We simultaneously investigated the genetic landscape of ankylosing spondylitis, Crohn's disease, psoriasis, primary sclerosing cholangitis and ulcerative colitis to investigate pleiotropy and the relationship between these clinically related diseases. Using high-density genotype data from more than 86,000 individuals of European-ancestry we identified 244 independent multi-disease signals including 27 novel genome-wide significant susceptibility loci and 3 unreported shared risk loci. Complex pleiotropy was supported when contrasting multi-disease signals with expression data sets from human, rat and mouse, and epigenetic and expressed enhancer profiles. The comorbidities among the five immune diseases were best explained by biological pleiotropy rather than heterogeneity (a subgroup of cases that is genetically identical to another disease, possibly due to diagnostic misclassification, molecular subtypes, or excessive comorbidity). In particular, the strong comorbidity between primary sclerosing cholangitis and inflammatory bowel disease is likely the result of a unique disease, which is genetically distinct from classical inflammatory bowel disease phenotypes.

The human gut microbiota has now been associated with drug responses and efficacy, while chemical compounds present in these drugs can also impact the gut bacteria. However, drug-microbe interactions are still understudied in the clinical context, where polypharmacy and comorbidities co-occur. Here, we report relations between commonly used drugs and the gut microbiome. We performed metagenomics sequencing of faecal samples from a population cohort and two gastrointestinal disease cohorts. Differences between users and nonusers were analysed per cohort, followed by a meta-analysis. While 19 of 41 drugs are found to be associated with microbial features, when controlling for the use of multiple medications, proton-pump inhibitors, metformin, antibiotics and laxatives show the strongest associations with the microbiome. We here provide evidence for extensive changes in taxonomy, metabolic potential and resistome in relation to commonly used drugs. This paves the way for future studies and has implications for current microbiome studies by demonstrating the need to correct for multiple drug use.

No abstract

Changes in the gut microbiota have been associated with two of the most common gastrointestinal diseases, inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). Here, we performed a case-control analysis using shotgun metagenomic sequencing of stool samples from 1792 individuals with IBD and IBS compared with control individuals in the general population. Despite substantial overlap between the gut microbiome of patients with IBD and IBS compared with control individuals, we were able to use gut microbiota composition differences to distinguish patients with IBD from those with IBS. By combining species-level profiles and strain-level profiles with bacterial growth rates, metabolic functions, antibiotic resistance, and virulence factor analyses, we identified key bacterial species that may be involved in two common gastrointestinal diseases.

ObjectiveThe microbiome directly affects the balance of pro-inflammatory and anti-inflammatory responses in the gut. As microbes thrive on dietary substrates, the question arises whether we can nourish an anti-inflammatory gut ecosystem. We aim to unravel interactions between diet, gut microbiota and their functional ability to induce intestinal inflammation.DesignWe investigated the relation between 173 dietary factors and the microbiome of 1425 individuals spanning four cohorts: Crohn’s disease, ulcerative colitis, irritable bowel syndrome and the general population. Shotgun metagenomic sequencing was performed to profile gut microbial composition and function. Dietary intake was assessed through food frequency questionnaires. We performed unsupervised clustering to identify dietary patterns and microbial clusters. Associations between diet and microbial features were explored per cohort, followed by a meta-analysis and heterogeneity estimation.ResultsWe identified 38 associations between dietary patterns and microbial clusters. Moreover, 61 individual foods and nutrients were associated with 61 species and 249 metabolic pathways in the meta-analysis across healthy individuals and patients with IBS, Crohn’s disease and UC (false discovery rate<0.05). Processed foods and animal-derived foods were consistently associated with higher abundances of Firmicutes, Ruminococcus species of the Blautia genus and endotoxin synthesis pathways. The opposite was found for plant foods and fish, which were positively associated with short-chain fatty acid-producing commensals and pathways of nutrient metabolism.ConclusionWe identified dietary patterns that consistently correlate with groups of bacteria with shared functional roles in both, health and disease. Moreover, specific foods and nutrients were associated with species known to infer mucosal protection and anti-inflammatory effects. We propose microbial mechanisms through which the diet affects inflammatory responses in the gut as a rationale for future intervention studies.

statistics from other independent studies 13,17,18 , we identify novel host-microbiota interactions. Furthermore, we explore the impact of potential confounding factors in modulating these genetic effects and identify potential diet-dependent host-microbiota interactions. We further assess the potential causal relationships between the gut microbiome and dietary habits, biomarkers and disease using Mendelian randomization (MR). Finally, we carry out a power analysis showing how microbiome studies, even at the current sample size, are underpowered to reveal the complex genetic architecture by which host genetics regulates the gut microbiome. ResultsGenome-wide associations with bacterial taxa and pathways. We investigated 5.5 million common (minor allele frequency (MAF) > 0.05) genetic variants on all autosomes and the X chromosome using linear mixed models 19 to test their association with 207 taxa and 205 bacterial pathways in 7,738 individuals from the DMP cohort (Methods and Supplementary Table 1) 19 . There was no evidence for test statistic inflation (median genomic lambda 1.002 (range, 0.75-1.03) for taxa and 1.004 (range, 0.87-1.04) for pathways). We identified 37 single nucleotide polymorphism (SNP)trait associations at 24 independent loci at a genome-wide P value threshold of 5 × 10 −8 (Fig. 1 and Supplementary Table 2). Genetic variants at two loci passed the more stringent study-wide threshold of 1.89 × 10 −10 that accounts for the number of independent tests performed (Methods).The strongest signal was seen for rs182549 located in an intron of MCM6, a perfect proxy of rs4988235 (r 2 = 1, 1000 Genomes Project European populations), one of the variants known to regulate the LCT gene and responsible for lactase persistence in adults (ClinVar accession RCV000008124). The T allele of rs182549, which confers lactase persistence through a dominant model of inheritance, was found to be associated with decreased abundances of the species Bifidobacterium adolescentis (P = 7.6 × 10 −14 ) and Bifidobacterium longum (P = 3.2 × 10 −08 ), as well as decreased abundances of higher-level taxa (Supplementary Table 2 (ref. 5 )). Associations at this locus were also seen for other taxa of the same genus but at lower levels of significance (Bifidobacterium catenulatum, P = 3.9 × 10 −5 ) and for species of the Collinsella genus (Extended Data Fig. 1). The genetic association at the LCT locus has been previously described, albeit only at the genus level, in Dutch, UK and US cohorts 6,8,14 , as well as in a recent large-scale meta-analysis 13 .The second locus that passed study-wide significance consisted of genetic variants near the ABO gene. ABO encodes the BGAT protein, a histo-blood group ABO system transferase. Associations found at this locus include species Bifidobacterium bifidum (rs8176645, p = 5.5 × 10 −15 ) and Collinsella aerofaciens (rs550057, P = 2.0 × 10 −8 , r 2 = 0.59 with rs8176645 in 1000 Genomes Project Europeans) and higher-order taxa (rs550057, genus Collinsella, P = 9.3 × 10 −11 ; family Coriobacteriac...

Several gastrointestinal diseases show a sex imbalance, although the underlying (patho)physiological mechanisms behind this are not well understood. The gut microbiome may be involved in this process, forming a complex interaction with host immune system, sex hormones, medication and other environmental factors. Here we performed sex-specific analyses of fecal microbiota composition in 1135 individuals from a population-based cohort. The overall gut microbiome composition of females and males was significantly different (p = 0.001), with females showing a greater microbial diversity (p = 0.009). After correcting for the effects of intrinsic factors, smoking, diet and medications, female hormonal factors such as the use of oral contraceptives and undergoing an ovariectomy were associated with microbial species and pathways. Females had a higher richness of antibiotic-resistance genes, with the most notable being resistance to the lincosamide nucleotidyltransferase (LNU) gene family. The higher abundance of resistance genes is consistent with the greater prescription of the Macrolide-Lincosamide-Streptogramin classes of antibiotics to females. Furthermore, we observed an increased resistance to aminoglycosides in females with self-reported irritable bowel syndrome. These results throw light upon the effects of common medications that are differentially prescribed between sexes and highlight the importance of sex-specific analysis when studying the gut microbiome and resistome.

The gut microbiome is an ecosystem that involves complex interactions. Currently, our knowledge about the role of the gut microbiome in health and disease relies mainly on differential microbial abundance, and little is known about the role of microbial interactions in the context of human disease. Here, we construct and compare microbial co-abundance networks using 2,379 metagenomes from four human cohorts: an inflammatory bowel disease (IBD) cohort, an obese cohort and two population-based cohorts. We find that the strengths of 38.6% of species co-abundances and 64.3% of pathway co-abundances vary significantly between cohorts, with 113 species and 1,050 pathway co-abundances showing IBD-specific effects and 281 pathway co-abundances showing obesity-specific effects. We can also replicate these IBD microbial co-abundances in longitudinal data from the IBD cohort of the integrative human microbiome (iHMP-IBD) project. Our study identifies several key species and pathways in IBD and obesity and provides evidence that altered microbial abundances in disease can influence their co-abundance relationship, which expands our current knowledge regarding microbial dysbiosis in disease.