Aggiornamenti in Gastroenterologia Latina, 19 novembre 2014 RUOLO DEL MICROBIOTA NELLE PATOLOGIE DELL’APPARATO DIGERENTE Antonio Gasbarrini Medicina Interna e Gastroenterologia Policlinico Universitario Gemelli Universita’ Cattolica, Roma At birth the human body is (almost) sterile Vaginal microbiota (mother) Fecal microbiota (mother) Diet Skin microbiota (mother/father/parents/ babysitter/animals..) Ambient Native CORE microbiota (6-48 months of life) GUT BARRIER Microbiota Mucosal Barrier Epithelial barrier Endocrine system Vascular and lymphatic systems Acquired and Innate immunity Neuroenteric system Digestive enzymes Not only Bacteria.. Bacteria Virus Bacteriophages Protozoa Helminth Yeast Parasite Archea Mucosal Barrier Epithelial barrier Endocrine system Vascular and lymphatic systems Acquired and Innate immunity Neuroenteric system Digestive enzymes Yeast: GUT MYCOME • Commensal to the gut at low concentrations • In the healthy gut dominant species are: Wallemia, Trichocomaceae, Rhodotorula, Saccharomycetaceae, Pleosporaceae, Agaricaceae, Metschnikowiaceae, Cystofilobasidiaceae, Ascomycota, Amphisphaeriaceae... • Yeast’s functions in the gut it is not clear • Yeasts overgrowth/dysbiosis (related to host genetic and physiology, lifestyle, antibiotic usage, immune system disfunction) could be pathogenic fo the gut Dollive S, et al. Genome Biol 2012 Cui et al. Genome Medicine 2013 Thewes S, Mol Microbiol 2007 GUT MYCOME Liver Cirrhosis Candida (33.78%), uncult. fungi (12.53%), Aspergillus (7.99%), Simplicillium (5.65%), Chaetomium (2.46%), Galactomyces (2.33%), Rhizopus (1.96%), Wallemia (1.10%), Fusarium (1.1%), Iodophanus (0.1%), Penicillium (0.49%), Saccharomyces (25.18%), uncult. Pezizomycotina (0.86%), uncult. Pucciniomycotina (1.10%), uncult.Agaricomycotina (0.74%), Aureobasidium (0.61%), Hyphozyma and Asterotremella (0.49%), Cryptococcus (0.49%), Doratomyces (0.37%) Ott SJ, et al. Scand J Gastroenterol 2008 Virus: GUT VIROME Random pyrosequencing of virus-enriched metagenomes have been isolated from bovine rumen and human gut In the gut have been isolated up to 28.000 different viral genotypes The majority (∼78%) of sequences did not match any previously described virus Pro phages outnumbered lytic phages approximately 2:1 Metabolic profiling revealed an enrichment of sequences with putative functional roles in DNA and protein metabolism, but a low proportion of sequences assigned to carbohydrate and amino acid metabolism Berg Miller et al, Environ Microbiol 2011 Bacteria: GUT BACTERIOME 900-1200 gr, >5.000.000 genes >9 phyla 95% genes identity >1000 species 99% genes identity >15000 strains 100% genes identity Microbiome Leser et al, Environ Microbiol 2011 Metabolome Qin et al, Nature 2011 BACTERIAL TAXONOMY Genes identity DOMINIUM REGNUM 95% PHYLUM CLASSE ORDO FAMILIA GENUS 99% SPECIES 100% SUBSPECIES (STRAIN) MOLECULAR BACTERIOLOGY: most abundant PHYLA in the GUT (>70%) BACTEROIDETES FIRMICUTES Eckburg et al, Science 2005 HUMAN GUT ENTEROTYPE INDIVIDUAL ENTEROTYPE of pe oplea sle a n or obe seca n bemadesole ly on theba sisof the ir gut microbiotawith90%a ccura cy46,47, but the ydonot se pa ra teintodis tinct microbiota-base d clus te rson commonly use d principal coordina te s plots, which a reuse d to ide ntify s ta tis tical diffe re nce sbe twe e n groups. Thus, multiplesta tis tical te chnique sarenee de dtoshowfullythediffe rnces in the microbiota between different physiological states (Fig. 2). Some differences in the microbiota can contribute directly to disease ta te s. Gnotobioticmicetha t we rera ise dge rm-fre ethe n colonize dwith hemicrobiotafroma n obe semousega ine dfa t morera pidlytha n those 7,45 olonized with themicrobiotaof alean mouse . A phe notypecan e me rgefromdiffe re nt compos itional ba ckgrounds, which ma yindica te ha ts pe cificcompone ntsof themicrobiotacan e xe rt la rgee ffe ctsor tha t many different changes can lead to the same functional result. Diffe re nce sin fa e cal microbial communitydive rs ity, compos ition a nd unction ha vealsobe e n corre la te dwith Crohn’sdise ase9, ulce ra tivecoli10 48 s , irrita blebowe ls yndrome(IBS ) , Clos tridiumdifficile - as s ocia te d 50 dis ea s e(CDAD)49 and a cutedia rrhoe a .S ome time s, thena tureof the microbiotade via tion fromhe alth iscons iste nt acros sindividualswith hes a medis ea s e . For ins ta nce , atwin s tudy of IBD found ma rke da nd eproducible deviations in patients with ileal Crohn’s disease relative to hecontrols ,a ndmores ubtle , but cha ra cte ris tic, cha nge sin pa tie ntswith 51 olonicCrohn’sdis e a se ,a nd s pe cificfunctional diffe re nce swe realso obse rve dfromme ta bolicprofilingof thesa mesa mple s24. Othe r dise a se s re associated with marked deviations from health that are inconsistent cross individuals. For instance, individuals with recurrent CDAD had aphylum-le ve l dive rs ity tha t wa sve ry diffe re nt fromcontrolsbut not mila r toeachothe r49. Manydiseasestudie sareconfoundedbye xte ns ive seof tre a tme nts, suchasa ntibiotics, tha t ma yobscuretruedise ase -assoia te dcha nge s, highlightingtheurge nt ne e dfor pros pe ctivelongitudinal udies that establish cause and effect. Parallels betw een host physiological states S tudiesof themicrobiotaoften target onespecific diseaseor state, but comparisonsof themicrobiotaacrossmany diseasescan show ommon changesin thegut environment. Disturbed mucouslayersthat linetheintestinal cell wall and concomitant inflammation re seen i n i ndi vi duals wi th I BD, coeli ac di sease, H I V enteropathy, 52 acutediarrhoea, diverticulosis, carcinomaand IBS . Given these aral lels, an i ncrease or decrease i n abundance of si mi l ar mi crobes acrossdifferent disturbancesmight beexpected53, but elucidation Phylum level diversity can have a marked variation even across healthy adults in the same population. Each individual has many unique phylotypes not found in the other. R E VIE W INSIG HT Ph ylu m Fir m icu t es Act in ob act er ia Bact er oid et es Pr ot eob act er ia Fu sob act er ia Ten er icu t es Sp ir och aet es Cyan ob act er ia Ver r u com icr ob ia TM 7 Fu n ct ion Cen t r al car b oh yd r at e m et ab olism Cofact or an d vit am in b iosyn t h esis Oligosacch ar id e an d p olyol t r an sp or t syst em Pu r in e m et ab olism ATP syn t h esis Ph osp h at e an d am in o acid -t r an sp or t syst em Am in oacyl t r an sfer RNA Pyr im id in e m et ab olism Rib osom e Ar om at ic am in o-acid m et ab olism Figure 4 | Functional redundancy. The functi onal redundancy in microbi al ecosystems may mirror that in macroecosystems. As shown in the HM P data set 14, oral communiti es (top panels) and faecal communiti es (bottom panels) analysed using 16SrRNA (coloured by microbial phyla, left panels) show tremendous abundance diversity. The same samples analysed by shotgun Lozupone et al. Nature 2012 U.S. adults sampled >5 times up to 296 weeks apart revealed that they harbored 195±48 bacterial strains, representing 101 ± 27 species ..in stable conditions, microbiota is stable, with 60% of strains remaining over the course of 5 years: stable core of dominant species Animal-based diet had a greater impact on the gut microbiota than the plant-based diet Abundance of 22 microbial clusters significantly changed while on the animal-based diet (especially Firmicutes, Bacteroidetes, Proteobacteria, Tenericutes, Verrucomicrobia) Only 3 clusters showed significant abundance changes while on the plantbased diet Prevotella spp reduced in vegetarians after animal-based diet David – Nature 2013 The human gut microbiome can rapidly switch between herbivorous and carnivorous functional profiles It may reflect past selective pressures during human evolution Microbial communities that could quickly, and appropriately, shift their functional repertoire in response to diet change would have subsequently enhanced human dietary flexibility Examples of this flexibility may persist today in the form of the wide diversity of modern human diets David – Nature 2013 Microbiota composition is affected by life events Ottmann N et al. Front Cell Infect Microb 2012 INTERV NO-SMOKE SMOKE EFFECTS OF GUT MICROBIOTA ON HOST HEALTH Barrier effect Immunocompetence/Tolerance Synthesis Metabolism Drug metabolism Behavior conditioning …specific effects in each GI tract! EFFECTS OF GUT MICROBIOTA ON HOST HEALTH Barrier effect Immunocompetence/Tolerance Synthesis Metabolism Drug metabolism Behavior conditioning Small Bowel Lifelong immunostimulation by enteric commensal and pathogenic bacteria Maynard CL et al. Nature 2012 EFFECTS OF GUT MICROBIOTA ON HOST HEALTH Barrier effect Immunocompetence/Tolerance Synthesis Metabolism Drug metabolism Behavior conditioning Colon CARBOHYDRATES METABOLISM Microbiota plays an essential role in catabolism of dietary fibers into metabolizable monosaccharides and disaccharides. Ibrahim M et al, Bioch Bioph Res Comm 2012 GUT microbiota of ruminant has a powerful metabolic action: herbivores derive 70% of their energy intake from microbial breakdown of dietary plant polysaccharides HJ Flint et al. Nature Review Microbiol 2008 ‘‘NUTRIENT SENSOR PATHWAY’’ Tilg H, J Hepatology 2010 GUT BARRIER Microbiota Mucosal Barrier Epithelial barrier Endocrine system Vascular and lymphatic systems Acquired and Innate immunity Neuroenteric system Digestive enzymes MUCO-EPITHELIAL BARRIER IMPORTANCE OF THE MUCUS LAYERS • The inner mucus layer is dense and does not allow bacteria to penetrate, thus keeping the epithelial cell surface free from bacteria • The inner mucus layer is converted into the outer layer, which is the habitat of the commensal flora Good bacteria Loosely adherent mucus layer Firmly adherent mucus layer Epithelial cells Johansson, M.E., Proc Natl Acad Sci U S A, 2010 GUT MICROBIOTA HAS TO BE UNDER CONTROL Mucosal barrier integrity Secretion of : Gastric acid Biliary salts Antimicrobial substances Mucosal pH Local mucosal and systemic immunity Intestinal motility Interactions among different bacteria species EUBIOSIS Failure of MICROBIOTA control’s mechanisms Quali-quantitative alterations of oral, esophageal, gastric, small bowel and/or colonic microbiota DYSBIOSIS Digestive and extradigestive diseases DYSBIOSIS LEAKY GUT