Riboflavin supplementation in patients with Crohn's disease (RISE-UP study).
J Crohns Colitis. 2019 Dec 24. Epub 2019 Dec 24. PMID: 31873717
Julius Z H von Martels
BACKGROUND AND AIMS: Crohn's disease (CD) is characterized by chronic intestinal inflammation and dysbiosis in the gut. Riboflavin (vitamin B2) has anti-inflammatory, anti-oxidant and microbiome-modulatory properties. Here, we analyzed the effect of riboflavin on oxidative stress, markers of inflammation, clinical symptoms and the faecal microbiome in patients with CD.
METHODS: In this prospective clinical intervention study, patients received 100 mg riboflavin (DSM, Nutritional Products Ltd.) daily for 3 weeks. Clinical disease activity (Harvey-Bradshaw Index: HBI), serum biomarkers of inflammation and redox status (plasma free thiols), and faecal microbiome taxonomical composition and functionality (fluorescent in-situ hybridization, FISH, and metagenomic shotgun sequencing, MGS), were analyzed before and after riboflavin intervention.
RESULTS: In total, 70 patients with CD with varying disease activity were included. Riboflavin supplementation significantly decreased serum levels of inflammatory markers. In patients with low faecal calprotectin (FC) levels IL-2 decreased, while in patients with high FC levels C-reactive protein (CRP) was reduced, and free thiols significantly increased after supplementation. Moreover, HBI was significantly decreased by riboflavin supplementation. Riboflavin supplementation led to decreased Enterobacteriaceae in patients with low FC levels as determined by FISH, however, MGS analysis showed no effects on diversity, taxonomy or metabolic pathways of the faecal microbiome.
CONCLUSIONS: Three weeks of riboflavin supplementation resulted in a reduction in systemic oxidative stress, mixed anti-inflammatory effects, and a reduction in clinical symptoms (HBI). FISH analysis showed decreased Enterobacteriaceae in patients with CD with low FC levels, though this was not observed in MGS analysis. Our data demonstrates that riboflavin supplementation has a number of anti-inflammatory and anti-oxidant effects in CD.
NCT NUMBER: 02538354.