Abstract Background Inflammatory bowel disease (IBD) pathogenesis involves the gut epithelia. However, no specific epithelial interventions exist, and models that capture epithelial and human gut variations for pre-clinical screening of therapies are limited Methods Monolayered organoides, derived from human rectal mucosal biopsies, were incubated with fecal samples from Crohn's disease (CD), ulcerative colitis (UC), and healthy control. Organoid viability was quantified by ATP levels and validated by live microscopy imaging. Fecal metabolites were measured using a semi-targeted library of 550 predefined metabolites. Gut bacteria were characterized using 16Sseq. Results Fecal samples were processed by separating the supernatant, heat-killing (HK) the bacteria, and rejoining the samples (Fig. 1A). We generated three pools per group (CD p#1-3, UC p#1-3, controls p#1-3). Each fecal p#1 (CD, UC, and controls) was a mix of ten subjects, and fecal pools p#2-3 were each a mix of five other independent subjects. An additional saliva/oral pool was processed similarly as an independent bacterial/metabolite source. Microbial characterization shows the overall variations of the original and pooled samples, with separation between IBD and control samples (Fig. 1B). We then inculcated the oral or fecal contents pools with differentiated colonoid and compared epithelial viability to untreated organoids and to those exposed to inflammatory triggers. Fecal content from UC and CD patients significantly reduced colonoid viability and ATP metabolism compared to healthy controls (p<0.001, Fig. 1C-D). This effect was mediated mainly by the fecal supernatant that also includes the metabolites, rather than the HK fraction (Fig. 1E). Live microscopy confirmed cell clumping already after 3 hours with the IBD fecal material (Fig. 1F). Characterizing metabolite levels in the joined and supernatant pools and correlating them with disease state (IBD vs. controls) and the colonoids viability outcomes highlighted several metabolites higher in controls and linked with improved viability (Fig. 2A-B). Notably, supplementing these identified metabolites with the fecal content pools, UC p#3 and CD p#2 improved epithelial viability (Fig. 2C-D). Lower metabolite supplementation mediated the improvement of the CD pool, but only higher concentrations resulted in improvement of the UC pools. Similarly, microscopy showed improvement in cell clumping when the IBD pools were supplemented with the prioritized metabolites (Fig. 2E). Conclusion Fecal content from IBD patients was associated with significantly reduced organoid viability and ATP metabolism compared to fecal content from controls, which improved, in part, with supplementation with prioritized metabolites.
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