Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2018; 24(39): 4510-4516
Published online Oct 21, 2018. doi: 10.3748/wjg.v24.i39.4510
Fungal dysbiosis predicts the diagnosis of pediatric Crohn’s disease
Mohammad I El Mouzan, Kirill S Korolev, Mohammad A Al Mofarreh, Rajita Menon, Harland S Winter, Ahmad A Al Sarkhy, Scot E Dowd, Ahmad M Al Barrag, Asaad A Assiri
Mohammad I El Mouzan, Ahmad A Al Sarkhy, Department of Pediatrics, King Saud University, Riyadh 11461, Saudi Arabia
Kirill S Korolev, Rajita Menon, Bioinformatics Program, Boston University, Boston, MA 02215, United States
Mohammad A Al Mofarreh, Al Mofarreh PolyClinic, Riyadh 11423, Saudi Arabia
Harland S Winter, MassGeneral Hospital for Children, Boston, MA 02114, United States
Scot E Dowd, MRDNA, Shallowater, TX 79363, United States
Ahmad M Al Barrag, Department of Microbiology, King Saud University, Riyadh 11461, Saudi Arabia
Asaad A Assiri, Department of Pediatrics, Supervisor of Prince Abdullah Bin Khalid Celiac Disease Research Chair, King Saud University, Riyadh 11461, Saudi Arabia
Author contributions: El Mouzan MI and Winter HS contributed to the conception and design of the study; Al Mofarreh MA, Al Sarkhy AA, Assiri AA and Al Barrag AM contributed to data acquisition and samples’ storage; Dowd SE performed DNA extraction and fungal sequencing; Korolev KS and Menon R performed the biostatistics and bioinformatics; El Mouzan MI drafted the manuscript and all co-authors contributed to reviewing, editing and giving approval of the final manuscript.
Institutional review board statement: The manuscript is part of the study of the characteristics of inflammatory bowel disease in Saudi children approved by the IRB of the College of Medicine, King Saud University (No: 10/2647/IRB dated 29/6/2010).
Informed consent statement: Parents and/or children gave consent and/or assent to participate in the study before enrollment.
Conflict-of-interest statement: All authors declare no conflict of interest related to this study.
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 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: Mohammad I El Mouzan, MD, Professor and Consultant Pediatrician, Department of Pediatrics, Gastroenterology Unit, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia. drmouzan@gmail.com
Telephone: +966-55-5479281 Fax: +966-11-4679364
Received: June 29, 2018
Peer-review started: July 2, 2018
First decision: July 12, 2018
Revised: September 3, 2018
Accepted: October 5, 2018
Article in press: October 5, 2018
Published online: October 21, 2018
Research background

Bacterial dysbiosis has been reported to predict the diagnosis of Crohn’s disease (CD), but no similar reports for fungal dysbiosis exist. The study is of scientific significance to stimulate further research important for further clarification of the role of fungi in CD.

Research motivation

The role of microbiota in CD, bacterial or fungal, is of worldwide research interest. However, a key problem to be solved is whether dysbiosis is the cause or the result of inflammation. Solving this problem may facilitate discovery of new microbiota-based treatment options. Regarding the accuracy of fungal dysbiosis in predicting the diagnosis, the main problem would be the current high cost of fungal analysis. Solving this problem could lead to development of a dysbiosis screening test for CD.

Research objectives

The objective of this study was to evaluate the accuracy of intestinal fungal dysbiosis as a predictor of CD. High accuracy was found. Future research is needed to confirm this finding and to develop low-cost fungal dysbiosis tests.

Research methods

Mucosal and stool samples were collected from children with CD at presentation and controls. Fungal DNA was extracted from theses samples and sequencing was performed. Fungal abundance and diversities were determined. Fungal dysbiosis in children with CD was demonstrated. This is the first study of the accuracy of fungal dysbiosis in predicting the diagnosis of CD in children.

Research results

The main finding was the high accuracy of fungal dysbiosis in predicting diagnosis of CD. This should stimulate further research to confirm our findings and to develop a low-cost dysbiosis test.

Research conclusions

The high accuracy of fungal dysbiosis in predicting the diagnosis of CD is a new finding. The finding could lead to further research in the role of fungal dysbiosis in CD. A new theory suggests the possibility of design of a noninvasive fungal dysbiosis screening test for CD.

Research perspectives

The role of microbiota in CD may include development of a noninvasive screening test. Further research is needed to confirm the findings and to develop low-cost fungal analysis.