Objective To evaluate the efficacy and safety of fecal microbiota transplantation (FMT) for refractory irritable bowel syndrome (IBS). Methods Microbiota suspensions from feces of the donors were injected into the intestines of 30 Chinese patients with refractory IBS. Microbiota composition analysis and genomic DNA extraction of fecal samples obtained from these patients at baseline and 1 month after FMT were performed. Clinical efficacy and safety of FMT were assessed using questionnaires covering four aspects of IBS therapeutic efficacy and assessment of adverse effects during a 6‐month follow‐up. Results FMT improved IBS gastrointestinal symptoms and alleviated depression and anxiety, as shown by the improved IBS‐QOL, IBS‐SSS, GSRS, HAMA and HAMD scores at 1 month and 3 months after FMT. A total adverse event rate of FMT was 6.7% (2/30). Gut microbiota analysis revealed that FMT responders had a significantly higher Shannon diversity index before FMT than non‐responders. In addition, analysis of differences in bacterial composition before and after FMT in responders showed specific abundance of the phyla Verrucomincrobia and Euryarchaeota at 1 month after FMT. At the genus level, Methanobrevibacter and Akkermansia were the most abundant fecal microbiota 1 month after FMT compared with those before FMT. Conclusions FMT may be an effective and safe therapeutic strategy for treating IBS that achieves a sustained clinical response 3‐6 months after the first procedure. Changes in the diversity and dominant flora may contribute to its therapeutic effect.
Purpose To evaluate the effects of multidisciplinary collaborative empowerment education on psychological distress and quality of life (QoL) in patients with colorectal cancer undergoing chemotherapy. Methods A quasi-experimental study was conducted using repeated measures at pre- and post-intervention in the fourth chemotherapy cycle. Sixty patients with colorectal cancer aged 36–84 years were allocated to the intervention and control groups. The intervention group received multidisciplinary empowerment education, while the control group received routine health education. Psychological distress involving depression and anxiety symptoms was assessed using The Kessler Psychological Distress Scale (K10) and QoL was measured using The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTCQLQ-C30). Repeated-measures analysis of variance was used to examine intervention effects. Statistical analyses were performed using the SPSS software (version 26.0). Results Psychological distress was considerably lower and QoL was considerably better in patients following multidisciplinary empowerment education in the intervention group than those in the control group. In addition, psychological distress significantly decreased and QoL improved in the intervention group compared to baseline. Conclusion Multidisciplinary collaborative empowerment education was effective in improving the psychological distress and QoL among patients with colorectal cancer undergoing chemotherapy. These findings suggest that the establishment of multidisciplinary collaborative empowerment education might be considered as an innovative means of clinical patient education during combination chemotherapy to improve health outcomes in patients with colorectal cancer. However, our results should be interpreted with caution because of the small sample size. Further validation in a larger sample or randomized controlled design is necessary in the future.
Although the antitumor efficacy of immune checkpoint blockade (ICB) has been proved in colorectal cancer (CRC), the results are unsatisfactory, presumably owing to the presence of tryptophan metabolism enzymes indoleamine 2,3-dioxygenase 1 (IDO1) and tryptophan 2,3-dioxygenase 2 (TDO2). However, only a few dual inhibitors for IDO1 and TDO2 have been reported. Here, we discovered that sodium tanshinone IIA sulfonate (STS), a sulfonate derived from tanshinone IIA (TSN), reduced the enzymatic activities of IDO1 and TDO2 with a half inhibitory concentration (IC50) of less than 10 μM using enzymatic assays for natural product screening. In IDO1- or TDO2- overexpressing cell lines, STS decreased kynurenine (kyn) synthesis. STS also reduced the percentage of forkhead box P3 (FOXP3) T cells in lymphocytes from the mouse spleen cocultured with CT26. In vivo, STS suppressed tumor growth and enhanced the antitumor effect of the programmed cell death 1 (PD1) antibody. Compared with anti-PD1 (α-PD1) monotherapy, combined with STS had lower level of plasma kynurenine. Immunofluorescence assay suggested that STS decreased the number of FOXP3+ T cells and increased the number of CD8+ T cells in tumors. Flow cytometry analysis of immune cells in tumor tissues demonstrated an increase in the percentage of tumor-infiltrating CD8+ T cells. According to our findings, STS acts as an immunotherapy agent in CRC by inhibiting both IDO1 and TDO2.
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