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Synbiotics protected radiation-induced tissue damage in rectal cancer patients: A controlled trial.

  • 2025-06
  • Clinical nutrition (Edinburgh, Scotland) 49
    • Christina Stene
    • Jie Xu
    • Sérgio Fallone de Andrade
    • Ingrid Palmquist
    • Göran Molin
    • Siv Ahrné
    • Henrik Thorlacius
    • Louis B Johnson
    • Bengt Jeppsson

Study Design

Type
Randomized Controlled Trial (RCT)
Population
thirty patients with rectal adenocarcinoma scheduled for preoperative short-term RT
Methods
divided into three groups: a control group, a prebiotic group receiving oat bran, and a synbiotic group receiving oat bran with L. plantarum HEAL19 and blueberry husks; administered daily for two weeks, starting one week before RT
Blinding
Open-label
Duration
two weeks
Funding
Unclear

Background & aims

Colorectal cancer (CRC), particularly rectal cancer, often requires neoadjuvant radiotherapy (RT) as part of its treatment plan. Although effective, RT can cause significant gastrointestinal side effects. Because the onset of RT-induced tissue injury can be anticipated, there is an opportunity to apply preventive measures before the damage occurs. This study aimed to assess whether prebiotic and synbiotic interventions could mitigate RT-induced gut injury by modulating the mucosa-associated microbiota, reducing inflammation, and enhancing gut barrier function in patients undergoing RT for rectal cancer.

Methods

Thirty patients with rectal adenocarcinoma scheduled for preoperative short-term RT (5 × 5 Gy) were divided into three groups: a control group (Ctrl), a prebiotic group (Fiber) receiving oat bran, and a synbiotic group (Synbiotics) receiving oat bran with L. plantarum HEAL19 and blueberry husks. The study products were administered daily for two weeks, starting one week before RT. Blood, faecal, and biopsy samples were collected before and after RT to evaluate inflammatory markers, intestinal permeability, histopathological changes, and mucosa-associated microbiota.

Results

The Fiber and Synbiotics groups exhibited a significant reduction in white blood cell counts following RT (p = 0.01 for both), whereas the Ctrl group did not demonstrate a significant change. However, there was no significant difference in the magnitude of change in white blood cell counts among the three groups (p = 0.12). Histopathological analysis revealed that the Synbiotics group had reduced inflammation and fibrosis compared to the Fiber and Ctrl groups. Although RT reduced bacterial diversity overall, the Synbiotics group preserved a greater proportion of bacterial species, experiencing only a 25.1 % reduction compared to a 55.4 % reduction in the Fiber group.

Conclusion

Synbiotic interventions may protect rectal mucosa by reducing inflammation and modulating mucosa-associated microbiota. The effects were primarily localized to the tissue, reflecting the short-term duration of treatment. While immediate benefits were observed, longer-term interventions should be explored to reduce systemic inflammation.

Research Insights

  • Oat Bran→Reduced White Blood Cell Count

    The Fiber and Synbiotics groups exhibited a significant reduction in white blood cell counts following RT (p = 0.01 for both), whereas the Ctrl group did not demonstrate a significant change. However, there was no significant difference in the magnitude of change in white blood cell counts among the three groups (p = 0.12).

    Effect
    Neutral
    Effect size
    Small

Adverse Events Reported

  • Oat Bran→white blood cell count

    there was no significant difference in the magnitude of change in white blood cell counts among the three groups (p = 0.12)

    Finding
    No significant difference
    Magnitude
    p = 0.12 for difference among groups
    Significant
    No
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