Characterization of Intestinal Microbiomes of Hirschsprung's Disease Patients with or without Enterocolitis Using Illumina-MiSeq High-Throughput Sequencing.

Valeriy Poroyko,Zhoulonglong Xie,Liya Pan,Yuqing Li,Yi Feng,Peihua Zhao,Emmanuel Dias-Neto,Li Hong,Zhilong Yan

doi:10.1371/journal.pone.0162079

Abstract

Hirschsprung-associated enterocolitis (HAEC) is a life-threatening complication of Hirschsprung’s disease (HD). Although the pathological mechanisms are still unclear, studies have shown that HAEC has a close relationship with the disturbance of intestinal microbiota. This study aimed to investigate the characteristics of the intestinal microbiome of HD patients with or without enterocolitis. During routine or emergency surgery, we collected 35 intestinal content samples from five patients with HAEC and eight HD patients, including three HD patients with a history of enterocolitis who were in a HAEC remission (HAEC-R) phase. Using Illumina-MiSeq high-throughput sequencing, we sequenced the V4 region of bacterial 16S rRNA, and operational taxonomic units (OTUs) were defined by 97% sequence similarity. Principal coordinate analysis (PCoA) of weighted UniFrac distances was performed to evaluate the diversity of each intestinal microbiome sample. The microbiota differed significantly between the HD patients (characterized by the prevalence of Bacteroidetes) and HAEC patients (characterized by the prevalence of Proteobacteria), while the microbiota of the HAEC-R patients was more similar to that of the HAEC patients. We also observed that the specimens from different intestinal sites of each HD patient differed significantly, while the specimens from different intestinal sites of each HAEC and HAEC-R patient were more similar. In conclusion, the microbiome pattern of the HAEC-R patients was more similar to that of the HAEC patients than to that of the HD patients. The HD patients had a relatively distinct, more stable community than the HAEC and HAEC-R patients, suggesting that enterocolitis may either be caused by or result in a disruption of the patient’s uniquely adapted intestinal flora. The intestinal microbiota associated with enterocolitis may persist following symptom resolution and can be implicated in the symptom recurrence.

Highlights

Hirschsprung’s disease (HD), a developmental disorder of the enteric nervous system, is characterized by the congenital absence of parasympathetic intrinsic ganglion cells in the submucosal and myenteric plexuses of a variable portion of the distal gut, with proximal extension and functional intestinal obstruction [1,2]
The patients were divided into the Hirschsprung-associated enterocolitis (HAEC) (n = 5) and HD (n = 8) groups according to the presence of enterocolitis at the time of sampling
In the HD group, three patients had a medical history of enterocolitis but were in remission when sampled; they were assigned to a subgroup termed the HAEC remission (HAEC-R) group (Table 1)

Summary

Introduction

Hirschsprung’s disease (HD), a developmental disorder of the enteric nervous system, is characterized by the congenital absence of parasympathetic intrinsic ganglion cells in the submucosal and myenteric plexuses of a variable portion of the distal gut, with proximal extension and functional intestinal obstruction [1,2]. HD can be treated surgically in most cases using a minimally invasive approach, and is often resolved without colostomy [1], the incidence rate of a severe life-threatening complication Hirschsprung-associated enterocolitis (HAEC) remains as high as 17 to 50% [3,4]. HAEC is an inflammatory colitis that causes distension, diarrhea, and fever and can lead to bacterial translocation, sepsis, and death. HAEC remission is characterized by resolution of clinical symptoms of inflammation and by a return of circulating levels of inflammatory factors to the normal range [5]. HAEC remains the leading cause of morbidity and the most common cause of death in infants and children with HD [3,4]

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