2019: Scientific Reports: Adsorption of Bacterial Toxins, Bile Acids and Drugs: Peer-Reviewed Laboratory Study
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Scientific Reports — Nature Portfolio · 2019
Investigation of the Adsorption Capacity of Enterosgel® for Bacterial Toxins, Bile Acids and Pharmaceutical Drugs
Dr Carol A Howell · Prof Sergey V Mikhalovsky · Dr Alexander V Khovanov · Scientific Reports (Nature Portfolio) · 2019
Full citation
Investigation of the adsorption capacity of the enterosorbent Enterosgel for a range of bacterial toxins, bile acids and pharmaceutical drugs.
Howell CA, Mikhalovsky SV, Khovanov AV. Scientific Reports (Nature Portfolio) 2019. nature.com/articles/s41598-019-42176-z
What this study investigated
Understanding exactly how Enterosgel® works in the gut
Enterosgel® is an oral intestinal adsorbent — but what exactly does it adsorb, how quickly, and crucially, does it interfere with medications taken alongside it? This peer-reviewed laboratory study, published in Scientific Reports (Nature Portfolio), set out to answer those questions systematically.
The researchers tested Enterosgel®'s ability to bind a range of substances relevant to gut health: bacterial toxins responsible for infection and diarrhoea, bile acids implicated in IBS-D, and two commonly prescribed medications — to assess the risk of drug interactions.
Key findings
What the laboratory confirmed
Finding 1 — Bacterial toxins
Enterosgel® effectively adsorbs the key toxins responsible for gut infection and diarrhoea
Confirmed adsorption of C. difficile Toxins A and B, E. coli / Shigella Toxin (Stx-2B), and E. coli endotoxin — the bacterial toxins most commonly associated with serious gut infection, gastroenteritis, and diarrhoea. Much of this binding occurred within the first 15–30 minutes of exposure.
Finding 2 — Bile acids
Significant adsorption of excess bile acids implicated in IBS-D
Excess bile acids in the gut are a recognised driver of diarrhoea and urgency in IBS-D. Enterosgel® demonstrated meaningful binding of these bile acids, providing a mechanistic explanation for its clinical effectiveness in IBS-D patients — as later confirmed in the RELIEVE IBS-D randomised controlled trial published in GUT journal (2022).
Finding 3 — Drug interactions
At least ten times lower drug adsorption than activated charcoal
While activated charcoal removed 100% of cetirizine and amitriptyline within 15 minutes, Enterosgel® adsorbed significantly less — at least ten times lower than charcoal. This reflects Enterosgel’s unique selectivity: its affinity naturally increases with molecular weight, favouring large harmful toxins over small-molecule medications.
Enterosgel®’s low interaction with pharmaceutical drugs supports its use as a complementary therapy alongside other medications, with a recommended two-hour gap between doses to further protect drug bioavailability.
Howell CA, Mikhalovsky SV, Khovanov AV — Scientific Reports (Nature Portfolio) 2019
What this means clinically
Why Enterosgel®’s selectivity matters for patients
The selectivity demonstrated in this study is a clinically important property. Unlike activated charcoal — which adsorbs virtually everything indiscriminately and cannot safely be taken alongside medications — Enterosgel® preferentially binds large molecular weight harmful substances while largely leaving small-molecule drugs intact.
This means Enterosgel® can be used safely by patients who take regular medications, including those managing IBS-D alongside antidepressants, antispasmodics, or other prescribed treatments — provided a two-hour gap is maintained between taking Enterosgel® and other medications. This is a significant practical advantage for the many IBS-D patients who are already on other treatments.
The confirmation that Enterosgel® adsorbs C. difficile toxins, E. coli endotoxin, and excess bile acids also helps explain the breadth of conditions for which it has demonstrated clinical benefit — from acute gastroenteritis to IBS-D to bile acid diarrhoea.
The investigators
About the research team
Authors — Scientific Reports (Nature Portfolio) 2019
Dr Carol A Howell
University of Brighton, School of Pharmacy & Biomolecular Sciences, Brighton, UK. Research Director, Enteromed Ltd.
Prof Sergey V Mikhalovsky, MSc, PhD
University of Brighton, UK.
Dr Alexander V Khovanov
Co-author, Scientific Reports (Nature Portfolio) 2019.
Read the full study in Scientific Reports
Published in Nature Portfolio — the full peer-reviewed paper is freely available online.
View the research →References
- Howell CA, Mikhalovsky SV, Khovanov AV. Investigation of the adsorption capacity of the enterosorbent Enterosgel for a range of bacterial toxins, bile acids and pharmaceutical drugs. Scientific Reports (Nature Portfolio) 2019. nature.com/articles/s41598-019-42176-z
- Howell CA et al. Double-blinded randomised placebo controlled trial of enterosgel for the treatment of IBS with diarrhoea (IBS-D). Gut 2022;71:2430–2438. doi:10.1136/gutjnl-2022-327293