An excess of fecal bile acids (BAs) is thought to be one of the mechanisms for diarrhea-predominant irritable bowel syndrome (IBS-D). However, the factors causing excessive BA excretion remain incompletely studied. Given the importance of gut microbiota in BA metabolism, we hypothesized that gut dysbiosis might contribute to excessive BA excretion in IBS-D. By performing BA-related metabolic and metagenomic analyses in 290 IBS-D patients and 89 healthy volunteers, we found that 24.5% of IBS-D patients exhibited excessive excretion of total BAs and alteration of BA-transforming bacteria in feces. Notably, the increase in Clostridia bacteria (e.g., C. scindens) was positively associated with the levels of fecal BAs and serum 7α-hydroxy-4-cholesten-3-one (C4), but negatively correlated with serum fibroblast growth factor 19 (FGF19) concentration. Furthermore, colonization with Clostridia-rich IBS-D fecal microbiota or C. scindens individually enhanced serum C4 and hepatic conjugated BAs but reduced ileal FGF19 expression in mice. Inhibition of Clostridium species with vancomycin yielded opposite results. Clostridia-derived BAs suppressed the intestinal FGF19 expression in vitro and in vivo. In conclusion, this study demonstrates that the Clostridia-rich microbiota contributes to excessive BA excretion in IBS-D patients, which provides a mechanistic hypothesis with testable clinical implications.

Reference values for peripheral blood lymphocyte subsets of healthy children in China To the Editor: Immunophenotyping of peripheral blood lymphocyte subsets can provide important information for the diagnosis and treatment of immunological and hematological disorders. Lymphocyte compartments undergo dramatic changes during childhood; age-matched reference values derived from healthy individuals are crucial and have been evaluated in various ethnic populations. 1-5 However, extensively detailed immunophenotyping reference values of peripheral blood lymphocytes in whole spectrum of childhood are rare. Our aim was to determine the relative and absolute numbers of lymphocyte subpopulations in healthy Chinese children from birth to age 18 years. We recruited 1075 Chinese children (604 males and 471 females) who were grouped into 7 categories according to age: group 1, 0 to 28 days; group 2, 1 to 6 months; group 3, 6 to 12 months; group 4, 1 to 4 years; group 5, 4 to 8 years; group 6, 8 to 12 years; and group 7, 12 to 18 years. Whole blood was used and staining for lymphocyte surface markers was performed after red cell lysis, according to a standard flow cytometric multicolor protocol. A total of 20 subpopulations were examined: T cells (CD45 1 SSC low CD3 1), CD4 T cells (CD45 1 SSC low CD3 1 CD4 1), CD8 T cells (CD45 1 SSC low CD3 1 CD8 1), B cells (CD45 1 SSC low CD19 1), natural killer cells (CD45 1 SSC low CD3 2 CD56 1 /CD16 1), TCRab 1 double-negative T (DNT) cells TABLE I. Distribution of the percentage of total T and B cells and their subsets by age and sex in the peripheral blood of 1075 healthy children (%) Subset Sex Group 1 0-28 d (n 5 21) Group 2 1-6 mo (n 5 104) Group 3 6-12 mo (n 5 97) Group 4 1-4 y (n 5 289) Group 5 4-8 y (n 5 271) Group 6 8-12 y (n 5 158) Group 7 12-18 y (n 5 135)

The epidemiological characteristics of Sjögren syndrome (SS) are significantly varied in different countries. We conducted the present study to survey the epidemiological characteristics of primary SS in China. We recruited 483 primary SS patients from 16 Chinese medical centers nationwide from January 2009 to November 2011 and assessed salivary and lacrimal gland dysfunction, organ involvement, and autoimmunity in these patients. The cohort included 456 women and 27 men (ratio, 17:1; mean age at onset, 42 ± 11 years; median age at diagnosis, 49 years; range, 41–56 years). Male patients showed a lower frequency of xerophthalmia (37.0% vs 60.7%) and a higher frequency of arthritis (40.7% vs 16.4%). Young-onset patients showed a higher frequency of low C3 levels (57.7% vs 36.3%) and pancytopenia (22.2% vs 8.8%). Patients with systemic involvement had a higher frequency of immunoglobulin A (IgA) (39.4% vs 22.5%) and immunoglobulin M (IgM) (12.4% vs 37.9%). Patients with pulmonary involvement had a higher parotid enlargement (21.4% vs 10.2%), purpura (12.1% vs 5.7%) and higher anti-La/SS-B (61.7% vs 41.8%), immunoglobulin G (IgG) (80.7% vs 64.6%) and IgA (48.9% vs 30.6%) levels. Patients with anti-Ro/SSA antibodies had more frequent exocrine gland symptoms and some extraglandular symptoms and immunological alterations. Compared with previous studies performed in other countries, SS patients in China showed particular clinical manifestation, systemic involvement, and immunological alterations.