Altered Profile of Fecal Microbiota in Newly Diagnosed Systemic Lupus Erythematosus Egyptian Patients

Abstract

Background. Dysbiosis of gut microbiota could promote autoimmune disorders including systemic lupus erythematosus (SLE). Clarifying this point would be of great importance in understanding the pathogenesis and hence the development of new strategies for SLE treatment. Aim. This study aimed to determine the fecal microbiota profile in newly diagnosed SLE patients compared to healthy subjects and to investigate the correlation of this profile with disease activity. Methods. Newly diagnosed SLE patients who fulfilled at least four of the American College of Rheumatology (ACR) criteria were enrolled during the study period. Patients with lupus were matched to healthy subjects. SLE activity was evaluated using the Systemic Lupus Disease Activity Index (SLEDAI-2K). Fresh fecal samples were collected from each subject. Genomic DNA was extracted from fecal samples. Quantitative real-time PCR was applied for quantitation of Firmicutes phylum, Bacteroidetes phylum, and Lactobacillus genus in comparison to the total fecal microbiota. Results of patients’ samples were compared to those of healthy subjects and were correlated to patients’ SLEDAI-2K score. Results. Twenty SLE patients’ samples were compared with 20 control samples. There was a significant alteration in SLE patients’ gut microbiota. A significantly lower ( p ≤ 0.001 ) Firmicutes/Bacteroidetes (F/B) ratio in SLE patients (mean ratio: 0.66%) compared to healthy subjects (mean ratio: 1.79%) was found. Lactobacillus showed a significant decrease in SLE patients ( p = 0.006 ) in comparison to healthy controls. An inverse significant correlation between SLEDAI-2K scores for disease activity and F/B ratio (r = −0.451; p = 0.04 ) was found. However, an inverse nonsignificant correlation between SLEDAI-2K scores for disease activity and Lactobacillus (r = −0.155; p = 0.51 ) was detected. Conclusion. Compared to healthy controls, recently diagnosed SLE Egyptian patients have an altered fecal microbiota profile with significant lowering of both F/B ratio and Lactobacillus abundance, which is weakly correlated with disease activity.

Gut Microbiota as Regulators of Th17/Treg Balance in Patients With Myasthenia Gravis

“…Specifically, decreased phylum Firmicutes along with increased phylum Proteobacteria and Bacteroidetes were observed in the fecal samples of patients with MG. Accordingly, the ratio of Firmicutes/Bacteroidetes (F/B ratio) in patients with MG was markedly lower, which was consistent with the decreased F/B ratio observed in systemic lupus erythematosus and inflammatory bowel disease ( 62 , 63 ). In fact, the F/B ratio can reflect a pro-inflammatory environment, where the inflammatory microbiota could damage the intestinal epithelium and subsequently trigger an immune response, leading to immunological imbalance.…”

Changes in Gut Microbiota and Systemic Inflammation after Synbiotic Supplementation in Patients with Systemic Lupus Erythematosus: A Randomized, Double-Blind, Placebo-Controlled Trial

“…OTU 165 ( Bifidobacterium bifidum ), one of the bacteria in the synbiotic used in this study, increased in the synbiotic group from 1.04 to 1.21 ( p = 0.93) and decreased from 0.86 to 0 ( p = 0.38) in the placebo group. OTU 068 ( Ruminococcus gnavus ), which is in a study by Azzouz et al [ 9 ] was found to be highly represented in SLE patients, decreased from 38.96 to 17.65 ( p = 1) in the synbiotic group and increased from 3.97 to 19.56 ( p = 0.51) in the placebo group.…”

“…A study in young, female, lupus-prone mice showed depletion of Lactobacilli compared with age-matched healthy controls [ 8 ]. Studies in patients with SLE have reported significant decreases in the species richness, species diversity and Firmicutes/Bacteroidetes ratio compared with healthy controls and also changes in the metabolic function of gut microbiota [ 9 , 10 , 11 , 12 ]. Another study from China found increased Bacteroidetes , Proteobacteria, Actinobacteria and decreased Firmicutes.…”

“…In SLE patients with high disease activity, the species richness and diversity severely decrease [ 6 ]. Studies have reported that disease activity is negatively correlated with Bifidobacterium, Firmicutes , Lactobacillus , and Firmicutes/Bacteroidetes ratio [ 6 , 9 ]. Meanwhile, it is positively correlated with Ruminococcus gnavus, Streptococcus, Campylobacter, Streptococcus anginosus and Veillonella dispar [ 6 , 7 ].…”

Lactobacillus: Friend or Foe for Systemic Lupus Erythematosus?

“…Although there were few randomized controlled trials (RCTs) about the Lactobacillus ’s effect on SLE patients, a large amount of cohort clinical studies on the relation between Lactobacillus and SLE were increasing. Newly diagnosed treatment-naive SLE cases ( 44 ) and SLE patients that had not received glucocorticoid (GC) therapy ( 45 ) possessed a decrease of Lactobacillus in feces in Chinese and Egyptian patients compared with the healthy controls. However, SLE patients in most cohorts both active and remissive, both adults and children all manifested the enrichment of Lactobacillus in both fecal and oral sample in China and Netherlands ( 14 , 15 , 18 , 19 , 46 ) ( Table 1 ).…”