The difference of gut microbiome in different biliary diseases in infant before operation and the changes after operationOriginal paper
Karen Pendergrass is a microbiome researcher specializing in microbiome-targeted interventions (MBTIs). She systematically analyzes scientific literature to identify microbial patterns, develop hypotheses, and validate interventions. As the founder of the Microbiome Signatures Database, she bridges microbiome research with clinical practice. In 2012, based on her own investigative research, she became the first documented case of FMT for Celiac Disease, four years before the first published case study.
Read MoreWhat was studied?
This study compared the gut microbiome of infants with biliary atresia versus non-biliary atretic cholestasis, two conditions that are hard to tell apart yet need different, time-sensitive care. Early distinction improves surgical outcomes. Researchers used 16S ribosomal DNA gene sequencing of fecal samples to characterise intestinal flora. They sampled before surgery and after surgery to track how relieving bile obstruction changed the microbiota, and used LEfSe and PICRUSt2 to find markers and predict functions.
Who was studied?
The cohort was 25 infants under 90 days at a children's hospital in Nanjing, China, enrolled from November 2019 to September 2020. Of these, 17 had biliary atresia and 8 had non-biliary atretic cholestasis. All infants underwent Kasai portoenterostomy or biliary irrigation after diagnosis was confirmed during surgery. Feces were collected one day before surgery, one week after, and one month after discharge. Postoperative fresh feces were available from only 4 biliary atresia and 3 cholestasis infants.
What were the most important findings?
Before surgery both groups showed increased Proteobacteria and depleted probiotics, but their structures differed significantly. Proteobacteria reached 53.87 to 58.87 percent in biliary atresia versus 39.44 percent in cholestasis, indicating more severe dysbiosis in biliary atresia. LEfSe analysis found Enterococcus, Ralstonia, and Nitriliruptoraceae enriched in biliary atresia. Veillonella, Clostridium_sensu_stricto_1, and Lactobacillus were enriched in cholestasis. After surgery, potential pathogens fell and probiotics rose. Functional prediction linked biliary atresia to energy-releasing degradation and cholestasis to amino acid biosynthesis.
What are the greatest implications of this study?
Distinct gut signatures suggest microbes such as Enterococcus, Ralstonia, and Nitriliruptoraceae could serve as biomarkers to separate biliary atresia from other cholestasis. Faster diagnosis would help time the Kasai operation. The postoperative rebound in probiotics hints that early probiotic supplementation might aid recovery of intestinal balance. The sample was small, bile acids were not measured, and antibiotic effects were not controlled, so the markers need larger studies before clinical use.