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Cellulose helped donor microbiota increase insulin sensitivity in obese patients

Anastasia Kuznetsova , N+1

Fecal microbiota transplantation in capsules helped to improve insulin sensitivity only to those patients who consumed cellulose. Such results of the clinical study were published in Nature Medicine by scientists from three countries (Mocanu et al., Fecal microbial transplantation and fiber supplementation in patients with severe obesity and metabolic syndrome: a randomized double-blind, placebo-controlled phase 2 trial). They analyzed how the effect of fecal microbiota treatment in capsules depends on the type of dietary fiber consumed in obese people. Scientists believe that cellulose helps microorganisms linger longer in the intestine and gives beneficial bacteria an advantage in survival.

The most common methods of treating obesity – diet and physical activity – do not always cope with the problem. Then doctors resort to other methods, such as drugs. These medications usually contain hormones and have side effects, so sometimes patients have to give them up. In recent years, the method of fecal microbiota transplantation for the treatment of obesity and metabolic disorders has been studied. Fecal transplantation from healthy donors without excess weight helped people with obesity to lose weight, but the effect of treatment was short-lived. Most likely, this was because over time, the donor microbiota disappeared from the patients' body. Previous studies also had limitations: they were conducted on men with mild metabolic disorders and used invasive techniques for delivering donor microbiota, so scientists need to work out the treatment method on all groups of patients and improve it.

Researchers from Ireland, Canada and China led by Karen K. Madsen from The University of Alberta applied noninvasive transplantation of fecal microbiota with a capsule preparation for the treatment of obesity. To create it, they used the feces of healthy donors with normal body weight (BMI up to 25). Scientists decided to give patients dietary fiber along with pills as an additive to food in order to increase the lifespan of the donor microbiota in the intestine. Two types of dietary fibers were used in the experiment: well-fermented by microbiota (corn fibers, wheat starch) and poorly fermented by microbiota (cellulose). The study involved obese patients (BMI over 30), who were divided into four groups. The first group was given both microorganisms in capsules and well-fermented microbiota fibers (15 people). The second group was given capsules with microorganisms and cellulose (14 people). And the third and fourth groups were given only poorly or well-fermented dietary fiber (17 and 15 people, respectively). The microorganisms in the capsules were taken by the participants on the first day of the experiment, and they received dietary fiber throughout the study. To assess the metabolic changes in the participants, the HOMA2-IR insulin resistance index was used, calculated on the basis of blood glucose and insulin indicators. A decrease in the index indicates an improvement in insulin sensitivity.

After 6 weeks of the study, only in the group that received the donor microbiota and cellulose, the HOMA2-IR index decreased significantly (3.77 at the beginning of the study and 3.16 at the end of the experiment, p=0.02). In the other three groups, the changes were insignificant (p>0.05). No serious side effects were registered during the study in any group.

Scientists have concluded that for a positive effect from the transplantation of fecal microbiota, additional maintenance of dietary fiber, which is poorly fermented by microorganisms, is necessary. They explain this effect by the fact that cellulose has binding properties, and this can affect the concentration of microbial metabolites in the intestinal space, the movement of contents through the digestive tract, as well as the properties of intestinal mucus. All this contributes both to the delay of the donor microbiota in the intestine and to the selection of beneficial classes of bacteria.

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