Roles of Sphincter of Oddi Laxity in Bile Duct Microenvironment in Patients with Cholangiolithiasis: From the Perspective of the Microbiome and Metabolome

• Published in: Journal of the American College of Surgeons Vol. 222; no. 3; pp. 269 - 280.e10
• Main Authors: Liang, Tingbo, MD, PhD, FACS, Su, Wei, MD, Zhang, Qi, MD, Li, Guogang, MD, Gao, Shunliang, MBBS, Lou, Jianying, MD, Zhang, Yun, PhD, Ma, Tao, PhD, Bai, Xueli, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2016
• Subjects: Adult; Aged; Bile - metabolism; Bile - microbiology; Bile Ducts - metabolism; Bile Ducts - microbiology; Biomarkers - metabolism; Case-Control Studies; Cholelithiasis - etiology; Cholelithiasis - metabolism; Cholelithiasis - microbiology; Cholelithiasis - physiopathology; Cross-Sectional Studies; Female; Humans; Male; Metabolome; Microbiota; Middle Aged; Prospective Studies; Sphincter of Oddi - physiopathology; Surgery; microbiota; liquid chromatography-mass spectrometry; operational taxonomic unit; rRNA; OPLS-DA; bile duct stone; variable importance in projection; total ion chromatogram; sphincter of Oddi laxity; TIC; endoscopic retrograde cholangiopancreatography; OTU; SOL; LC-MS; orthogonal partial least squares discriminant analysis; ribosomal RNA; metabolomics; ERCP; sphincter of Oddi dysfunction; VIP
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2015.12.009

Background Bile duct microenvironment plays key roles in cholangiolithiasis occurrence. Sphincter of Oddi laxity (SOL) is associated with cholangiolithiasis, probably due to enhanced reflux of intestinal contents that changes the microenvironment. However, the microenvironment has not been comprehensively investigated. Study Design Patients with cholangiolithiasis were consecutively recruited and their bile was collected intraoperatively for high-throughput experiments. Pyrosequencing of 16S ribosomal RNA gene was performed to characterize the microbiota in the bile. A liquid chromatography-mass spectrometry-based method was used to profile bile composition. Clinical manifestation, microbiome, and bile composition were compared between patients with and without SOL. Results 18 patients with SOL and 27 patients without SOL were finally included. Patients with SOL showed severer inflammation. Bacteria in the bile duct were overwhelmingly aerobes and facultative anaerobes. Proteobacteria and Firmicutes were the most widespread phylotypes, especially Enterobacteriaceae . Compared with those without SOL, patients with SOL possessed more varied microbiota. In the SOL group, pathobionts, such as Bilophila and Shewanella algae had richer communities while harmless bacteria were reduced. Metabolomics analysis showed the differences in bile composition between groups were mainly distributed in lipids and bile acids. Particularly, the increased abundance of Bilophila involved in taurine metabolism was associated with reduced contents of taurine derivatives in the bile of patients with SOL. Conclusions A bile duct microenvironment with more severe bacterial infection and stronger lithogenicity was found in patients with SOL. The findings suggest a possible mechanism of cholangiolithiasis and provide the basis for future strategies for prevention of cholangiolithiasis recurrence.