INTRODUCTION: Small intestinal bacterial overgrowth (SIBO) is defined by abnormal and excessive numbers of bacteria in the small bowel. As the viscosity of small bowel aspirates makes assessing the full microbiome profile by next generation sequencing difficult, we have used the mucolytic agent dithiothreitol (DTT) to reduce aspirate viscosity. In this study, we assessed the use of DTT in the identification and analysis of microbiome profiles in SIBO and non-SIBO subjects. METHODS: Gastrointestinal symptoms were assessed by questionnaire as part of the REIMAGINE (Revealing the Entire Intestinal Microbiota and its Associations with the Genetic, Immunologic, and Neuroendocrine Ecosystem) study. Duodenal aspirates were collected using a novel sterile dual-lumen aspiration catheter, and a subset were treated with DTT. All samples were cultured on MacConkey agar (MAC). DNA was isolated using the MagAttract PowerSoil DNA Kit. Microbiota were analyzed by 16S rRNA sequencing. Operational Taxonomic Units clustering and taxonomic analysis were performed with CLC Microbial Genomics Module v. 2.5. Statistical analysis was performed in R 3.6.0. RESULTS: Of 239 samples, 117 (79 non-SIBO and 38 SIBO, based on culture results) were treated with DTT and the remaining 122 samples (100 non-SIBO and 22 SIBO) were not treated with DTT. Overall microbiome profiles were similar in DTT (Figure 1A) and non-DTT (Figure 1B) samples. DTT-treated samples were better able to cluster subjects into SIBO and non-SIBO groups based on symptoms than non-DTT samples (P = 0.0001) (Figure 1C & D). DTT samples exhibited different relative abundances of several microbial taxa (Figure 2). Genus Klebsiella was more abundant in SIBO subjects (log fold change (LFC) = 7.167183, P < 0.0001), as was family Enterobacteriaceae (LFC = 3.631824, P < 0.0001). Using DTT-treated samples showed significant differences in bloating (P = 0.0618), diarrhea (P = 0.0065), urgency (P = 0.0274) and rectal mucous discharge (P = 0.0258) in SIBO and non-SIBO subjects. Absence of all 4 cardinal SIBO symptoms ruled out SIBO (specificity = 100%) based on culture in DTT-treated samples (sensitivity = 36.54%). CONCLUSION: While not changing the overall microbiome profile, using DTT improves the accuracy of culture results and identification of SIBO by sequencing, and better differentiates SIBO-related symptoms. Therefore, mucolytic treatment appears to be a crucial step in assessing the small bowel microbiome.Figure 1.: Overall microbiome relative abundance distribution of DTT-treated aspirate samples (A) and non-DTT-treated aspirate samples (B). Principal Coordinates Analysis of Bray Curtis distance between non-DTT (C) and non-DTT samples (D) (β-diversity analysis), colored by SIBO condition. P-value for the PERMANOVA test for the differentiation between groups in DTT data is 0.001, indicating significant separation between SIBO and non-SIBO patient.Figure 2.: Differentially expressed (significant) taxa between SIBO and non-SIBO in DTT samples.
Read full abstract