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Journal Microbiome ecology
Discovery

Microbial and Environmental Factors Associated With Polyps Development in Familial Adenomatous Polyposis (MicrobEnvironment in FAP)

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Editor's note
Why identical APC mutations produce wildly different polyp burdens across families remains unexplained—this prospective study directly tests whether dysbiotic signatures predict adenoma development in FAP patients, potentially shifting management from surgery-first to microbiota-informed surveillance. The finding would be foundational rather than confirmatory, bridging long-standing clinical mystery to mechanistic intervention. Colorectal surgeons, gastroenterologists managing FAP, and microbiome researchers focused on cancer prevention should watch for enrollment completion and interim results.

Source: ctgov · Hospices Civils de Lyon · RECRUITING · 2026-05-27

URL: https://clinicaltrials.gov/study/NCT06614738

AI rationale (4/5, tier: unclassified): Longitudinal FAP cohort linking microbiota dysbiosis to adenoma development; testable mechanistic hypothesis fits emerging RCT intervention tier.


Familial adenomatous polyposis (FAP) is an autosomal dominant inherited disorder linked to a mutation in the APC gene, associated with the development of multiple colonic and duodenal adenomas, which in 100% of cases progress to colorectal cancer (CRC) if left untreated. Management of affected patients is usually based on prophylactic total colectomy with or without rectal preservation, followed by regular endoscopic surveillance of the duodenum and rectum or ileal reservoir. However, there is considerable inter- and intra-familial variability in the rate of adenoma appearance and development for identical mutations. This strongly suggests the additional role of environmental factors. Recently, the gut microbiota has been identified as a co-factor of carcinogenesis in patients with FAP, but no prospective evaluation of the association between the incidence and severity of adenomatous proliferations and a microbiological signature has been studied, particularly at duodenal level in oper

Published 2026-05-28 · Last kit-update 2026-05-28