{
  "abstract": "Children with intestinal failure (IF) due to short bowel syndrome (SBS) depend on parenteral nutrition (PN) until intestinal rehabilitation (IR) is achieved. The gut microbiome is increasingly recognised as having important roles in health and disease. 1 Our previous systematic review demonstrated reduced gut microbial richness and diversity in children with IF due to SBS compared to healthy controls, independent of whether they had achieved IR. However, small sample sizes and mostly cross-sectional designs impacted the robustness of these results.2 The Gut Microbiota and Intestinal Rehabilitation: A prospective Childhood cohort Longitudinal study of Short bowel syndrome (MIRACLS) Study aimed to characterise temporal changes in the gut microbiome of children with SBS and identify clinical factors influencing its composition. A key objective was to determine whether microbial features differ between children who achieved IR and those who did not, and to explore the potential of the microbiome as a biomarker or modulator of IR. The MIRACLS study represents the largest single cohort study to date examining gut microbial changes leading up to and beyond IR in children with SBS. Full-length 16S rRNA gene sequencing was used to profile the gut microbiome, integrated with detailed serial clinical data. The final analysis included 108 stool samples from 18 children with SBS recruited from a major IF specialist centre, with a median (IQR) age of 2.9 years (0.46-6.6) at study entry. Among these, 32 samples were from seven children who achieved IR, and 76 samples were from 11 children who did not achieve IR during the study period. The median (IQR) number of samples per participant was 5.5 (2.8–8.0) over 434 days (214–680). The most abundant and prevalent genera in faecal samples from children with SBS were Escherichia, Bifidobacterium, Veillonella, Enterococcus, and Lactobacillus. Clinical covariates significantly associated with the gut microbiome include remnant small bowel length, antibiotic exposure, PN dependency (hours per week), type of enteral intake, prior receipt of breastmilk, intestinal failure-associated liver disease, and exposure to ursodeoxycholic acid. Longitudinal analysis revealed that microbial diversity increased across IR and with the introduction of solid food, but not with the timing of PN cessation. Notably, an analysis of faecal samples collected within six weeks before IR, compared to age-matched samples from children that did not achieve IR, showed that the IR group accounted for a significant proportion of total variance in microbiome composition. This suggests that distinct microbiome features may emerge at the pre-IR stage and could serve as indicators of IR. These findings advance understanding of clinical-microbiome interactions in SBS and set priorities for future larger cohorts. Such efforts should be facilitated through multi-centre collaboration, with mechanistic studies to establish causality, identify microbiome biomarkers, and ultimately identify therapeutic targets for IR.References Valdes AM, Walter J, Segal E, Spector TD. Role of the gut microbiota in nutrition and health. BMJ (Clin res ed) 2018;361:k2179.Cleminson JS, Young GR, Campbell DI, et al. Gut microbiome in paediatric short bowel syndrome: a systematic review and sequencing re-analysis. Pediatr Res. 2025.",
  "authors": [
    {
      "affiliations": [
        "Newcastle University",
        "Royal Victoria Infirmary, Newcastle upon Tyne"
      ],
      "name": "Jemma Cleminson"
    },
    {
      "affiliations": [
        "Royal Victoria Infirmary, Newcastle upon Tyne"
      ],
      "name": "David Campbell"
    },
    {
      "affiliations": [
        "Newcastle University",
        "Royal Victoria Infirmary, Newcastle upon Tyne"
      ],
      "name": "Andrew Gennery"
    },
    {
      "affiliations": [
        "Northumbria University"
      ],
      "name": "Andrew Nelson"
    },
    {
      "affiliations": [
        "Newcastle University",
        "Royal Victoria Infirmary, Newcastle upon Tyne"
      ],
      "name": "Janet Berrington"
    },
    {
      "affiliations": [
        "Newcastle University"
      ],
      "name": "Christopher Stewart"
    }
  ],
  "title": "OC12 The MIRACLS study: longitudinal profiling of the gut microbiome in children with short bowel syndrome undergoing intestinal rehabilitation",
  "uid": "3a710b02-8683-505d-a8b8-1ca09ef8e3d4"
}