Rifaximin reduces gut-derived inflammation in severe acute pancreatitis: an experimental animal model and randomized controlled trial

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Citation
PMID PubMed identifier for scientific articles.
DOI Digital object identifier for electronic documents.
URI Uniform resource identifier for web resources.
Authors
Zou Y.-.y., Yu B.-.j., He C., Ding L., Xu X., Wan J.-.h., Lei Y.-.p., Huang X., Xiong H.-.f., He W.-.h., Luo L.-.y., Xia L., Lv N.-.h., Zhu Y.
Journal
Microbiology spectrum
Year
2025
Keywords:
acute pancreatitis, gut microbiota, rifaximin, systemic inflammatory response syndrome
UNLABELLED: Severe acute pancreatitis (SAP) is characterized by systemic inflammation and intestinal barrier dysfunction and is often associated with gut microbiota dysbiosis. Rifaximin, a gut-specific non-absorbable antibiotic, is known to modulate the gut microbiota. Here, we investigated rifaximin's effects and mechanisms in SAP using murine models and a single-center, open-label, randomized controlled trial (Chinese Clinical Trial Registry: ChiCTR2100049794). In mice, rifaximin attenuated pancreatic injury and systemic inflammation and altered gut microbiota composition by decreasing mucin-degrading genera such as Akkermansia (P < 0.05). These protective effects persisted in antibiotic-treated and germ-free mice, suggesting mechanisms not solely dependent on gut microbiota modulation. In patients with predicted SAP (n  =  60), rifaximin significantly reduced systemic inflammation compared with controls. WBC decreased from a median of 11.50 × 10⁹/L (IQR 8.76-15.68) to 8.49 × 10⁹/L (6.93-10.20; P = 0.04) and TNF-α from 15.05 pg/mL (12.73-19.75) to 11.00 pg/mL (8.74-15.40; P = 0.009). However, the incidence of culture-confirmed infection did not differ between the rifaximin and control groups (13.3% vs. 13.3%; RR, 1.00; 95% CI, 0.28-3.63). Adverse events were comparable between groups. Metagenomic analyses revealed suppression of mucin-degrading bacteria (e.g., Akkermansia, Bacteroides fragilis, and Hungatella hathewayi) (P < 0.05) and reductions in mucin-degrading carbohydrate-active enzymes, including sialidases and fucosidases. In conclusion, among patients with predicted SAP, rifaximin did not reduce culture-confirmed infectious complications within 90 days after randomization compared with standard care, despite significant improvements in systemic inflammatory markers and selected fecal microbiome features. Larger randomized controlled trials are warranted to validate these findings. IMPORTANCE: Although rifaximin has been used to target gut-derived inflammation in other contexts, its role in SAP remains largely unexplored. In this study, rifaximin treatment was associated with reduced pancreatic injury and systemic inflammation in both murine models and patients with predicted SAP. Treatment also led to changes in gut microbial composition, notably a decrease in mucin-degrading taxa. Importantly, similar protective effects were also observed in antibiotic-treated and germ-free mice, indicating that rifaximin may act via microbiota-dependent and host-directed pathways. These findings offer novel insights into the gut-pancreas axis and suggest that rifaximin holds therapeutic potential by modulating gut microbial composition and host inflammatory responses in SAP.

Experiment 1


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Curated date: 2025/09/28

Curator: SheikhAlMamun

Revision editor(s): SheikhAlMamun

Subjects

Location of subjects
China
Host species Species from which microbiome was sampled. Contact us to have more species added.
Mus musculus
Body site Anatomical site where microbial samples were extracted from according to the Uber Anatomy Ontology
Feces Cow dung,Cow pat,Droppings,Dung,Excrement,Excreta,Faeces,Fecal material,Fecal matter,Fewmet,Frass,Guano,Matières fécales@fr,Merde@fr,Ordure,Partie de la merde@fr,Piece of shit,Porción de mierda@es,Portion of dung,Portion of excrement,Portion of faeces,Portion of fecal material,Portion of fecal matter,Portion of feces,Portion of guano,Portion of scat,Portionem cacas,Scat,Spoor,Spraint,Stool,Teil der fäkalien@de,Feces,feces
Condition The experimental condition / phenotype studied according to the Experimental Factor Ontology
Gut microbiome measurement Gut microbiome measurement,gut microbiome measurement
Group 0 name Corresponds to the control (unexposed) group for case-control studies
Control (Con)
Group 1 name Corresponds to the case (exposed) group for case-control studies
Rifaximin (Rif)
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Wilcoxon rank-sum test identified the most differentially abundant phyla and genera between Con group and Rif group.

Lab analysis

Sequencing type
16S
16S variable region One or more hypervariable region(s) of the bacterial 16S gene
Not specified
Sequencing platform Manufacturer and experimental platform used for quantifying microbial abundance
Illumina

Statistical Analysis

Data transformation Data transformation applied to microbial abundance measurements prior to differential abundance testing (if any).
relative abundances
Statistical test
Mann-Whitney (Wilcoxon)
Significance threshold p-value or FDR threshold used for differential abundance testing (if any)
0.05


Signature 1

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Curated date: 2025/09/28

Curator: SheikhAlMamun

Revision editor(s): SheikhAlMamun

Source: Figure 2E

Description: Wilcoxon rank-sum test identified the most differentially abundant phyla and genera between Con group and Rif group.

Abundance in Group 1: increased abundance in Rifaximin (Rif)

NCBI Quality ControlLinks
Pseudomonadota
Staphylococcus
Lactobacillus
Corynebacterium
Klebsiella
Sporosarcina

Revision editor(s): SheikhAlMamun

Signature 2

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Curated date: 2025/09/28

Curator: SheikhAlMamun

Revision editor(s): SheikhAlMamun

Source: Figure 2E

Description: Wilcoxon rank-sum test identified the most differentially abundant phyla and genera between Con group and Rif group.

Abundance in Group 1: decreased abundance in Rifaximin (Rif)

NCBI Quality ControlLinks
Lachnospiraceae_UCG001Lachnospiraceae_UCG001
Lachnospiraceae_NK4A136_groupLachnospiraceae_NK4A136_group
Clostridium_innocuum_groupClostridium_innocuum_group
Actinomycetota
Thermodesulfobacteriota
Patescibacteria group
Desulfovibrio
Facklamia
Atopostipes
Alistipes
Lachnoclostridium
Citrobacter

Revision editor(s): SheikhAlMamun

Experiment 2


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Curated date: 2025/09/28

Curator: SheikhAlMamun

Revision editor(s): SheikhAlMamun

Differences from previous experiment shown

Subjects

Condition The experimental condition / phenotype studied according to the Experimental Factor Ontology
Acute pancreatitis acute necrotizing pancreatitis,acute pancreatic necrosis,acute pancreatitis,acute pancreatitis (disorder) [ambiguous],pancreatitis necrotizing,pancreatitis, acute,Acute pancreatitis
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Wilcoxon rank-sum test identified the most differentially abundant phyla and genera between Cer + Bom group and Cer + Bom + Rif group. *P < 0.05, **P < 0.01, and ***P < 0.001. Rif, rifaximin; Cer, caerulein; Bom, bombesin; Con, control; PCoA, principal coordinate analysis.

Lab analysis

Statistical Analysis

Signature 1

Needs review

Curated date: 2025/09/28

Curator: SheikhAlMamun

Revision editor(s): SheikhAlMamun

Source: Figure 2F

Description: Wilcoxon rank-sum test identified the most differentially abundant phyla and genera between Cer + Bom group and Cer + Bom + Rif group. *P < 0.05, **P < 0.01, and ***P < 0.001. Rif, rifaximin; Cer, caerulein; Bom, bombesin; Con, control; PCoA, principal coordinate analysis.

Abundance in Group 1: increased abundance in Rifaximin (Rif)

NCBI Quality ControlLinks
Campylobacterota
Desulfovibrio
Helicobacter
Thermodesulfobacteriota

Revision editor(s): SheikhAlMamun

Signature 2

Needs review

Curated date: 2025/09/28

Curator: SheikhAlMamun

Revision editor(s): SheikhAlMamun

Source: Figure 2F

Description: Wilcoxon rank-sum test identified the most differentially abundant phyla and genera between Cer + Bom group and Cer + Bom + Rif group. *P < 0.05, **P < 0.01, and ***P < 0.001. Rif, rifaximin; Cer, caerulein; Bom, bombesin; Con, control; PCoA, principal coordinate analysis.

Abundance in Group 1: decreased abundance in Rifaximin (Rif)

NCBI Quality ControlLinks
Pseudomonadota
Verrucomicrobiota
Actinomycetota
Patescibacteria group
Klebsiella
Lachnoclostridium
Lachnospiraceae_NK4A136_groupLachnospiraceae_NK4A136_group
Alloprevotella
Enterococcus
Akkermansia
Citrobacter
Candidatus Saccharimonas
Bifidobacterium
Faecalibaculum
Parasutterella
Clostridium_innocuum_groupClostridium_innocuum_group
Alistipes

Revision editor(s): SheikhAlMamun

Experiment 3


Needs review

Curated date: 2025/09/28

Curator: SheikhAlMamun

Revision editor(s): SheikhAlMamun

Differences from previous experiment shown

Subjects

Host species Species from which microbiome was sampled. Contact us to have more species added.
Homo sapiens


Group 0 name Corresponds to the control (unexposed) group for case-control studies
Con_T0
Group 1 name Corresponds to the case (exposed) group for case-control studies
Con_T1
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
Rifaximin induces specific alterations in the abundance and function of the gut microbiota in patients predicted to SAP. The top 30 differentially abundant bacterial species before and after treatment in the control group.
Group 0 sample size Number of subjects in the control (unexposed) group
0
Group 1 sample size Number of subjects in the case (exposed) group
30
Antibiotics exclusion Number of days without antibiotics usage (if applicable) and other antibiotics-related criteria used to exclude participants (if any)
3 months

Lab analysis

Statistical Analysis

Signature 1

Needs review

Curated date: 2025/09/28

Curator: SheikhAlMamun

Revision editor(s): SheikhAlMamun

Source: Figure 7A

Description: Rifaximin induces specific alterations in the abundance and function of the gut microbiota in patients predicted to SAP. (A) The top 30 differentially abundant bacterial species before and after treatment in the control group.

Abundance in Group 1: increased abundance in Con_T1

NCBI Quality ControlLinks
Alistipes putredinis
Alistipes sp.
Bacteroides stercoris
Bacteroides uniformis
Clostridia bacterium
Enterococcus faecalis
Eubacterium xylanophilum
Fusobacterium mortiferum
Megamonas funiformis
Ndongobacter sp.
Oscillospiraceae bacterium
Parabacteroides distasonis
Roseburia sp.
Shigella sp.
Odontobacter dentiumOdontobacter dentium
Alistipes guggisbergiiAlistipes guggisbergii
Clostridium bacteriumClostridium bacterium

Revision editor(s): SheikhAlMamun

Signature 2

Needs review

Curated date: 2025/09/28

Curator: SheikhAlMamun

Revision editor(s): SheikhAlMamun

Source: Figure 7A

Description: Rifaximin induces specific alterations in the abundance and function of the gut microbiota in patients predicted to SAP. (A) The top 30 differentially abundant bacterial species before and after treatment in the control group.

Abundance in Group 1: decreased abundance in Con_T1

NCBI Quality ControlLinks
Enterococcus faecium
Escherichia_coliEscherichia_coli
Bacteroides stercoris
Parabacteroides merdae
Blautia_sporothermoduransBlautia_sporothermodurans

Revision editor(s): SheikhAlMamun

Experiment 4


Needs review

Curated date: 2025/10/06

Curator: SheikhAlMamun

Revision editor(s): SheikhAlMamun

Differences from previous experiment shown

Subjects

Group 0 name Corresponds to the control (unexposed) group for case-control studies
(Lower in RL_T1)
Group 1 name Corresponds to the case (exposed) group for case-control studies
(Higher in RL_T1)
Group 1 definition Diagnostic criteria applied to define the specific condition / phenotype represented in the case (exposed) group
The top 30 differentially abundant bacterial species before and after treatment in the rifaximin group.

Lab analysis

Statistical Analysis

Data transformation Data transformation applied to microbial abundance measurements prior to differential abundance testing (if any).
Not specified


Signature 1

Needs review

Curated date: 2025/10/06

Curator: SheikhAlMamun

Revision editor(s): SheikhAlMamun

Source: Figure 7B

Description: Rifaximin induces specific alterations in the abundance and function of the gut microbiota in patients predicted to SAP. (B) The top 30 differentially abundant bacterial species before and after treatment in the rifaximin group.

Abundance in Group 1: increased abundance in (Higher in RL_T1)

NCBI Quality ControlLinks
Prevotella corporis
Bacteroides faecis
Bacteroides thetaiotaomicron
Bacteroides caccae
Enterococcus faecium
Fusobacterium nucleatum
Prevotella sp. CAG:520
Faecalibacterium sp.
Bacteroides uniformis
Phocaeicola plebeius
Bacteroides_sp._AF10-6Bacteroides_sp._AF10-6
Klebsiella aerogenes
Dorea longicatena
Blautia wexlerae
Bacteroides_cagerhiBacteroides_cagerhi
Faecalibacterium_sp._4F29-13ACFaecalibacterium_sp._4F29-13AC

Revision editor(s): SheikhAlMamun

Signature 2

Needs review

Curated date: 2025/10/09

Curator: SheikhAlMamun

Revision editor(s): SheikhAlMamun

Source: Figure 7B

Description: Fig 7 Rifaximin induces specific alterations in the abundance and function of the gut microbiota in patients predicted to SAP. (B) The top 30 differentially abundant bacterial species before and after treatment in the rifaximin group.

Abundance in Group 1: decreased abundance in (Higher in RL_T1)

NCBI Quality ControlLinks
Enterobacter hormaechei
Streptococcus parasanguinis
Lachnospiraceae bacterium
Ruminiclostridium
Prevotella sp.
Alistipes putredinis

Revision editor(s): SheikhAlMamun

Signature 3

Needs review

Curated date: 2025/10/09

Curator: SheikhAlMamun

Revision editor(s): SheikhAlMamun

Source: Figure 7B

Description: Fig 7 Rifaximin induces specific alterations in the abundance and function of the gut microbiota in patients predicted to SAP. (B) The top 30 differentially abundant bacterial species before and after treatment in the rifaximin group.

Abundance in Group 1: decreased abundance in (Higher in RL_T1)

NCBI Quality ControlLinks
Bacteroides fragilis
Bacteroides thetaiotaomicron
Bacteroides caccae
Enterocloster bolteae
Streptococcus parasanguinis
Enterobacter hormaechei

Revision editor(s): SheikhAlMamun