PT  - JOURNAL ARTICLE
AU  - David Gallacher
AU  - Emma Mitchell
AU  - Dagmar Alber
AU  - Richard Wach
AU  - Nigel Klein
AU  - Julian R. Marchesi
AU  - Sailesh Kotecha
TI  - Dissimilarity of the gut-lung axis and dysbiosis of the lower airways in ventilated preterm infants
AID  - 10.1183/13993003.01909-2019
DP  - 2020 Jan 01
TA  - European Respiratory Journal
PG  - 1901909
4099  - http://erj.ersjournals.com/content/early/2020/02/06/13993003.01909-2019.short
4100  - http://erj.ersjournals.com/content/early/2020/02/06/13993003.01909-2019.full
AB  - Background Chronic lung disease of prematurity (CLD), also called bronchopulmonary dysplasia, is a major consequence of preterm birth but the role of the microbiome in its development remains unclear. We, therefore, assessed the progression of the bacterial community in ventilated preterm infants over time in the upper and lower airways, and assessed the gut-lung axis by comparing the upper and lower airways bacterial communities with the stool findings. Finally, we assessed if the bacterial communities were associated with lung inflammation to suggest dysbiosis.Methods We serially sampled multiple anatomical sites including the upper airway (nasopharyngeal aspirates, NPA), lower airways (tracheal aspirate fluid, TAF, and bronchoalveolar lavage fluid, BAL) and the gut (stool) of ventilated preterm-born infants. Bacterial DNA load was measured in all samples and sequenced using the V3-V4 region of the 16S rRNA geneResults From 1102 (539 NPA, 276 TAF, 89 BAL, 198 stool) samples from 55 preterm infants, 352 (32%) amplified suitably for 16 s RNA gene sequencing. Bacterial load was low at birth, quickly increased with time but was associated with predominant operational taxonomic units (OTUs) in all sample types. There was dissimilarity in bacterial communities between the upper and lower airways and the gut with a separate dysbiotic inflammatory process occurring in the lower airways of infants. Individual OTUs were associated with increased inflammatory markers.Conclusions Taken together, these findings suggest that targeted treatment of the predominant organisms, including those not routinely treated such as Ureaplasma spp., may decrease the development of CLD in preterm-born infants.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Gallacher has nothing to disclose.Conflict of interest: Dr. Mitchell has nothing to disclose.Conflict of interest: Dr. Alber has nothing to disclose.Conflict of interest: Dr. Wach has nothing to disclose.Conflict of interest: Dr. Klein has nothing to disclose.Conflict of interest: Dr. Marchesi has nothing to disclose.Conflict of interest: Dr. Kotecha has nothing to disclose.