Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China; Department of Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China.
Int Immunopharmacol. 2024 Feb 15;128:111470. doi: 10.1016/j.intimp.2023.111470. Epub 2024 Jan 6.
Pemphigus vulgaris (PV) and bullous pemphigoid (BP) are two prevalent bullous diseases. Previous studies found that the antibodies of BP could be expressed in the intestinal epithelium and BP was tightly related to inflammatory bowel disease. Therefore, gut microbiota might also play an important role in bullous disease. However, the specific relationship between gut microbiota and bullous diseases remains unknown. Our study aimed to investigate the potential role of gut microbiota in the development and progression of different bullous diseases.
We conducted a prospective and observational cohort study at Peking Union Medical College Hospital. Untreated BP and PV patients were recruited, along with healthy controls (HC) who were spouses or caregivers of these patients. Fecal samples were collected, followed by 16S rRNA gene sequencing. Bioinformatics analyses were performed to assess the composition and function of gut microbiota.
A total of 38 HC, 32 BP, and 19 PV patients were enrolled in this study. Compared to HC, BP, and PV exhibited a distinct gut microbiota composition, especially BP. The gut microbiota changes were mainly observed in the phylum Bacteroidetes, Firmicutes, and Proteobacteria. The ratio of Faecalibacterium to Escherichia-Shigella (F/E ratio) had a considerable predictive value (AUC: 0.705) for recognizing BP from PV. The levels of Faecalibacterium and Enterobacter were correlated to the anti-BP 180 and anti-desmoglein 3. Microbial functional prediction revealed elevated activity in pathways related to gut microbiota translocation significantly increased in BP patients, indicating a potential pathogenetic role in BP.
Our study suggests that the composition of gut microbiota is specific in different bullous diseases and the role of gut microbiota differs. Gut microbiota could help distinguish BP and PV, and might play a role in the pathogenesis of different bullous diseases.
寻常型天疱疮（PV）和大疱性类天疱疮（BP）是两种常见的大疱性疾病。既往研究发现 BP 的抗体可在肠道上皮细胞中表达，且 BP 与炎症性肠病密切相关。因此，肠道菌群可能在大疱性疾病中也发挥着重要作用。然而，肠道菌群与大疱性疾病之间的确切关系尚不清楚。本研究旨在探讨肠道菌群在不同大疱性疾病发生和发展中的潜在作用。
我们在北京协和医院进行了一项前瞻性、观察性队列研究。纳入未经治疗的 BP 和 PV 患者，以及作为这些患者配偶或护理者的健康对照（HC）。采集粪便样本，进行 16S rRNA 基因测序。通过生物信息学分析评估肠道菌群的组成和功能。
本研究共纳入 38 名 HC、32 名 BP 和 19 名 PV 患者。与 HC 相比，BP 和 PV 表现出明显不同的肠道微生物群组成，尤其是 BP。肠道微生物群的变化主要发生在厚壁菌门、拟杆菌门和变形菌门。柔嫩梭菌与大肠埃希菌/志贺菌的比值（F/E 比值）对识别 BP 和 PV 具有相当的预测价值（AUC：0.705）。柔嫩梭菌和肠杆菌的水平与抗 BP180 和抗桥粒芯糖蛋白 3 相关。微生物功能预测显示，BP 患者中与肠道菌群易位相关的途径活性显著升高，提示其在 BP 发病机制中可能发挥作用。
本研究表明，不同大疱性疾病的肠道菌群组成具有特异性，且肠道菌群的作用也不同。肠道菌群有助于区分 BP 和 PV，并可能在不同大疱性疾病的发病机制中发挥作用。
