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Gut Bugs Differ in Chronic Prostatitis
Difference in taxa may aid biomarker, researchers say



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by Wayne Kuznar, Contributing Writer
May 11, 2016

Action Points
SAN DIEGO -- The gut microbiome was altered in men with chronic prostatitis/chronic pelvic pain syndrome (CPPS) versus controls, researchers reported here.
Microbiome processing of fecal matter using next-generation RNA gene sequencing and bioinformatics analyses revealed underrepresentation of several taxa, including Prevotella, in the guts of men with chronic prostatitis/CPPS compared with controls,
according to Daniel Shoskes, MD, from the Cleveland Clinic, and colleagues. Prevotella is a genus of gram-negative bacteria that protects against inflammation. Data from gut microbiome analyses may eventually allow for identification of potential biomarkers and targets of therapy, he reported in a presentation at the American
Urological Association meeting.
In humans, the number of bacterial genes exceeds the number of human genes by a factor of at least 100:1. Further, 60% of the dry weight of feces are bacteria that normally live in humans in states of health.
Molecular techniques are now available to identify bacteria that cannot be identified in culture. "There have been several studies looking for non-cultural bacteria in urine, prostate fluid, and prostate tissue," Shoskes said. "My interpretation of the
results to date is that we have not yet found that smoking gun pathogen...causing this condition. Maybe looking in the urine is looking in the wrong place."
A great deal is known about the normal gut microbiome, he continued, including the presence of a gut-brain axis, which is a bidirectional communication between the gut and the brain that affects mental health, anxiety, and emotions. The gut microbiome
also has known importance in irritable bowel syndrome.
The hypothesis for his group's study was that the gut microbiome would differ between CPPS patients and controls, and that these differences might be reflected at the ecological level (i.e., alpha diversity) and at the individual genus and species level.

They studied 25 patients with symptomatic category III CPPS and a like number of controls who were either asymptomatic or only had lower urinary tract symptoms but no pain. Neither patients nor controls were currently being treated with or were recently
treated with antibiotics. Fecal matter was collected from a digital rectal examination and subjected to microbiome processing using next-generation RNA gene sequencing and bioinformatics analyses using principal coordinate analysis (PCoA),which captures
the diversity of the microbiome, in addition to QIME, LEfSe and PiCRUSt algorithms.
Three-dimensional Unifrac PCoA demonstrated tighter clustering of controls in an area that was distinct from the wider clustering of cases (P=0.001). This analysis correctly predicted cases and controls 88% of the time.
There was statistically significantly reduced alpha diversity in the gut in the patients compared with the controls based on two standard measurements (P=0.001 for both).
Three taxa were overrepresented and one (Prevotella) was significantly underrepresented in cases. "When you look at the individual taxa in the individual patients, you do not see a consistent pattern that one would expect if you were simply knocking out
certain bacteria with antibiotics," Shoskes said.
Differences were also discovered in the taxa of patients with gastrointestinal symptoms and those without such symptoms, as well as for CPPS patients with the neurologic/systemic phenotype.

The bacterial changes "have the potential to impact the metabolome and influence the gut, the brain, and systemic inflammation," he said.
In commenting on the study, J. Curtis Nickel, MD, of Queen's University in Kingston, Ontario, remarked, "the gut, the microbiome is a seeping mass...a biomass...that is still a very big mystery to us. I think it's going to be an interaction between the
gut and the vagina in women, the perineum in men, the urethra, the prostate and the bladder...so the general urinary tract, and the bowel."
Shoskes replied, "What I think is unique about the gut is this proven brain-gut axis...that I don't think we're necessarily going to see with the vagina or with the bladder. I don't know there there's the same crosstalk with the brain. So I think the gut
will remain unique."
A separate presentation by Shoskes' team examined the urinary microbiome in the same set of CPPS patients and controls, and again found significant differences between the cases and controls, as well as between patients with different clinical phenotypes.
In particular, higher counts of Clostridia were found in the cases, with separation sufficient to potentially serve as a biomarker.
Shoskes disclosed relevant relationships with Astellas and Farr Labs.
Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
LAST UPDATED 05.11.2016
Primary Source
American Urological Association
Source Reference: Shoskes D, et al "Analysis of gut microbiome revealse significant differences between men with chronic prostatitis/chronic pelvic pain syndrome and controls" AUA 2016; Abstact PD20-03.
Secondary Source
American Urological Association
Source Reference: Shoskes D, et al "The urinary microbiome differs significantly between patients with chronic prostatitis/chronic pelvic pain syndrome and controls as well as between patients with different clinical phenotypes" AUA 2016; Abstract MP36-
01.


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