Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Brief Communications Arising
  • Published:

Decompensated cirrhosis and microbiome interpretation

Nature volume 525, pages E1–E2 (2015)Cite this article

Subjects

arising from N. Qin et al. Nature 513, 59–64 (2014);

The diagnosis of cirrhosis, especially in the advanced/decompensated stages, is made using simple and inexpensive clinico-radiologic-pathological techniques1. Qin et al.2, whose paper has replicated prior studies3,4,5, reported a relatively novel profile to diagnose cirrhosis using complex stool metagenomics despite having a majority (65% discovery and 76% validation cohorts) decompensated cirrhotic population. We have found that the decompensated cirrhosis cohort, which does not require these complicated diagnostic strategies, was responsible for a significant proportion of these microbiota changes on further analysis of their metagenomics data and using a new cohort of 360 subjects. Therefore, given several confounders and the ease of decompensated cirrhosis diagnosis using current techniques, a careful re-interpretation of newer microbiota-based diagnostic strategies that do not a priori differentiate between early (compensated) and decompensated cirrhosis and treat all people with cirrhosis as one uniform population should be performed. There is a Reply to this Brief Communication Arising by Qin, N. et al. Nature 525, http://dx.doi.org/10.1038/nature14852 (2015).

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Microbiota distribution between compensated and decompensated cirrhotic subjects.

References

  1. Schuppan, D. & Afdhal, N. H. Liver cirrhosis. Lancet 371, 838–851 (2008)

    Article  CAS  Google Scholar 

  2. Qin, N. et al. Alterations of the human gut microbiome in liver cirrhosis. Nature 513, 59–64 (2014)

    Article  ADS  CAS  Google Scholar 

  3. Bajaj, J. S. et al. Linkage of gut microbiome with cognition in hepatic encephalopathy. Am. J. Physiol. Gastrointest. Liver Physiol. 302, G168–G175 (2012)

    Article  CAS  Google Scholar 

  4. Chen, Y. et al. Characterization of fecal microbial communities in patients with liver cirrhosis. Hepatology 54, 562–572 (2011)

    Article  Google Scholar 

  5. Bajaj, J. S. et al. Colonic mucosal microbiome differs from stool microbiome in cirrhosis and hepatic encephalopathy and is linked to cognition and inflammation. Am. J. Physiol. Gastrointest. Liver Physiol. 303, G675–G685 (2012)

    Article  CAS  Google Scholar 

  6. Chavez-Tapia, N. C., Tellez-Avila, F. I., Garcia-Leiva, J. & Valdovinos, M. A. Use and overuse of proton pump inhibitors in cirrhotic patients. Med. Sci. Monit. 14, CR468–CR472 (2008)

    PubMed  Google Scholar 

  7. Bajaj, J. S. et al. A longitudinal systems biology analysis of lactulose withdrawal in hepatic encephalopathy. Metab. Brain Dis. 27, 205–215 (2012)

    Article  CAS  Google Scholar 

  8. Bajaj, J. S. et al. Altered profile of human gut microbiome is associated with cirrhosis and its complications. J. Hepatol. 60, 940–947 (2014)

    Article  CAS  Google Scholar 

  9. Bajaj, J. S. et al. Modulation of the metabiome by rifaximin in patients with cirrhosis and minimal hepatic encephalopathy. PLoS ONE 8, e60042 (2013)

    Article  ADS  CAS  Google Scholar 

  10. Kanno, T. et al. Gastric acid reduction leads to an alteration in lower intestinal microflora. Biochem. Biophys. Res. Commun. 381, 666–670 (2009)

    Article  CAS  Google Scholar 

  11. Bajaj, J. S. et al. Systems biology analysis of omeprazole therapy in cirrhosis demonstrates significant shifts in gut microbiota composition and function. Am. J. Physiol. Gastrointest. Liver Physiol. 307, G951–G957 (2014)

    Article  CAS  Google Scholar 

  12. Segata, N. et al. Metagenomic biomarker discovery and explanation. Genome Biol. 12, R60 (2011)

    Article  Google Scholar 

  13. Gillevet, P., Sikaroodi, M., Keshavarzian, A. & Mutlu, E. A. Quantitative assessment of the human gut microbiome using multitag pyrosequencing. Chem. Biodivers. 7, 1065–1075 (2010)

    Article  CAS  Google Scholar 

  14. Zhang, Z. et al. Large-scale survey of gut microbiota associated with MHE via 16S rRNA-based pyrosequencing. Am. J. Gastroenterol. 108, 1601–1611 (2013)

    Article  ADS  CAS  Google Scholar 

  15. Elkrief, L. et al. Diabetes mellitus is an independent prognostic factor for major liver-related outcomes in patients with cirrhosis and chronic hepatitis C. Hepatology 60, 823–831 (2014)

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, 23249, Virginia, USA

    Jasmohan S. Bajaj

  2. Microbiome Analysis Center, George Mason University, Manassas, 20110, Virginia, USA

    Naga S. Betrapally & Patrick M. Gillevet

Authors
  1. Jasmohan S. Bajaj
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naga S. Betrapally
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patrick M. Gillevet
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

J.S.B. supervised the patient recruitment, sample collection and clinical analysis. He was also involved in the data interpretation, analysis and drafting of the manuscript. N.S.B. was involved in data analysis and interpretation. P.M.G. was responsible for data analysis, interpretation and drafting of the manuscript. All authors participated in the critical revision of the manuscript.

Corresponding author

Correspondence to Jasmohan S. Bajaj.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

PowerPoint slides

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bajaj, J., Betrapally, N. & Gillevet, P. Decompensated cirrhosis and microbiome interpretation. Nature 525, E1–E2 (2015). https://doi.org/10.1038/nature14851

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nature14851

This article is cited by

Comments

By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate.

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing