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Anorexia Nervosa (AN) has the highest mortality of all psychiatric disorders. Patients who experience the onset of AN in their teens suffer on average 10 years from an eating or other mental disorder. Recently many clinicians in the US and Europe have addressed the inadequacy of treatment for this disabling disease which – at least in adult patients - is mainly based on individual psychotherapeutic interventions. Against the background of a recent GWAS and genetic correlations with other mental disorders, but also inverse correlations with important metabolic parameters such as fasting insulin and leptin new treatment strategies must be developed. This presentation wants to elucidate two different interventions, a biological strategy, and a more pragmatic treatment setting in the “real world”. The biological strategy refers to the gut-brain axis which has been shown to be severely affected in AN. Patients show a deep perturbation of the gut microbiome with no significant improvement with weight rehabilitation. Thus, additional ways must be found such as nutritional strategies (e.g., administration of pre- or probiotics, stool transfer) to probably improve the outcome of this disorder. In addition, inpatient treatment which is still the gold standard for treatment of AN in Europe, has not been proven to alter the long-term prognosis of AN. Consequently, other interventions such as home treatment which involve the family and interrupt eating disorder associated habits as disease preserving factors will be introduced and the results of a pilot study in adolescent AN be presented.

Anorexia nervosa (AN) is one of the most common chronic disorders in adolescence with still high mortality rates. Knowledge on gut-brain interaction might help to develop new treatments, as severe starvation-induced changes of the microbiome in AN-patients have been demonstrated, which do not alleviate with weight gain. In our own pilot study alpha-diversity was increased in patients with AN after short-term weight recovery, while beta diversity showed clear group differences with healthy controls before and after weight gain. A reduction of taxa belonging to Enterobacteriaceae at admission and discharge and an increase in taxa belonging to Lachnospiraceae at discharge were typically found in patients with AN. The work plan of our European project comprises an observational study and two phase II RCTs with the application of omega-3-PUFA and a multistrain psychobiotic to both, humans and rodents. With the help of a well-established animal model for AN (activity-based anorexia, ABA), the effect of stool transplants from patients to rodents will be analysed. Longitudinal MRI will be conducted in rodents together with cellular and molecular brain analyses. In addition, immune response and circulating antibodies associated with the presence of certain bacterial strains and interaction with hunger and satiety hormones will be explored. We hope that by this translational research we may systematically investigate the role of an altered microbiome for the course of AN and to identify new therapeutic tools.