Primary sclerosing cholangitis is characterised by intestinal dysbiosis independent from IBD
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Objective: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease often leading to end-stage liver disease. Its pathogenesis remains largely unknown, although frequent concomitant IBD hints towards common factors underlying gut and bile duct inflammation. Considering the mounting evidence on the involvement of the intestinal microbiota in initiating and determining IBD phenotype, we investigated intestinal microbiota composition in patients with PSC. Design: Stool samples were collected from 147 individuals (52 patients with PSC, 52 age, gender and body mass index-matched healthy volunteers, 13 UC and 30 patients with Crohn's disease). An independent validation cohort of 14 PSC and 14 matched controls was recruited. 16S rDNA sequencing of faecal DNA was performed (Illumina MiSeq). Results: The microbiota of patients with PSC was characterised by decreased microbiota diversity, and a significant overrepresentation of Enterococcus (p=3.76e-05), Fusobacterium (p=3.76e-05) and Lactobacillus (p=0.0002) genera. This dysbiosis was present in patients with PSC with and without concomitant IBD and was distinct from IBD, and independent of treatment with ursodeoxycholic acid. A decision tree based on abundances of these three genera allowed reliable classification in the validation cohort. In particular, one operational taxonomic unit belonging to the Enterococcus genus was associated with increased levels of serum alkaline phosphatase (p=0.048), a marker of disease severity. Conclusions: We here present the first report of PSC-associated faecal dysbiosis, independent from IBD signatures, suggesting the intestinal microbiota could be a contributing factor in PSC pathogenesis. Further studies are needed to confirm these findings and assess causality.
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Recent studies support an association between changes in the microbiome and the progression of cholestatic liver disease in patients.
“Recent studies have further supported the association between changes in the microbiome and the progression of cholestatic liver disease in patients9–14.”
From Cholestasis induced by bile duct ligation promotes changes in the intestinal microbiome in mice (2019) · cites this paper as [11]
Changes at genera level in cholestatic patients differ among studies and include enrichment in Veillonella, Akkermansia, Ruminococcaceae (undefined genus) and Clostridium and decrease in Prevotella.
“The changes described at genera level differ among studies9–12 and include the enrichment in Veillonella, Akkermansia, Ruminococcaceae (undefined genus) and Clostridium9 and the decrease in Prevotella10, overall supporting the association between changes in the microbiome and cholestatic disease.”
From Cholestasis induced by bile duct ligation promotes changes in the intestinal microbiome in mice (2019) · cites this paper as [11]
Recent studies described that cholestatic patients with PSC have an overall less diverse microbiome composition.
“Recent studies described that cholestatic patients with PSC have an overall less diverse microbiome composition.”
From Cholestasis induced by bile duct ligation promotes changes in the intestinal microbiome in mice (2019) · cites this paper as [11]
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- Authors
- Sabino, J., Vieira-Silva, S., Machiels, K., Joossens, M., Falony, G., Ballet, V., Ferrante, M., Van Assche, G., Van der Merwe, S., Vermeire, S., & Raes, J.
- Affiliations
- KU Leuven (BE)
- Department of Microbiology and Immunology, Laboratory of Molecular Bacteriology, KU Leuven—University of Leuven, Rega Institute for Medical Research, Leuven, Belgium
- Vrije Universiteit Brussel (BE)
- Rega Institute for Medical Research (BE)
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
- Department of Microbiology and Immunology, Center for the Biology of Disease, REGA institute, KU Leuven—VIB, Leuven, Belgium
- Corresponding author
- Raes, Jeroen
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2016-05-20
- Volume
- 65
- Issue
- 10
- Pages
- 1681-1689
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC5036217
- OpenAlex
- W2408052000
- Cited by
- 413
- References
- 40
- Citations by year
- 2026: 28 · 2025: 28 · 2024: 46 · 2023: 46 · 2022: 42 · 2021: 52 · 2020: 44 · 2019: 45 · 2018: 33 · 2017: 34 · 2016: 13
- FWCI
- 21.65
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Gut (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Socio-Environmental Systems Modeling (acceptedVersion, cc-by-nc)
- Lirias (submittedVersion, cc-by-nc)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Digital Access to Libraries (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Fonds Wetenschappelijk Onderzoek
- KU Leuven
- Vlaamse regering
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Keywords
- primary sclerosing cholangitis, gut dysbiosis, gut microbiota, inflammatory bowel disease, Enterococcus, Fusobacterium, Lactobacillus, microbiome diversity, Crohn's disease, ulcerative colitis, ursodeoxycholic acid, alkaline phosphatase, disease severity
- MeSH terms
- Gastrointestinal Microbiome, Adult, Aged, Alkaline Phosphatase, Biopsy, Cholagogues and Choleretics, Colonoscopy, Feces, Female, Humans, Male, Middle Aged, Severity of Illness Index, Statistics as Topic, Ursodeoxycholic Acid, Cholangitis, Sclerosing, Inflammatory Bowel Diseases, Enterococcus, Dysbiosis
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