<i>Collinsella aerofaciens</i> as a predictive marker of response to probiotic treatment in non-constipated irritable bowel syndrome

Probiotics are exploited for adjuvant treatment in IBS, but reliable guidance for selecting the appropriate probiotic to adopt for different forms of IBS is lacking. We aimed to identify markers for recognizing non-constipated (NC) IBS patients that may show significant clinical improvements upon treatment with the probiotic strain <i>Lacticaseibacillus paracasei</i> DG (LDG). To this purpose, we performed a post-hoc analysis of samples collected during a multicenter, double-blind, parallel-group, placebo-controlled trial in which NC-IBS patients were randomized to receive at least 24 billion CFU LDG or placebo capsules <i>b.i.d</i>. for 12 weeks. The primary clinical endpoint was the composite response based on improved abdominal pain and fecal type. The fecal microbiome and serum markers of intestinal (PV1 and zonulin), liver, and kidney functions were investigated. We found that responders (R) in the probiotic arm (25%) differed from non-responders (NR) based on the abundance of 18 bacterial taxa, including the families <i>Coriobacteriaceae</i>, <i>Dorea</i> spp. and <i>Collinsella aerofaciens</i>, which were overrepresented in R patients. These taxa also distinguished R (but not NR) patients from healthy controls. Probiotic intervention significantly reduced the abundance of these bacteria in R, but not in NR. Analogous results emerged for <i>C. aerofaciens</i> from the analysis of data from a previous trial on IBS with the same probiotic. Finally, <i>C. aerofaciens</i> was positively correlated with the plasmalemmal vesicle associated protein-1 (PV-1) and the markers of liver function. In conclusion, LDG is effective on NC-IBS patients with NC-IBS with a greater abundance of potential pathobionts. Among these, <i>C. aerofaciens</i> has emerged as a potential predictor of probiotic efficacy.