Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2018; 24(30): 3448-3461
Published online Aug 14, 2018. doi: 10.3748/wjg.v24.i30.3448
Altered oral microbiota in chronic hepatitis B patients with different tongue coatings
Yu Zhao, Yu-Feng Mao, Yi-Shuang Tang, Ming-Zhu Ni, Qiao-Hong Liu, Yan Wang, Qin Feng, Jing-Hua Peng, Yi-Yang Hu
Yu Zhao, Yu-Feng Mao, Yi-Shuang Tang, Ming-Zhu Ni, Qiao-Hong Liu, Yan Wang, Qin Feng, Jing-Hua Peng, Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Yi-Yang Hu, Institute of Liver Diseases, Key Laboratory of Liver and Kidney Diseases (Ministry of Education), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Author contributions: Hu YY designed the study; Zhao Y and Tang YS performed the tongue coating microbial experiments; Tang YS, Liu QH and Wang Y performed the tongue coating metabolic experiments; Tang YS, Feng Q and Peng JH performed the clinical trial; Mao YF and Ni MZ performed the statistical analyses; Zhao Y wrote the paper.
Supported by the Shanghai Educational Development Foundation, No. 14CG41; the National Natural Science Foundation of China, No. 81403298 and No. 81373857; and the National Key New Drug Creation Project, No. 2017ZX09304002.
Institutional review board statement: The study was reviewed and approved by the IRB of Shuguang Hospital affiliated with the Shanghai University of TCM Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yi-Yang Hu, MD, PhD, Doctor, Senior Researcher, Institute of Liver Diseases, Key Laboratory of Liver and Kidney Diseases (Ministry of Education), Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, No.528 Zhangheng Road, Pudong New Area, Shanghai 201203, China. yyhuliver@163.com
Telephone: +86-21-20256526 Fax: +86-21-20256521
Received: May 4, 2018
Peer-review started: May 4, 2018
First decision: May 23, 2018
Revised: June 8, 2018
Accepted: June 25, 2018
Article in press: June 25, 2018
Published online: August 14, 2018
Abstract
AIM

To elucidate tongue coating microbiota and metabolic differences in chronic hepatitis B (CHB) patients with yellow or white tongue coatings.

METHODS

Tongue coating samples were collected from 53 CHB patients (28 CHB yellow tongue coating patients and 25 CHB white tongue coating patients) and 22 healthy controls. Microbial DNA was extracted from the tongue samples, and the bacterial 16S ribosomal RNA gene V3 region was amplified from all samples and sequenced with the Ion Torrent PGM™ sequencing platform according to the standard protocols. The metabolites in the tongue coatings were evaluated using a liquid chromatography-mass spectrometry (LC-MS) platform. Statistical analyses were then performed.

RESULTS

The relative compositions of the tongue coating microbiotas and metabolites in the CHB patients were significantly different from those of the healthy controls, but the tongue coating microbiota abundances and diversity levels were not significantly different. Compared with the CHB white tongue coating patients, the CHB yellow tongue coating patients had higher hepatitis B viral DNA (HBV-DNA) titers (median 21210 vs 500, respectively, P = 0.03) and a significantly lower level of Bacteroidetes (20.14% vs 27.93%, respectively, P = 0.013) and higher level of Proteobacteria (25.99% vs 18.17%, respectively, P = 0.045) in the microbial compositions at the phylum level. The inferred metagenomic pathways enriched in the CHB yellow tongue coating patients were mainly those involved in amino acid metabolism, which was consistent with the metabolic disorder. The abundances of bacteria from Bacteroidales at the order level were higher in the CHB white tongue coating patients (19.2% vs 27.22%, respectively, P = 0.011), whereas Neisseriales were enriched in the yellow tongue coating patients (21.85% vs 13.83%, respectively, P = 0.029). At the family level, the abundance of Neisseriaceae in the yellow tongue patients was positively correlated with the HBV-DNA level but negatively correlated with the S-adenosyl-L-methionine level.

CONCLUSION

This research illustrates specific clinical features and bacterial structures in CHB patients with different tongue coatings, which facilitates understanding of the traditional tongue diagnosis.

Keywords: 16S rRNA gene sequencing, Metabolomics, Chronic hepatitis B, Tongue diagnosis, Microbiota

Core tip: Tongue diagnosis has important guiding significance for clinical syndrome differentiation and drug use in traditional Chinese medicine (TCM), but lacks scientific explanations. This study illustrates the existence of specific clinical features and bacterial structure in chronic hepatitis B (CHB) patients with different tongue coatings. Compared with the CHB white tongue coating patients, the yellow tongue coating patients had higher viral titers and a significantly lower level of Bacteroidetes and higher level of Proteobacteria in their microbial compositions at the phylum level. This study explores the micro-features between different tongue coatings, which will promote our understanding of the TCM tongue diagnosis and facilitate therapeutic strategies for individualized treatment.