Pomegranate: from the Promised Land to calm the fire in Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) has a multifactorial aetiology and it is thought to be related to a combination of individual genetic susceptibility and environmental triggers that stimulate an inflammatory response. Although evidence indicates that dietary intake plays an important role, few studies have focused on the effect of (poly)phenol-rich food consumption on early markers of mucosal inflammation. At present only one study has investigated the anti-inflammatory effects of ellagitannins (ETs), a (poly)phenolic subclass mainly found in some fruits and nuts, related to IBD in rats [1]. Therefore, we hypothesised that treatment with a fruit juice containing ETs can significantly modulate biomarkers of mucosal inflammation compared with a control group receiving placebo. The double-blind, randomised controlled trial will include patients with IBD, ulcerative colitis and Crohn's disease, in stable clinical remission (≥3 months). Participants will be randomly allocated to one of two groups: active treatment (125 mL pomegranate juice, naturally rich in ETs) or placebo taken twice daily for 12 weeks. The primary outcome is to measure changes to the faecal neutrophil-derived protein calprotectin, surrogate marker of mucosal improvement, between the two groups from baseline to 12 weeks later. The secondary outcomes include systemic and mucosal changes of biochemical and molecular inflammatory response markers. The compliance of trial participants will be tested by uHPLC system coupled to mass spectrometer to quantify ET-metabolites in plasma and urine. In addition to the primary and secondary objectives, this trial will include plasma level of trimethylamine-N-oxide (TMAO) that may have potential as a biomarker to assess disease activity in IBD [2]. References. 1. Rosillo et al. 2012 Pharmacol Res. 2012; 66:235-42. 2. Wilson et al. 2015 Dig Dis Sci. 60:3620-30. Acknowledgments. This study was funded by the Italian Ministry of Education, University and Research MIUR - SIR Programme no. RBSI14LHMB funded to F.D. All beverages will be provided by Conserve Italia (Bologna, Italy).