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Jichan Shi,1,* Gexin Gao,2,* Zhijie Yu,3,* Kaihuai Wu,4 Youquan Huang,5 Lian-Peng Wu,6 Zhengxing Wu,1 Xinchun Ye,1 Chaochao Qiu,1 Xiangao Jiang1 1Department of Infectious Disease, Wenzhou Central Hospital, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, Peopleâs Republic of China; 2Department of Nursing School, Wenzhou Medical University, Wenzhou, Zhejiang, 325000, Peopleâs Republic of China; 3Department of Hematology, Wenzhou Key Laboratory of Hematology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Peopleâs Republic of China; 4Departments of Infectious Diseases, Taishun Peopleâs Hospital, Wenzhou, 325000, Peopleâs Republic of China; 5Departments of Infectious Diseases, Yongjia Peopleâs Hospital, Wenzhou, 325000, Peopleâs Republic of China; 6Department of Laboratory, Wenzhou Central Hospital, The Dingli Clinical Institute of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, Peopleâs Republic of China*These authors contributed equally to this workCorrespondence: Xiangao Jiang, Department of Infectious Disease of Wenzhou Central Hospital, The Dingli Clinical Institute of Wenzhou Medical University, 252 Baili East Road, Lucheng District, Wenzhou, Zhejiang, 325000, Peopleâs Republic of China, Tel +86 13587691822, Fax +86 577 88070007, Email jiang_xiangao@126.comBackground: Tuberculosis (TB) is still the single pathogen infectious disease with the largest number of deaths worldwide. The relationship that intestinal microbiota disorder and de novo fatty acid synthesis metabolism have with disease progression in multi-drug resistant TB (MDR-TB) has not yet been fully studied.Objective: To investigate the effects of long periods of MDR-TB, pre-extensively drug-resistant TB (pre-XDR-TB), or rifampicin-resistant TB (RR-TB) on gut microbiome dysbiosis and advanced disease.Methods: The sample was chosen between March 2019 and September 2019 in Wenzhou Central Hospital and comprised 11 patients with pre-XDR-TB, 23 patients with RR-TB, and 28 patients with MDR-TB. Healthy individuals were chosen as the control group (CK group). An overnight fast blood sample was drawn via venipuncture into tubes without anticoagulant. For analysis, 300 mg of faeces from patients from the same group was mixed and analysed using DNA extraction, NGS sequencing, and bioinformatics. A QIAamp Fecal DNA Mini Kit was used to isolate the DNA. The extracted DNA was stored at â 20°C.Results: Advanced TB was concurrent with an elevated level of the proportions of acetyl-CoA carboxylase (ACC1) to glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and fatty acid synthase (FASN) to GAPDH in de novo fatty acids synthesis, and Eubacterium, Faecalibacterium, Roseburia, and Ruminococcus were increased significantly in RR-TB patients compared to healthy individuals, whereas their abundance in the pre-XDR-TB and MDR-TB groups showed little change in comparison with the control group. Proteobacteria levels were greatly increased in the RR-TB and MDR-TB patient groups but not in the patients with pre-XDR-TB or the healthy subjects. The pre-XDR-TB group exhibited alterations of the intestinal microbiome: coliform flora showed the highest abundance of Verrucomicrobiales, Enterobacteriales, Bifidobacteriales and Lactobacillales. De novo fatty acids synthesis was enhanced in patients and was associated with the gut microbiome dysbiosis induced by the antimicrobials, with Bacteroidetes, Bacteroidales, and Bacteroidaceae displaying the most important correlations on a phylum, order, and family level, respectively.Conclusion: The progression to advanced TB was observed to be a result of the interaction between multiple interrelated pathways, with gutâlung crosstalk potentially playing a role in patients with drug-resistant TB.Keywords: multi-drug resistant TB disease, gut commensal, microbial imbalance, de novo fatty acids synthesis, microbiome biosignature alterations |
