16S Rdna Sequencing Analysis of Upper Respiratory Tract flora in Patients with Influenza H1N1 Virus Infection
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Frontiers in Laboratory Medicine xxx (2017) xxx–xxx Contents lists available at ScienceDirect Frontiers in Laboratory Medicine journal homepage: www.keaipublishing.com/en/journals/frontiers-in-laboratory-medicine 16S rDNA sequencing analysis of upper respiratory tract flora in patients with influenza H1N1 virus infection Yanhua Li a,1, Jianbing Ding b,1, Yunfeng Xiao c, Bin Xu d, Wenfang He a, Yuqi Yang a, Liu Yang a, ⇑ ⇑ Mingquan Su a, Xiaoke Hao a, , Yueyun Ma a, a Department of Clinical Laboratory Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi 710032, PR China b Department of Immunology, Xinjiang Medical University, Urumqi, Xinjiang, 810034, PR China c Department of Pharmacy, Tangdu Hospital, The Fourth Military Medical University, Xi’an, Shaanxi 710038, PR China d Shandong International Trust Co., Ltd, Jinan, Shandong 250013, PR China article info abstract Article history: Background: We analyzed respiratory tract bacterial flora in patients with influenza H1N1 virus infection, Received 13 December 2016 and investigated the role of H1N1 virus in secondary bacterial infection. Received in revised form 13 January 2017 Method: A total of 12,766 operational taxonomic units (OTUs) were obtained, of which, 12,127 were Accepted 17 January 2017 identified to phylum level and 10,494 to genus level. We used next-generation sequencing technology Available online xxxx to evaluate bacterial abundance in swab specimens from patients infected with influenza H1N1 virus or Non-H1N1 influenza and from healthy controls. Data analysis was carried out by using alpha analysis Keywords: (Shannon-Wiener index and Rarefaction-Curve), beta analysis [UniFrac(abundance) and Metastats 16S rDNA analysis], and Community-and-Phylogenesis analysis. Influenza H1N1 Upper respiratory tract flora Results: At phylum level, Proteobacteria in patients with H1N1 virus infection (99.928 ± 0.008%) and Next-generation sequencing common cold (89.019 ± 1.845%) were significantly higher than in healthy controls (26.103 ± 2.495%) (p < 0.01). In contrast, proportions of Firmicutes, Bacteroidetes, Actinobacteria, Candidate division TM7, Fusobacteria and SR1 were down-regulated (p < 0.01) in patients with H1N1 virus infection. At genus level, Pseudomonas increased >500-fold in patients with H1N1 virus infection compared with healthy controls. Ochrobactrum, Brevundimonas, Caulobacter, Aquabacterium and Serratia also increased signifi- cantly in H1N1 virus infection, while Neisseria, Prevotella, Veillonella, Actinomyces, Porphyromonas, Streptococcus, Haemophilus and Acinetobacter decreased. Conclusion: Our data indicated that microbial abundance of the upper respiratory tract decreased in patients with H1N1 virus infection. Pseudomonas was the dominant genus among the upper respiratory tract bacterial flora in H1N1-infected patients. The changes in upper respiratory tract flora probably be closely related to the occurrence and progression of secondary bacterial infection. Ó 2017 Published by Elsevier B.V. on behalf of Laboratorial Medicine Committee of the Chinese Research Hospital Association. This is an open access article under the CC BY-NC-ND license (http://creativecom- mons.org/licenses/by-nc-nd/4.0/). Introduction that has a serious negative impact on economic development and human health. The early symptoms of H1N1 influenza are similar Influenza A virus subtype H1N1 [denoted as A(H1N1) or H1N1] to Non-H1N1 influenza, however, progression is rapid and may is one of the most commonly found influenza viruses in humans.26 lead to secondary and severe bacterial pneumonia, respiratory fail- Epidemic H1N1 influenza spreads rapidly in autumn and winter in ure and multiple organ injury and even death. Secondary bacterial the Northern Hemisphere, such as North America, Europe and infection accounted for 26–33% of deaths caused by H1N1 virus Asia.22,25 This has become a major social and public health problem infection,13,20,28,41,8 and 30–33% of patients with H1N1 virus in intensive care might have secondary bacterial infection.35,36 ⇑ H1N1 virus was the leading main cause of death in the three large Corresponding authors at: Department of Clinical Laboratory, Xijing Hospital, 30 The Fourth Military Medical University, 169 Changle West Road, Xi’an, Shaanxi influenza pandemics in 1918, 1957 and 1968. 710032, PR China. Secondary bacterial infection is attributed to the capacity of E-mail addresses: [email protected] (X. Hao), [email protected] H1N1 virus to replicate in the lower airways, causing extensive (Y. Ma). epithelial destruction, viral pneumonia, and secondary bacterial 1 These authors contributed equally to this study. http://dx.doi.org/10.1016/j.flm.2017.02.005 2542-3649/Ó 2017 Published by Elsevier B.V. on behalf of Laboratorial Medicine Committee of the Chinese Research Hospital Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Li Y., et al. 16S rDNA sequencing analysis of upper respiratory tract flora in patients with influenza H1N1 virus infection Frontiers in Laboratory Medicine (2017), http://dx.doi.org/10.1016/j.flm.2017.02.005 2 Y. Li et al. / Frontiers in Laboratory Medicine xxx (2017) xxx–xxx infections with increased lethality.22 Viral infection may enhance Guangzhou, China) and criteria for influenza infection were simul- bacterial pathogenesis and include impairment of mucociliary taneously met. According to the examination results, patients were clearance and increased bacterial adherence to epithelial cells. divided into two groups: G1, infection with H1N1 (n = 100), and Virus-induced epithelial damage facilitates bacterial translocation G2, infection without H1N1 but other type of influenza infection and dissemination and/or inhibition of antibacterial immune (Flu group or other influenza group) (n = 72). And the clinical fea- response. The healthy nose/nasopharynx has a bacterial tures are summarized in Table 1. community dominated by Actinobacteria, Firmicutes and Thirty healthy individuals were chosen as the normal control Proteobacteria.6 Secondary bacterial pneumonia is usually (N) group, whose average age was 26.5 years. Inclusion criteria: caused by Haemophilus influenzae, Pseudomonas aeruginosa, Staphy- despite their regular physical examinations, they were normal or lococcus epidermidis, Staphylococcus aureus and Corynebacterium healthy, without upper respiratory tract infection within the past tuberculostearicum.38,15,1,12,25 3 months. Exclusion criteria: same as for influenza. The occurrence and development of many human diseases are Pharyngeal swab specimens were collected with Copan 480CE usually closely related to changes in their bacterial flora.33,11 The (Copan, Brescia, Italy). In addition, we used five standard strains normal flora in the respiratory mucous membrane can be involved as positive controls: Streptococcus pneumoniae (ATCC 49619), in the regulation of adaptive immune response against influenza Escherichia coli (ATCC25922), P. aeruginosa (ATCC 27853), S. aureus virus.43,17,2 It can maintain a high tolerance threshold to modulate (ATCC 25923), and H. influenzae (ATCC 49247). the inflammatory response.29,37,23 So, it is reasonable to hypothe- size that the changes in respiratory tract flora caused by acute DNA extraction and PCR amplification H1N1 virus infection stimulate secondary and severe bacterial pneumonia, but the mechanisms are still not clear. The swabs were transferred to new 1.5-mL centrifuge tubes, The gold standard of identification by bacterial culture has been dissolved in PBS buffer by stirring, and centrifuged for 3 min at unable to meet the demand of bacterial diversity analysis, because 20,000g. The supernatant was discarded and 100–200 mL suspen- 34 >90% of the clinical bacteria cannot be cultured. Next-generation sion was left. Microbial DNA was extracted from swab samples sequencing (NGS) provides a new technology to study the micro- using the E.Z.N.A.Ò DNA Kit (Omega Bio-tek, Norcross, GA, USA). 16 biota and pathogenic mechanisms. The V3–V4 region of the bacterial 16S rDNA was amplified by 16S rDNA sequencing is a powerful tool for researching taxon- PCR (95 °C for 2 min, followed by 25 cycles at 95 °C for 30 s, omy and phylogeny of samples from a complex microorganism 55 °C for 30 s, and 72 °C for 30 s and a final extension at 72 °C for or environment. The generated operational taxonomic units 5 min) using primers 338F 50-barcode-ACTCCTACGGGAGG (OTUs) can be analyzed at seven levels: kingdom, phylum, class, CAGCA)-30 and 806R 50-GGACTACHVGGGTWTCTAAT-30, where 32 order, family, genus and species. Nasidze et al. found 39 bacteria barcode is an eight-base sequence unique to each sample. PCRs that have never been reported in the mouth through 16S rDNA were performed in triplicate with a 20-lL mixture containing 45 sequencing. Yang et al. analyzed salivary microorganisms in 19 4 lL5Â FastPfu Buffer, 2 lL 2.5 mM dNTPs, 0.8 lL each primer individuals with active caries and 26 without caries with 16S rRNA (5 lM), 0.4 lL FastPfu Polymerase, and 10 ng template DNA. and whole genome sequencing technology. They found that the microbial changes were greater in patients with active caries. The present study applied NGS of 16S rDNA sequencing and Illumina MiSeq sequencing bioinformatics to analyze variation of the microbiome during H1N1 virus infection and might show how respiratory tract flora Amplicons were extracted from 2% agarose gels and purified changes cause severe secondary pulmonary infection