title: Microbial manipulation as primary therapy for Crohn's disease.
abstract: While antimicrobials are clinically effective in preventing post-operative recurrence, the role for antibiotics in primary therapy for Crohn's disease (CD) remains unclear. The recent multicenter phase 2 trial by Prantera et al received wide attention because it demonstrated an increase in the week 12 remission rate in patients with moderately active CD treated with rifaximin and renewed interest in microbial manipulation as primary therapy for CD. In this commentary, we discuss aspects of durability, immune cell polarization, and safety of microbial manipulation as primary therapy for CD.
authors.affiliation: Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA.
authors.forename: Randy S
authors.initials: RS
authors.lastname: Longman
authors.forename: Arun
authors.initials: A
authors.lastname: Swaminath
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D017322:Clinical Trials, Phase II as Topic; D003106:Colon / Q000187:drug effects* / Q000276:immunology / Q000382:microbiology; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D006801:Humans; D015337:Multicenter Studies as Topic; D012074:Remission Induction; D012294:Rifamycins / Q000627:therapeutic use*; D000078262:Rifaximin; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D012294:Rifamycins; D000078262:Rifaximin
keywords: Inflammatory bowel disease; Microbiome; Rifaximin
references.citation: Gastroenterology. 2012 Mar;142(3):473-481.e4
references.pmid: 22155172
references.citation: Dig Dis Sci. 1991 Apr;36(4):449-53
references.pmid: 2007362
references.citation: Inflamm Bowel Dis. 2011 Jan;17(1):179-84
references.pmid: 20839241
references.citation: Science. 2011 Jan 21;331(6015):337-41
references.pmid: 21205640
references.citation: Gastroenterology. 2010 Dec;139(6):1844-1854.e1
references.pmid: 20816835
references.citation: Expert Rev Gastroenterol Hepatol. 2010 Oct;4(5):589-600
references.pmid: 20932144
references.citation: Aliment Pharmacol Ther. 2006 Apr 15;23(8):1117-25
references.pmid: 16611272
references.citation: Aliment Pharmacol Ther. 2008 Jun;27(12):1233-9
references.pmid: 18315579
references.citation: ISME J. 2007 Sep;1(5):403-18
references.pmid: 18043660
references.citation: Inflamm Bowel Dis. 2002 Jan;8(1):10-5
references.pmid: 11837933
references.citation: Digestion. 2006;73 Suppl 1:13-27
references.pmid: 16498249
references.citation: Inflamm Bowel Dis. 2013 Jan;19(1):141-50
references.pmid: 22508665
references.citation: Proc Natl Acad Sci U S A. 2008 Oct 28;105(43):16731-6
references.pmid: 18936492
references.citation: Gastroenterology. 2002 Jul;123(1):33-40
references.pmid: 12105831
references.citation: Gastroenterology. 2007 Jun;132(7):2313-9
references.pmid: 17570206
references.citation: Science. 2012 Apr 27;336(6080):489-93
references.pmid: 22442383
references.citation: Gut. 1991 Sep;32(9):1071-5
references.pmid: 1916494
references.citation: Proc Natl Acad Sci U S A. 2007 Aug 21;104(34):13780-5
references.pmid: 17699621
references.citation: Am J Gastroenterol. 1994 Apr;89(4):513-8
references.pmid: 8147352