Intestinal microbiota is modified in pediatric food protein-induced enterocolitis syndrome

Abstract

Background: Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food hypersensitivity that affects the gastrointestinal system, especially in children, who often present with more severe clinical manifestations than adults do. Although its pathogenesis is poorly understood and biomarkers are still lacking, scientific evidence suggests that gut microbiota may play an important role in the development of FPIES.

Objective: We aimed to compare the composition of gut microbiota in children with FPIES with that in age- and sex-matched healthy controls.

Methods: We analyzed the gut microbiota profiles in fecal samples of 17 patients with FPIES (case patients) and 12 age-matched healthy children (controls) by tag sequencing of the 16S ribosomal RNA gene hypervariable V4-V5 regions. Subjects' sociodemographic, clinical, and food diary variables were described and compared between groups by using inferential statistical tests. Nonparametric linear discriminant analysis was performed for intestinal microbiota data.

Results: Patients with confirmed cases FPIES (n = 17; average patient age, 7.5 ± 3.2 years) and controls without FPIES or any atopy (n = 12, average patient age, 6.9 ± 2.7 years) were included. Fish was the main FPIES-inducing allergen in 65% of the cases. The patients with FPIES showed higher proportions of Lachnospiraceae spp (P < .0286) and a lower proportion of Ruminococcaceae spp (P < .0066), Lactobacillaceae spp (P < .0075), and Leuconostocaceae spp (P < .0173) than the controls.

Conclusions: Our data clearly show a different gut microbial signature in patients with FPIES, suggesting a new potential avenue for aiding the diagnosis and clinical management of FPIES. Larger studies are needed to confirm these results.

Keywords: FPIES; Lachnospiraceae; Lactobacillaceae; Leuconostocaceae; Ruminococcaceae; gut microbiota; microbiome; non–IgE-mediated food hypersensivity.

Fig 1

α-Diversity on fecal microbiota. The α-diversity, including study of the Chao index, Simpson evenness, Simpson reciprocal index, dominance, and phylogenetic distance descriptors were assessed and compared between sample groups (controls and case patients with FPIES). Distributions of the respective metrics are presented as box plots. Results of statistical assessment are shown on top of box plots, respectively.

Fig 2

Microbial community structure. β-Diversity evaluation of the fecal microbial community structure is provided using principal coordinate (PC) analysis. Filled points indicate distribution of samples from the controls (white) and patients with FPIES (gray) across bidimensional space (the 2 main PCs exhibiting the highest variation explained). Ellipses, delimiting the 95% CI of data distribution, are shown accordingly.

Fig 3

Taxonomy changes. Normalized proportions of DNA reads for the Lachnospiraceae (A), Ruminococcaceae (B), Lactobacillaceae (C), and Leuconostocaceae (D) bacterial families. Differential abundance between sample groups (samples from controls and patients with FPIES) was found. Relative proportions of DNA reads for each taxonomy category are shown as box plots. Blue points indicate outliers.