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World J Gastroenterol. Jan 28, 2023; 29(4): 682-691
Published online Jan 28, 2023. doi: 10.3748/wjg.v29.i4.682
Gaseous metabolites as therapeutic targets in ulcerative colitis
Chu K Yao, Chen Sarbagili-Shabat
Chu K Yao, Department of Gastroenterology, Monash University, Melbourne 3004, Australia
Chen Sarbagili-Shabat, Pediatric Gastroenterology Unit, PIBD Research Center, Wolfson Medical Center, Holon 5822012, Israel
Author contributions: Yao CK and Sarbagili-Shabat C conducted the literature search; Yao CK devised headings for the article; and all authors drafted, wrote the article and approved of the final content.
Conflict-of-interest statement: Yao CK has received support for investigator-initiated grants from Atmo Biosciences. She also works in a department that financially benefits from the sales of a digital application and booklets on the low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet. Funds raised contribute to research of the Department of Gastroenterology and to the University. She does not receive personal remuneration. Sarbagili-Shabat C has no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chu K Yao, PhD, RN, Senior Research Fellow, Department of Gastroenterology, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne 3004, Australia. chu.yao@monash.edu
Received: September 20, 2022
Peer-review started: September 20, 2022
First decision: November 15, 2022
Revised: December 19, 2022
Accepted: January 10, 2023
Article in press: January 10, 2023
Published online: January 28, 2023
Processing time: 122 Days and 9.6 Hours
Abstract

Diet therapies are currently under-utilised in optimising clinical outcomes for patients with active ulcerative colitis (UC). Furthermore, existing dietary therapies are framed by poorly defined mechanistic targets to warrant its success. There is good evidence to suggest that microbial production of gaseous metabolites, hydrogen sulfide (H2S) and nitric oxide (NO) are implicated in the development of mucosal inflammation in UC. On a cellular level, exposure of the colonic epithelium to excessive concentrations of these gases are shown to promote functional defects described in UC. Hence, targeting bacterial production of these gases could provide an opportunity to formulate new dietary therapies in UC. Despite the paucity of evidence, there is epidemiological and clinical data to support the concept of reducing mucosal inflammation in UC via dietary strategies that reduce H2S. Several dietary components, namely sulphur-containing amino acids and inorganic sulphur have been shown to be influential in enhancing colonic H2S production. More recent data suggests increasing the supply of readily fermentable fibre as an effective strategy for H2S reduction. Conversely, very little is known regarding how diet alters microbial production of NO. Hence, the current evidence suggest that a whole diet approach is needed. Finally, biomarkers for assessing changes in microbial gaseous metabolites in response to dietary interventions are very much required. In conclusion, this review identifies a great need for high quality randomised-controlled trials to demonstrate the efficacy of a sulphide-reducing dietary therapy for patients with active UC.

Keywords: Diet; Ulcerative colitis; Hydrogen sulfide; Nitric oxide; Sulphide-reducing diet

Core Tip: There is room to develop efficacious dietary therapies in ulcerative colitis (UC) by targeting underlying pathogenic mechanisms. Emerging data indicates that dietary factors play a significant role in modulating two gaseous metabolites, hydrogen sulphide and nitric oxide, that affect the integrity of the colonic mucosal barrier in UC. These gases are produced by the colonic microbiota in response to sulphur-containing protein and to a lesser extent, inorganic sulphur (sulphates and sulphites), but suppressed by the presence of fermentable fibre. Preliminary work suggests that a multi-prong diet that targets reduction of these gases have therapeutic potential and further randomised-controlled trials are underway.