Inducing Oxalobacter formigenes Colonization Reduces Urinary Oxalate in Healthy Adults

Introduction: Oxalate-degrading intestinal bacteria, including the oxalate-degrading specialist, Oxalobacter formigenes (O formigenes), have the potential to reduce urinary oxalate excretion in humans, and thus limit the risk of calcium oxalate kidney stone formation. The aim of this proof-of-concep...

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Main Authors: Sonia Fargue, Mangesh Suryavanshi, Kyle D. Wood, Joseph J. Crivelli, Robert A. Oster, Dean G. Assimos, Aaron Miller, John Knight
Format: Article
Language:English
Published: Elsevier 2025-05-01
Series:Kidney International Reports
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Online Access:http://www.sciencedirect.com/science/article/pii/S2468024925000932
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author Sonia Fargue
Mangesh Suryavanshi
Kyle D. Wood
Joseph J. Crivelli
Robert A. Oster
Dean G. Assimos
Aaron Miller
John Knight
author_facet Sonia Fargue
Mangesh Suryavanshi
Kyle D. Wood
Joseph J. Crivelli
Robert A. Oster
Dean G. Assimos
Aaron Miller
John Knight
author_sort Sonia Fargue
collection DOAJ
description Introduction: Oxalate-degrading intestinal bacteria, including the oxalate-degrading specialist, Oxalobacter formigenes (O formigenes), have the potential to reduce urinary oxalate excretion in humans, and thus limit the risk of calcium oxalate kidney stone formation. The aim of this proof-of-concept study, which was performed in healthy adults, was to demonstrate that ingestion of live O formigenes is safe, can establish sustainable gut colonization, and reduce urinary oxalate excretion. Methods: Twenty-two healthy adults without a history of kidney stones and not colonized with O formigenes ingested diets controlled in oxalate and calcium. In these participants, 24-hour urine and stool oxalate levels were quantified using ion chromatography coupled with mass spectrometry before and after ingestion of O formigenes. Results: All 22 participants were successfully colonized after a single dose of O formigenes (∼1010 cells); 10 remained colonized for at least 1 year. Colonization was lost in 11 participants, of whom 9 reported antibiotic use. Six participants who lost colonization were redosed, and 5 were successfully recolonized. Stool oxalate concentration and urine oxalate excretion significantly decreased by 54% and 14%, respectively, with varied responses after colonization. Microbiome molecular analyses of precolonized stool samples highlighted the abundance and diversity of other potential oxalate-degrading bacteria, which may have influenced the effect of O formigenes colonization on urinary oxalate excretion. Conclusion: These findings support future investigations to examine the effectiveness of O formigenes colonization in reducing urinary oxalate excretion in disease cohorts, including calcium oxalate kidney stone formers with enteric hyperoxaluria.
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spelling doaj-art-c50d6b051ac1440ea55a0d1300c2bc962025-08-20T03:47:10ZengElsevierKidney International Reports2468-02492025-05-011051518152810.1016/j.ekir.2025.02.004Inducing Oxalobacter formigenes Colonization Reduces Urinary Oxalate in Healthy AdultsSonia Fargue0Mangesh Suryavanshi1Kyle D. Wood2Joseph J. Crivelli3Robert A. Oster4Dean G. Assimos5Aaron Miller6John Knight7Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA; Correspondence: Sonia Fargue, Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, 720 20th St South Kaul 816F, Birmingham, Alabama, USA.Cardiovascular and Metabolic Sciences Department, Cleveland Clinic, Cleveland, Ohio, USADepartment of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USADepartment of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USADivision of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USADepartment of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USACardiovascular and Metabolic Sciences Department, Cleveland Clinic, Cleveland, Ohio, USA; Department of Urology, Cleveland Clinic, Cleveland, Ohio, USADepartment of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USAIntroduction: Oxalate-degrading intestinal bacteria, including the oxalate-degrading specialist, Oxalobacter formigenes (O formigenes), have the potential to reduce urinary oxalate excretion in humans, and thus limit the risk of calcium oxalate kidney stone formation. The aim of this proof-of-concept study, which was performed in healthy adults, was to demonstrate that ingestion of live O formigenes is safe, can establish sustainable gut colonization, and reduce urinary oxalate excretion. Methods: Twenty-two healthy adults without a history of kidney stones and not colonized with O formigenes ingested diets controlled in oxalate and calcium. In these participants, 24-hour urine and stool oxalate levels were quantified using ion chromatography coupled with mass spectrometry before and after ingestion of O formigenes. Results: All 22 participants were successfully colonized after a single dose of O formigenes (∼1010 cells); 10 remained colonized for at least 1 year. Colonization was lost in 11 participants, of whom 9 reported antibiotic use. Six participants who lost colonization were redosed, and 5 were successfully recolonized. Stool oxalate concentration and urine oxalate excretion significantly decreased by 54% and 14%, respectively, with varied responses after colonization. Microbiome molecular analyses of precolonized stool samples highlighted the abundance and diversity of other potential oxalate-degrading bacteria, which may have influenced the effect of O formigenes colonization on urinary oxalate excretion. Conclusion: These findings support future investigations to examine the effectiveness of O formigenes colonization in reducing urinary oxalate excretion in disease cohorts, including calcium oxalate kidney stone formers with enteric hyperoxaluria.http://www.sciencedirect.com/science/article/pii/S2468024925000932calcium oxalatehyperoxaluriakidney calculiOxalobacter formigenesprobiotics
spellingShingle Sonia Fargue
Mangesh Suryavanshi
Kyle D. Wood
Joseph J. Crivelli
Robert A. Oster
Dean G. Assimos
Aaron Miller
John Knight
Inducing Oxalobacter formigenes Colonization Reduces Urinary Oxalate in Healthy Adults
Kidney International Reports
calcium oxalate
hyperoxaluria
kidney calculi
Oxalobacter formigenes
probiotics
title Inducing Oxalobacter formigenes Colonization Reduces Urinary Oxalate in Healthy Adults
title_full Inducing Oxalobacter formigenes Colonization Reduces Urinary Oxalate in Healthy Adults
title_fullStr Inducing Oxalobacter formigenes Colonization Reduces Urinary Oxalate in Healthy Adults
title_full_unstemmed Inducing Oxalobacter formigenes Colonization Reduces Urinary Oxalate in Healthy Adults
title_short Inducing Oxalobacter formigenes Colonization Reduces Urinary Oxalate in Healthy Adults
title_sort inducing oxalobacter formigenes colonization reduces urinary oxalate in healthy adults
topic calcium oxalate
hyperoxaluria
kidney calculi
Oxalobacter formigenes
probiotics
url http://www.sciencedirect.com/science/article/pii/S2468024925000932
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