 6 months to one per 6 months. Total number of days needing intravenous opioid to treat pain also reduced from the expected 254 in 6 months to 98 during the study period. In addition, study participants not only felt better, they had less pain and were able to enjoy life during Rifaximin Therapy.
The recipe to a good gut is eating healthy, maintaining a good hygiene, reducing stress, exercise and having a good night’s sleep. For example, whole grains, nuts, yams and sweet potatoes provide lots of fiber and other nutrients.
Since this study is still in progress and the treatment is not yet approved by any agency, we do not suggest or recommend sickle cell patients to use rifaximin or any other antibiotic without proper medical advice. However, based on our studies we can suggest that having a healthy gut may help SCD patients to manage their pain a little better.
The recipe to a good gut is eating healthy, maintaining a good hygiene, reducing stress, exercise and having a good night’s sleep. For example, whole grains, nuts, yams and sweet potatoes provide lots of fiber and other nutrients. Gut bacteria ferment these fibers to produce short-chain fatty acids that help in the maintenance and repair of gut lining. It is known that parts of the world where yam is the staple diet, the severity of SCD is relatively less. Thus, having a healthy diet and by maintaining good hygiene, especially related to gut health, SCD patients may be able to better manage their health and enjoy life.
Researchers Drs Lim and Dutta are at the Division of Hematology and Oncology, Department of Medicine, New York Medical College, Valhalla, NY, USA.
NOTE: This study was supported by Bausch Health Companies, Inc.