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Research Article the Association of Gut Microbiota with Nonalcoholic Steatohepatitis in Thais

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Research Article the Association of Gut Microbiota with Nonalcoholic Steatohepatitis in Thais Hindawi BioMed Research International Volume 2018, Article ID 9340316, 8 pages https://doi.org/10.1155/2018/9340316 Research Article The Association of Gut Microbiota with Nonalcoholic Steatohepatitis in Thais Abhasnee Sobhonslidsuk ,1 Suwannee Chanprasertyothin ,2 Tanjitti Pongrujikorn,2 Piyaporn Kaewduang,1 Kwannapa Promson,1 Supanna Petraksa ,1 and Boonsong Ongphiphadhanakul 3 1 Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Tailand 2Ofce of Research Academic and Innovation, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Tailand 3Division of Endocrinology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Tailand Correspondence should be addressed to Abhasnee Sobhonslidsuk; [email protected] Received 26 June 2017; Revised 6 November 2017; Accepted 17 December 2017; Published 16 January 2018 Academic Editor: Somboon Tanasupawat Copyright © 2018 Abhasnee Sobhonslidsuk et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. Nonalcoholic steatohepatitis (NASH) can progress to advanced fbrosis; the link between intestinal bacterial overgrowth and NASH has been proposed. Gut microbiota may promote infammation and provoke disease progression. We evaluated gut microbiota pattern in NASH and its infuencing factors. Methods. A case-controlled study with sixteen NASH and eight control subjects was done. We performed DNA extraction from stool samples and bacterial 16S rRNA sequencing using MiSeq6.Te sequences were clustered into operational taxonomic units using Quantitative Insights Into Microbial Ecology sofware. We calculated relative abundances, determined alpha diversity, obtained beta diversity by principal coordinate analysis, and conducted the partial least-squares regression model. Results. Te relative abundance of Bacteroidetes tended to be higher in NASH group. Te Bacteroidetes/Firmicutes (B/F) ratio was signifcantly elevated in NASH patients. Te pattern of gut microbiota in NASH was clearly separated from that of control subjects. Factors infuencing the separation of NASH from control subjects were age, diabetes, body mass index, Bacteroidetes phylum, metformin, Actinobacteria, Verrucomicrobia, Termotogae, and Caldithrix and Bacteroidetes/Firmicutes ratio. Conclusions. Bacteroidetes phylum (Bacteroides and Prevotella genus) is abundant in NASH subjects, who exhibited an elevated B/F ratio. NASH patients showed a specifc pattern of gut microbiota independent of diabetes or metformin use. 1. Introduction that 41% of NASH patients had fbrosis progression and that 9% of the cohort developed advanced fbrosis and cirrhosis Nonalcoholic fatty liver disease (NAFLD), a condition in [1]. Once cirrhosis occurs in NASH patients, the annual which the liver is composed of over 5% fat, is a signifcant cumulative risk of hepatocellular carcinoma can reach 2.6% cause of chronic liver disease worldwide [1]. Based on a [1, 4]. Nonalcoholic fatty liver disease, especially NASH, has recent meta-analysis study, the global prevalence of NAFLD been associated with liver-specifc and overall mortality [1]. is estimated to be approximately 25.2% [1]. Te prevalence Fat deposition in the liver is regarded as the frst hit in of NAFLD is increased in some groups of patients, such the “two-hit hypothesis” of the pathogenesis of NASH [5]. as individuals with type 2 diabetes, obesity, hypertension, Insulin resistance, oxidative stress, infammatory cytokine, dyslipidemia, or polycystic ovarian syndrome [1–4]. Te andendotoxinreleasefromgutmicrobiotacanperpetuate spectrum of NAFLD ranges from simple steatosis to nonalco- infammatory pathway processes, resulting in fbrosis pro- holic steatohepatitis (NASH), which can progress to cirrhosis gression towards the advanced stages of NASH [5–7]. Te and hepatocellular carcinoma [4]. A recent study revealed “multi-hit” model, which suggests that many “hit” factors 2 BioMed Research International can act simultaneously and result in the development and 2.3. Transient Elastography. Patients with NASH and healthy progression of NASH, was subsequently proposed in 2010 control subjects underwent TE (Fibroscan5,Echosen,Paris) [6]. An association between NAFLD and gut microbiota to measure liver stifness (LS) and controlled attenuation has been known from the link between intestinal bacterial parameter (CAP), which refected the degree of liver fbrosis overgrowth and NASH [8]. Gut microbiota may infuence the and liver fat, respectively [14]. Te cutof levels of LS for development of liver infammation and NASH through Toll- hepatic fbrosis stage ≥ F2, ≥F3, and ≥F4 were 7.0, 8.7, and like receptors and short-chain fatty acids and the production 10.3kPa [14]. Control subjects were required to have CAP of gut hormones such as glucagon-like peptide 1 [6, 9]. level less than 239 dB/m prior to enrollment in the study [15]. AdistinctpatternofgutmicrobiotainNAFLDpatients compared with health controls has been reported [9, 10]. 2.4. Laboratory Testing. Blood samples were taken for bio- Zhu et al. used sequencing techniques to reveal an abun- chemical testing that included a complete blood count, a liver dance of alcohol-producing gut bacteria with an increase functiontest,glucose,glycatedhemoglobin(HbA1C),anda in ethanol concentration in blood circulation resulting in lipid panel. the progression of NASH [9]. In this study, NASH patients exhibited an increased abundance of the Bacteroidetes 2.5. Stool Collection. Stoolswerecollectedinaplasticcon- and Proteobacteria phyla, which was mainly explained by tainer with a tightly closing lid and stored in an insulated the increased abundance of the Enterobacteriaceae family bag with cooling elements in the morning before being [9]. Most of the Enterobacteriaceae sequences belonged immediately transported to the hospital. At the laboratory ∘ to ethanol-producing bacteria, Escherichia [9]. Boursier et unit, the stools were stored at −80 Cforfurtheranalysis al. identifed that Bacteroides was independently related to [10, 16, 17]. NASH and that Ruminococcus was associated with advanced fbrosis [11]. However, Mouzaki et al. found a lower per- 2.6. DNA Extraction. Bacterial DNA from stool was extract- centage of Bacteroidetes in NAFLD patients compared with 5 normal controls using the quantitative polymerase chain ed using a QIAamp Fast DNA stool mini kit (Qiagen, Dues- reaction (qPCR) technique to study gut microbiota [10]. seldorf, Germany) according to manufacturer’s instruction Duetotheseconfictingresults,weaimedtoinvestigatethe [18]: the sample was mixed with InhibitEX bufer. Ten, the pattern of gut microbiota in NASH versus healthy controls supernatant was mixed with proteinase K and AL bufer. and to identify the independent factor(s) associated with Afer that, ethanol was added to QIAamp spin column the distinctive pattern of gut microbiota in patients with and centrifuged. Ten, column was washed with AW1 and NASH. AW2 bufer and DNA was eluted with ATE bufer. DNA concentration was measured using Qubit5 2.0 Fluorometer ∘ (Life Technologies, Oregon, USA) and stored −20 Cfor 2. Materials and Methods further analysis. 2.1. Study Design. We carried out a case-controlled study 2.7. 16S Ribosomal RNA Sequencing and Microbiome Analysis. at the liver unit and research center of Ramathibodi Hos- Te 16S rRNA was sequenced using MiSeq (Illumina Inc., pital (Bangkok, Tailand) between 1 October 2015 and 30 California, USA). Te 16S metagenomic sequencing library September 2016. Te study was approved by the Committee preparation followed the manufacturer manual. We amplifed on Human Rights related to Research Involving Human DNA for the 16S rRNA region V3-V4 using the following Subjects, Faculty of Medicine, Ramathibodi Hospital (ID 02- primer set: 52-39), and carried out according to the 1975 Declaration of Helsinki. Informed consent was acquired from the study 16S Amplicon PCR Forward Primer subjects prior to their enrollment. � 5 -TCGTCGGCAGCGTCAGATGTGTAT- AAGAGACAGCCTACGGGNGGCWGCAG- � 2.2. Subjects. Patients who were diagnosed with NASH based 3 on a liver biopsy were invited to participate in the study. We carried out a histological assessment of NASH according to 16S Amplicon PCR Reverse Primer Brunt’s and Kleiner’s criteria [12]. Exclusion criteria included � 5 -GTCTCGTGGGCTCGGAGATGTGTA- regular alcohol consumption, hepatitis B or hepatitis C TAAGAGACAGGACTACHVGGGTATCTA- viral infection, or liver disorders from other causes. Healthy � ATCC-3 control patients did not have diabetes, dyslipidemia, or hypertension. We collected demographic data from each Afer the frst PCR clean-up step, the samples were amplifed patient. Body mass index (BMI) was calculated from weight with dual indices. We used an Illumina sequencing adapter (in kilograms) divided by height squared (in meters) [13]. with the Nextera XT Index Kit. Te Amplicon Library Te study subjects arrived at the hospital in the morning was pooled, normalized, combined with PhiX Control, and afer a 10–12-hour overnight fast and underwent a 24-hour sequenced. dietary assessment that consisted of an interview, transient We analyzed the taxonomic profle using 16S Metage- elastography (TE), and a blood draw. Stool samples were nomics (Illumina Inc.) and Quantitative Insights Into Micro- collected and transported
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