Preoperative prebiotic supplementation alleviates colitis and improves anastomotic healing associated with modulation of the gut microbiota in rats.

Abstract

Anastomotic leak is among the most feared complications in colorectal surgery. Patients with inflammatory bowel disease are particularly susceptible to impaired anastomotic healing, partially because of bacterial dysbiosis. Aiming to improve anastomotic healing, we examined the role of microbiota-targeted prehabilitation with a complex prebiotic supplement containing arabinogalactan, humic substances, and micronutrients in a rat model of experimental colitis. Rats were subjected to standard or prebiotic-supplemented diets for 4 weeks before receiving water or dextran sulfate sodium to induce colitis. Then, fecal samples were collected for microbial analysis with 16S ribosomal ribonucleic acid gene sequencing before colon resection surgery. Symptoms, laboratory parameters, and histopathologic changes were measured to determine colitis severity. To evaluate anastomotic healing, immunohistochemistry for caspase-1, claudin-1, matrix metalloproteinase-9, and a colorimetric hydroxyproline assay were performed after macroscopic assessment and bursting pressure tests. Prebiotic pretreatment protected against colitis-related microbial shifts by increasing the abundance of Lachnospiraceae NK4A136, decreasing Romboutsia, and preventing severe colonic damage caused by dextran sulfate sodium, reflected in improvements in all measured parameters. Prehabilitation with a complex prebiotic supplement enhanced epithelial barrier integrity and strengthened the anastomosis through favorable collagen homeostasis, which correlated with microbial diversity and led to accelerated surgical recovery. Our findings indicate that a complex prebiotic supplement containing arabinogalactan, humic substances, and micronutrients protects against colitis-induced disturbed anastomotic healing, supporting its potential role in microbiota-targeted prehabilitation.