Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2019; 25(25): 3242-3255
Published online Jul 7, 2019. doi: 10.3748/wjg.v25.i25.3242
Gut microbiota contributes to the distinction between two traditional Chinese medicine syndromes of ulcerative colitis
Rui-Xin Zhu, Zhi-Peng Tang, Li-Xin Zhu, Bei-Bei Wang, Lie Zheng, You-Lan Chen, Na Jiao, Yan-Cheng Dai, Yun-Zheng Lin, Jun-Yi Qi, Li-Ting Cai, Ya-Li Zhang
Ya-Li Zhang, Jun-Yi Qi, You-Lan Chen, Zhi-Peng Tang, Institute of Digestive Diseases, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
Li-Ting Cai, Yun-Zheng Lin, Na Jiao, Bei-Bei Wang, Rui-Xin Zhu, Department of Bioinformatics, School of Life Sciences and Technology, Tongji University, Shanghai 200092, China
Yan-Cheng Dai, Department of Gastroenterology, Shanghai Traditional Chinese Medicine-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200082, China
Lie Zheng, Department of Gastroenterology, Traditional Chinese Medicine Hospital of Shanxi Province, Xi’an 710000, Shanxi Province, China
Li-Xin Zhu, Genome, Environment and Microbiome Community of Excellence, the State University of New York at Buffalo, Buffalo, NY 14214, United States
Author contributions: Zhang YL and Cai LT contributed equally to this work, and both performed the majority of research; Qi JY, Lin YZ, Dai YC, Jiao N, Chen YL, Zheng L, and Wang BB performed the research and analyzed the data; Zhu LX, Zhu RX, and Tang ZP designed and coordinated the research; Zhang YL and Cai LT wrote and revised the paper.
Supported by the National Natural Science Foundation of China, No. 81704009, No. 81873253, No. 81573892, and No. 81770571; and the Project of Shanghai Municipal Health and Family Planning Commission, No. 201640122.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest related to this study
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Zhi-Peng Tang, PhD, Doctor, Professor, Institute of Digestive Diseases, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, 725 Wanping Road, Shanghai 200032, China.
Telephone: +86-21-6438-5700
Received: April 12, 2019
Peer-review started: April 15, 2019
First decision: May 16, 2019
Revised: June 2, 2019
Accepted: June 8, 2019
Article in press: June 9, 2019
Published online: July 7, 2019
Research background

Ulcerative colitis (UC) is considered to be closely associated with alteration of intestinal microorganisms. According to the traditional Chinese medicine (TCM) theory, UC can be divided into Pi-Xu-Shi-Yun syndrome (syndrome of spleen deficiency and dampness, PXSY) and Da-Chang-Shi-Re syndrome (syndrome of dampness-heat in the large intestine, DCSR). PXSY syndrome is a deficiency syndrome, while the DCSR syndrome is a sthenia syndrome. However, the relationships among gut microbiota, TCM syndromes, and UC pathogenesis are unclear.

Research motivation

The majority of studies have focused on the relationship between intestinal microbiota and the onset of UC, and the contribution of gut microbiota in these two distinct TCM syndromes is still unclarified. This study aimed to compare the difference in microbial composition and function between PXSY and DCSR syndromes to determine the molecular mechanism of TCM in UC by investigation of the gut microbiota.

Research objectives

The objective of this study was to investigate the role of gut microbiota in UC and the distinction of microbiota dysbiosis between PXSY and DCSR syndromes.

Research methods

We analysed gut microbiome composition of stool samples by 16S rRNA pyrosequencing. We assessed the beta diversity by UniFrac analysis. We also processed the high-throughput se-quencing reads with QIIME, and further predicted biological functions using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States.

Research results

We determined the composition of gut bacterial communities in 93 stool samples (30 healthy controls, 32 patients with PXSY syndrome, and 31 patients with DCSR syndrome) by 16S rRNA pyrosequencing. Beta diversity showed that the composition of the microbiota was different among the three groups. We found that Porphyromonadaceae, Rikeneliaceae, and Lach-nospiraceae significantly decreased while Enterococcus, Streptococcus, and other potential pathogens significantly increased in UC patients compared to healthy subjects at the family level. We further found that Parabacteroides, Dorea, and Ruminococcus decreased while Faecalibacterium showed increased abundance in UC compared to healthy controls at the genus level. Five differential taxa were identified between PXSY and DCSR syndromes. We observed a significantly increased abundance of Streptococcus in DCSR patients at the genus level, while Lachnoclostridium increased in PXSY patients. Additionally, we found that the differential fun-ctional pathways of the gut microbiome between the PXSY and DCSR groups mainly included lipid metabolism, immunity, and the metabolism of polypeptides.

Research conclusions

The present study identified that the gut microbiota is different between patients with PXSY syndrome and those with DCSR syndrome. The genus Streptococcus is significantly more abundant in DCSR patients than in PXSY patients, while Lachnoclostridium increases in PXSY patients. The microbial analysis of the two TCM syndromes essentially reflects different immune activities in the human body, but they all point to promotion of inflammation in the gut.

Research perspectives

The relationship between TCM syndromes and intestinal flora is an interesting and important research topic. Our study preliminarily explored the characteristics and differences of intestinal flora of patients with two different TCM syndrome. Further studies are required to confirm our findings and to clarify the precise mechanism of intestinal flora characteristics related to TCM deficiency and positive syndrome.