CHAPTER 2 DNA based human gut microbial diversity of Lean, Normal, Obese, and Surgically treated-Obese Indian Individuals - 22 - 2.1. Introduction World over 1.6 billion adults are overweight and 400 million adults are obese (World Health Organization 2005). Developing nations such as India are no exception. A recent analysis has identified an alarming prevalence of obesity in one of the metro cities of the country [1]. Due to the associated disorders such as atherosclerosis [2], hypertension [2,3], type 2 diabetes[4], and certain form of cancers[5], obesity has affected life expectancy at higher magnitudes. Genetic basis of this outbreak is well disputed, as the human genome is substantially unchanged over decades [6]. Among the newest explanations, rising prevalence of contemporary obesogenic environmental factors [7,8] is the most accepted. These factors usually promote uncontrolled food intake and discourage physical activity. Gut is recognized as an organ contributing to human health and physiology due to its role in endocrine control of food intake, digestion, and assimilation [9]. Its contribution to energy homeostasis has been recently identified [10]. Gut hormones such as ghrelin, PYY, and CCK effectively control appetite and satiety thereby regulating food intake [10] and energy input. Apart from gut hormones and digestive enzymes, it harbors a diverse array of microorganisms, which participate in digestion and many other crucial functions such as regulation of immunity [11], stimulation of angiogenesis [12], intestinal cell proliferation and differentiation [13], inflammatory immune response [14], and vitamin supplementation [15]. The recent discovery of association of gut bacteria with fat storage [16] and obesity [17] has been a milestone in the field of human physiology. Obese gut microbiome exhibits an enhanced efficiency to harvest energy from diet; furthermore, this phenomenon is demonstrated to be transmissible [18]. Weight loss program in obese humans induces a comparative increase in bacteria of phylum Bacteroidetes with significant reduction in phylum Firmicutes [19], although, researchers failed to see such an observation in another community [20]. It is noteworthy that, both the studies were performed independently but with different approaches. Similar contradictory observations were also reported from another community wherein higher weight loss displayed an increase Bacteroides-Prevotella group with a simultaneous decline in butyrateproducing bacteria [21], however, these observations were diet dependent. Among the existing diversity within gut microbiota, no study has yet identified any specific bacteria augmenting or abating obesity. However, an increase in bacteria of genus - 23 - Bacteroides was recently correlated to excessive weight gain during pregnancy, which is another proposed model of obesity [22]. Bariatric surgery is one of the majorly sought remedies[23] for morbid obesity. SG and AGB are two forms of restrictive bariatric surgery, which reduce the effective volume of stomach leading to early satiety and reduced caloric intake without affecting absorption of the digested food [24]. Gastric bypass surgery or Roux-en-Y procedure is another approach, which is an invasive and malabsorptive surgery. In this surgery, a small pouch of stomach is created from fundus of the stomach, which is connected to the mid-jejunum to form a proximal gastric pouch. The distal stomach and proximal small intestine are thus completely bypassed. Zhang et al [25] recently described fecal microbiota after gastric bypass anti-obesity surgery. Firmicutes were reported to be higher in normal and obese individuals in comparison to post-gastric bypass individuals. However, effects of SG and AGB on gut microbiota are not well studied and such a comparison could assist to unveil a discrete relationship between obesity and gut bacteria. Furthermore, a comparison of gut microbiota of lean individuals with that of normal, obese, and surgically treated individuals could substantiate the association of gut microbiota with obesity. To identify obesity-associated bacteria, recent studies largely focused on diet-based control models of obesity, but lean individuals and individuals who have undergone bariatric surgery have not been properly investigated. Here, we report analysis and comparison of 16S rRNA gene libraries based fecal microbiota from lean, normal, obese, and treated-obese (SG and AGB) individuals. Post-identification of dominant bacterial genera across the three groups, we quantified these genera or groups across 20 individuals classified based on BMI using real-time PCR. 2.2. Materials and Methods Flow of the methodologies adopted is shown in the flowchart given in Figure 2.1. 2.2.1. Collection of samples Early morning fecal samples were collected from unrelated healthy individuals (25-50 years-old) irrespective of gender (Table 2.1). Individuals were classified based on their BMI into lean (14-19 kg/m2, n=5 with low body fat percentage, LI), normal (2024 kg/m2, n=5, N), Obese (25-53 kg/m2, n=5, O), and treated-obese (25-36 kg/m2, n=5, - 24 - T, Obese individuals regressing to normal BMI after restrictive type surgeries, which primarily reduce stomach size; SG and AGB) groups. Individuals who had not used antibiotics, pre- or probiotics within the last 3 months preceding fecal sampling and who were not ill at the time of sampling were included in the present study. All the fecal samples were stored at 4°C and transported to laboratory in ice. The samples were either processed immediately or stored at -80°C until processed. All the fecal donors volunteered for the study, which was approved by the local hospital ethical committee of Ruby Hall Clinic, Pune. Fecal Sample Total DNA isolation 16S rRNA gene fragment amplification PEG purification/gel elution Agarose gel electrophoresis Ligation Agarose gel electrophoresis Agarose gel electrophoresis Real time PCR based quantification Transformation Colony PCR Library construction Bioinformatics analysis Sequencing Figure 2.1 | Flow of methodologies adopted for the study. - 25 - S. No. Sample ID# Gender & Age (in years)$ BMI before surgery (kg/m2)* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 LI1 LI2 LI3 LI4 LI5 N1 N2 N3 N4 N5 O1 O2 O3 O4 O5 T1 T2 T3 T4 T5 M27 M22 F21 M23 F24 M49 M45 M44 M28 F25 F42 F45 M41 M50 M49 F30 M42 F50 M62 F52 NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 37.65 40.68 39.35 45.18 36.12 BMI at the time of sample collection (kg/m2) 17.54 18.09 16.03 15.82 14.81 24.00 23.00 23.00 24.80 23.00 44.10 52.80 51.20 35.00 40.00 32.05 28.09 34.48 35.86 27.68 Body fat percentage¥ Surgical treatment§ Time required for weight loss (in days) † 17.80 18.70 21.66 12.04 19.06 ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA SG SG SG AGB AGB NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 93 196 104 371 278 Table 2.1 | Details of participating individuals understudy. #Each participating individual was given a sample ID, where LI=Lean, N=Normal, O=Obese, T=Surgically Treated-Obese. $M=Male, F=Female; the following two digit number is age (in years). *BMI before surgery, applicable to obese individuals, who underwent anti-obesity surgeries; NA=Not Applicable. ¥Body fat percentage was calculated using OMRON body fat analyzer (Fig. 2.2); ND= Not Determined. †§Only applicable to Surgically Treated-Obese; AGB= Adjustable Gastric Banding, SG=Sleeve Gastrectomy; NA=Not Applicable. 2.2.2. Assessment of BMI and leanness To assess leanness, body fat percentage was determined using OMRON HBF-306C hand-held body fat analyzer (OMRON HEALTHCARE INC., Illinois, USA) (Figure 2.2) as in reference 60. BMI was determined for all the individuals using the following formula: BMI = Weight in kg Height in meters square - 26 - Figure 2.2 | OMRON hand-held body fat analyzer. It works on the principle of Bioelectrical Impedance. Muscles, blood vessels, and bones due to their high water content conduct electricity easily. However, body fat has little electric conductivity. The body fat analyzer sends an extremely weak electrical current of 50 kHz and 500 µA through the body to determine the amount of fat tissue. This weak electrical current is not felt during the operation of the instrument. The Bioelectrical Impedance method safely combines electric resistance with the distance of the electricity conducted. Correct posture and consistent measuring conditions need to be maintained for the best results. 2.2.3. Fecal DNA extraction Total fecal DNA was extracted from each fecal sample using QIAamp DNA Stool Mini Kit (Qiagen, Cat#51504). An additional step of bead beating was performed using autoclaved silica beads of diameter 0.1, 0.2, and 0.5 mm. Purified DNA samples were analyzed by agarose gel electrophoresis and concentrations were estimated by Nanodrop (Thermo Scientific, USA). 2.2.4. Construction of 16S rRNA gene libraries and DNA Sequencing To assess the total gut microbial diversity, 16S rRNA gene fragment library was constructed for each sample individually. To avoid failure of PCR reactions due to potential fecal inhibitors, we performed PCR amplifications for 16S rRNA gene fragment using serially diluted DNA samples. The highest dilution producing maximum yield of PCR product was further used. For each DNA sample five replicates of 25 µl PCRs were set, each containing approximately 1X Thermopol Buffer (NEB), 1 unit of Taq Polymerase (NEB), 200 µM dNTPs, 200 µM concentration of 8F-I (5’-GGA TCC AGA CTT TGA TYM TGG CTC AI-3’) and 907R-I (5’-CCG TCA ATT CMT TTG AGT TI-3’) primers[26]. Cycling conditions were 95°C for three minutes, followed by 20 cycles of 95°C for ten seconds, 53°C for forty-five seconds, and 72°C for one minute, with a final extension of 20 minutes at 72°C. Replicate PCRs were pooled together. The resulting amplicons (approximately 900 bp) were gel-purified using gel extraction kit (Qiagen, Cat#28704) and were cloned into pGEM-T vector (Promega), followed by chemical transformation into E. coli DH5α (Invitrogen). Extraction controls (no fecal material added) did not produce detectable PCR products or colonies. For each sample, 192-384 colonies positive for the cloned amplicons were bi-directionally sequenced with vector-specific primers (M13F 5’- 27 - GTA AAA CGA CGG CCA G-3’ and M13R 5’-CAG GAA ACA GCT ATG AC-3’) using BigDye™ Terminator Cycle Sequencing Ready Reaction Kit v3.1 (ABI, Cat#4337457) in an automated 3730 DNA analyzer (ABI). 2.2.5. Sequence analysis The flow of methodologies adopted for sequence analysis is shown in Figure 2.3. Base-calling for each sequence read was performed using PHRED [27]. Forward & reverse (A) (B) Figure 2.3 | Flow of code for 16S rRNA gene sequence assembly and analysis. (A) Flow of the program code for assembly of forward and reverse trace files (ab1 format) into contig and singles. (B) Flow of analysis for 16S rRNA gene fragment library. sequences for each clone were assembled using CAP3 [28]. Sequences were converted to sense orientation using OrientationChecker [29], aligned in ClustalX [30], and screened for chimeras with Mallard [29]. Non-chimeric sequences above 300 bases were analyzed for nearest neighbors using BLAST based SEQMATCH tool at RDP-II (version 10.9) [31] database. To represent a pictorial distribution of phyla or genera in - 28 - various libraries, an algorithm was developed in Visual Basic 6.0 (Programming tool from Microsoft Corporation, USA) to produce a colored grid of blocks representing the percentage of sequences identified in the library. The intensity of red color is proportional to the dominance of the identified bacteria. A scale of distribution of sequences from 0 to 100% and the color pattern is placed adjacent to every distribution image. For estimation of OTU richness and microbial diversity, distance matrix was generated using DNADIST from Phylip 3.68 package[32], and operational taxonomic units (OTUs) were determined by 97% sequence similarity by the furthestneighbor method in DOTUR 1.53[33]. Non-parametric species richness estimates were also determined using the Abundance-based coverage estimator (ACE) and Chao I estimator at a distance of 0.03. Library comparison was performed using ∫-LIBSHUFF [34]. All the non-chimeric sequences were deposited to NCBI’s GenBank database (refer Appendix 1). Phylogenetic relationship between sequences was determined by Neighbor-joining method. Neighbor-joining tree was constructed with 1000 bootstrap and Kimura-2 parameter as a model of nucleotide substitution in MEGA4 [35]. 2.2.6. Quantification of bacteria and archaea Quantification of bacteria and archaea was performed by real-time PCR assays on 7300 Real-Time PCR system (ABI) using 2X Power SYBR green master mix (ABI, Cat#4368708) or 2X TaqMan® Universal PCR Master Mix (ABI, Cat#4351891) for Taqman probe based assays. Primer and probe details are given in Table 2.2. A 10fold dilution series of pCR4-TOPO vector with respective 16S rRNA gene fragment was used to generate standard curves. All the DNA samples were assayed in triplicates. - 29 - Domain/Phylum/Genus Eubacteria* Archaea* Bacteroidetes* Firmicutes* Bacteroides† Butyrate-producing bacteria* Primers Eub338 (5’-ACT CCT ACG GGA GGC AGC AG-3’) Eub518 (5’-ATT ACC GCG GCT GCT GG-3’) 931f (5’-AGG AAT TGG CGG GGG AGC A-3’) m1100r (5’-BGG GTC TCG CTC GTT RCC-3’) Cfb319 (5’-GTA CTG AGA CAC GGA CCA-3’) Eub518 (5’-ATT ACC GCG GCT GCT GG-3’ ) Lgc353 (5’-GCA GTA GGG AAT CTT CCG-3’) Eub518 (5’-ATT ACC GCG GCT GCT GG-3’) HuBac566f (5’-GGG TTT AAA GGG AGC GTA GG3’) HuBac692r (5’-CTA CAC CAC GAA TTC CGC CT-3’) HuBac594Bhqf(5’-(FAM) TAA GTC AGT TGT GAA AGT TTG CGG CTC (TAMRA)-3’) BCoATscrF (5’-GCI GAI CAT TTC ACI TGG AAY WSI TGG CAY ATG-3’) BCoATscrR (5’-CCT GCC TTT GCA ATR TCI ACR AAN GC-3’) Reference [36] [37] [38] [36] [38] [39] Table 2.2 | Details of the primers and probes used in this study. * SYBR green-based assay; † Taqman probe based assay. 2.2.7. Statistical analysis To determine correlation between BMI and various phyla, genera or gene distribution, non-parametric Spearman's Correlation Coefficient was determined using 2-tailed test of significance in Graphpad Prism 5.01 software. For statistical comparison of values between two groups, unpaired t-test with Welch’s correction was employed. 2.2.8. Proteome comparison Proteome comparison of the dominant and available bacterial genomes, and the human genome was carried out at the CAZy database (http://www.cazy.org). Functional classification of the proteomes was assessed using the assigned COG terms (http://www.ncbi.nlm.nih.gov/cog.cgi) in the available genomes for carbohydrate metabolism and on functional proteome classifier from TIGR database (http://www.tigr.org). - 30 - 2.3. Results and Discussion 1 2 1 2 3 4 5 6 7 8 9 10 11 12 13 (B) (A) 1000 bp 850 bp ~900 bp 1 2 3 4 5 6 7 8 9 10 11 12 1000 bp 850 bp 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 (C) 1250 bp 1000 bp 1250 bp 1000 bp ~900 bp Figure 2.4 | Representative gel image for isolated fecal DNA, 16S rRNA gene fragment PCR, and Colony PCR. (A) Isolated fecal DNA. Arrow indicates smear of bacterial genomic ~1100 bp DNA. (B) Low cycle PCR amplified 16S rRNA gene fragments from isolated fecal community DNA. Upper panel: Lane 1- Negative control, 21 kb plus DNA ladder (Invitrogen), 3 to 7-LI1 to LI-5, 8 to 12 N1 to N5 and 13- E. coli genomic DNA positive control. Lower panel: Lane 1Negative control, 2-1 kb plus DNA ladder (Invitrogen), 3 to 7-O1 to O5, 8 to 12-T1 to T5. (C) Colony PCR for assaying insert containing clones. Upper panel: Lane 1-1 kb plus DNA ~1100 bp ladder (Invitrogen), 2 to 6- clones from LI-1, 7 to 10- clones from N1 and 11-15- clones from O1. Lower panel: Lane 1-1 kb plus DNA ladder (Invitrogen), 2 to 6- clones from T1, 7 to 10clones from LI-2 and 11-16- clones from O2. 2.3.1. Clone libraries & Classification of clones Representative gel images are presented in Figure 2.4 for the extracted DNA quality (A), 16S rRNA gene fragment PCR amplification (B), and confirmation of inserts in some of the 16S rRNA gene libraries in pGEM-T vector (C). 192-384 clones were sequenced and analyzed from each sample in lean, normal, obese, and treated-obese groups. Low quality sequence trace files were automatically discarded and more than 50% of the sequence trace files assembled into contigs in most of the libraries. Sequences failing to assemble with the counterpart reverse sequence were identified as singlets. Table 2.3 shows sequence assembly details. Further analysis was carried out with the identified non-chimeric and long sequences (>300 bases). Otherwise, - 31 - chimeric and smaller sequences were discarded. Identification and classification of sequences was done using SEQMATCH tool at database RDP-II. All the taxonomic assignments were confirmed by phylogenetic analysis (Appendix 3). S. No. Library Singlets∫ Assembled Contigs† Total Sequences‡ 1 LI1 19 274 293 2 LI2 51 180 231 3 LI3 19 284 303 4 LI4 52 174 226 5 LI5 41 205 246 6 N1 36 131 167 7 N2 12 133 145 8 N3 23 136 159 9 N4 9 172 181 10 N5 11 161 172 11 O1 45 81 126 12 O2 16 162 178 13 O3 28 108 136 14 O4 31 102 133 15 O5 24 76 100 16 T1 6 180 186 17 T2 9 171 180 18 T3 13 156 169 19 T4 13 159 172 20 T5 15 154 169 Total Sequences 3672 Table 2.3 | Sequence assembly summary. The table represents summary of sequence assembly carried out using the bioinformatics pipeline shown in Figure 2.3A. ∫Sequences (either forward or reverse) which failed to assemble with its other partner due to low sequence quality or short length; †Formed by assembly of forward and reverse sequences for a clone; ‡Sum of Contigs and Singlets. 2.3.2. Estimation of OTU richness & Library comparison As evident from Table 2.4, human gut microbial community shows a great species richness. Total number of OTUs in each library was estimated using the non- parametric estimators Chao1 and ACE utilizing the DOTUR program. Both the estimators project a high OTU number in each library. So an additional sampling or deeper sequencing would be needed to capture the difference between the observed number of OTUs and the Chao1 or ACE estimates as shown by the rarefaction curves (Figure 2.5). No rarefaction curve reached an asymptote and despite of a higher sequence number in some libraries such as the lean ones, the number of OTUs continued to increase at 3% (species level). These observations warrant the need of - 32 - additional sampling to determine the existing microbial diversity in the microbial community of human intestine. Diversity indices such as Shannon index and Libraries Lean Normal Obese TreatedObese LI-1 LI-2 LI-3 LI-4 LI-5 N1 N2 N3 N4 N5 O1 O2 O3 O4 O5 T1 T2 T3 T4 T5 Observed OTU's 30 53 63 26 66 37 25 22 36 63 29 44 25 22 50 33 55 46 78 43 Richness estimators ACE Chao I 60.48 45.60 76.82 64.88 120.10 103.10 57.74 42.50 118.10 122.10 64.31 54.00 35.54 29.00 78.49 67.33 60.87 58.67 111.00 107.00 45.43 38.75 63.50 63.00 58.63 46.00 22.36 22.00 270.80 186.70 59.96 63.00 250.80 211.00 74.08 69.00 172.10 137.40 91.97 80.50 Diversity indices Shannon (H) Simpson (1-D) 2.5020 0.1212 3.3013 0.0636 3.0537 0.0937 2.4989 0.1088 3.5338 0.0463 3.2777 0.0403 2.6200 0.1153 1.0658 0.6467 2.8924 0.0919 3.6737 0.0369 2.8442 0.0775 3.0723 0.0918 2.1740 0.2353 2.6563 0.1047 3.6865 0.0217 2.6815 0.1145 3.1267 0.0809 2.8881 0.1189 3.8024 0.0475 2.8849 0.1043 Table 2.4 | Distance-based OTUs, Species richness estimates, and Diversity indices. OTU grouping is reported at 0.03 level, which refers to 3% distance and corresponds to the bacterial species level. - 33 - Figure 2.5 | Rarefaction curves calculated with the program DOTUR. Simpson’s diversity indices were also determined. No trend or correlation was observed between the bacterial diversity and BMI or a particular group, which is contradictory to an earlier report [19], wherein obesity is reported to be associated with reduced bacterial diversity. Library comparison was done using ∫-LIBSHUFF to determine whether differences in 16S rDNA sequence libraries are due to underlying variability in the microbial populations or any artifacts of population sub-sampling. Most of the libraries were significantly different from each other (P<0.05) (Table 2.5) and the data showed that each individual has a unique gut microbial community in agreement with previous reports about the individuality of human gut microbiota. Interestingly, except T1, all the surgically treated-obese individuals exhibited bacterial sequences from lean, normal and obese groups, which is described by insignificant P value (P>0.05, highlighted in Table 2.5). Individual T1, who has undergone Surgical Gastrectomy just 93 days prior to sample collection, displayed a unique gut microbiota. Therefore, according to the libshuff analysis, surgery-mediated weight loss displays an associated microbiota change especially towards the individuals of lean and normal group. These individuals showed bacterial sequences from obese group too, as no - 34 - individual has regressed to normalcy completely (refer Table 2.1) and were classified in the moderate obesity class at the time of sample collection. SG and AGB effectively reduced stomach volume thereby reducing the food intake and regulation of gut hormones expression. Therefore, the role of gut hormones and the amount of food ingested cannot be ignored in determining the host-gut microbiota profile and obesity. - 35 - LI1 LI2 LI3 LI4 LI5 N1 N2 N3 N4 N5 O1 O2 O3 O4 O5 T1 T2 T3 T4 T5 LI1 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 1.000 0 1.000 0 1.000 0 1.000 0 LI2 0.003 6 0.000 0 0.000 1 0.000 0 0.000 0 0.024 6 0.002 6 0.013 3 0.000 0 0.000 0 0.000 0 0.102 3 0.000 0 0.000 0 0.000 0 1.000 0 1.000 0 1.000 0 1.000 0 LI3 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.006 3 0.000 0 0.952 2 0.000 0 0.999 7 1.000 0 1.000 0 1.000 0 LI4 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 9 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.999 4 1.000 0 1.000 0 1.000 0 LI5 0.005 8 0.000 0 0.000 0 0.000 0 0.134 2 0.402 7 0.000 8 0.001 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 1 0.000 0 0.999 6 1.000 0 1.000 0 1.000 0 N1 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.024 9 0.000 9 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.980 2 1.000 0 1.000 0 1.000 0 N2 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.282 4 0.004 3 0.000 0 0.000 0 0.000 0 0.008 9 0.000 0 0.000 0 0.000 0 0.850 8 1.000 0 1.000 0 1.000 0 N3 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 9 0.000 0 0.000 0 0.000 0 0.500 8 1.000 0 1.000 0 1.000 0 N4 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.014 1 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 1.000 0 1.000 0 1.000 0 1.000 0 N5 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 5 0.000 5 0.000 1 0.000 6 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 1.000 0 1.000 0 1.000 0 1.000 0 O1 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.024 4 0.000 5 0.000 0 0.000 0 0.168 1 0.000 0 0.000 0 0.000 0 0.999 0 1.000 0 1.000 0 1.000 0 O2 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 2 0.000 0 0.000 0 0.000 0 0.181 1 0.000 0 0.363 4 0.000 0 1.000 0 1.000 0 1.000 0 1.000 0 O3 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 1 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.908 5 1.000 0 1.000 0 1.000 0 O4 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 1 0.000 0 0.000 0 0.002 6 0.000 0 1.000 0 1.000 0 1.000 0 1.000 0 O5 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 1 0.000 1 0.000 7 0.000 6 0.000 0 0.000 0 0.000 0 0.031 4 0.000 0 0.000 5 0.990 0 1.000 0 1.000 0 1.000 0 T1 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 1 0.000 0 0.317 0 0.413 4 1.000 0 1.000 0 1.000 0 T2 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 1.000 0 1.000 0 1.000 0 T3 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.003 5 1.000 0 1.000 0 T4 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 1.000 0 1.000 0 T5 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 0.000 0 1.000 0 1.000 0 - - 36 - Table 2.5 | ∫-LIBSHUFF comparison of 16S rRNA gene fragment libraries. The values in the table represent P values for ΔCXY of homologous library X and heterologous library Y (lower triangle) and ΔCYX of homologous library Y and heterologous library X (upper triangle). Two libraries are distinct if both pair wise comparisons (ΔCXY and ΔCYX) are statistically significant. If ΔCXY is statistically significant (in the lower triangle of the matrix) but ΔCYX is not (in the upper triangle), then library Y is a subset of library X. Library X is a subset of library Y in the opposite situation. Insignificant P values are highlighted grey. - 37 - Library/Total Total nonchimeric sequences Percent BLAST hits with Culturable & Unculturable bacterial reference sequences (at RDP-II) Percent BLAST hits with Culturable & typed bacterial isolate reference sequences (at RDP II) >97%£ <97%¥ >97% <97% L1 282 279 3 220 62 L2 218 211 7 160 58 L3 291 291 0 192 100 L4 218 217 1 159 59 L5 Total(L) 236 1245 227 9 20 154 82 361 N1 95 94 1 91 4 N2 98 96 2 88 10 N3 140 136 4 130 10 N4 162 160 2 146 16 N5 Total(N) 166 661 154 12 21 80 86 126 O1 100 98 2 88 12 O2 153 147 6 126 27 O3 102 100 2 98 4 O4 91 88 3 70 21 O5 Total(O) 71 517 63 8 21 40 31 95 T1 178 176 2 161 17 T2 175 161 14 139 36 T3 164 157 7 139 25 T4 166 135 31 43 123 T5 Total(T) Total Sequences (L+N+O+T) 164 847 150 14 68 140 24 225 3270 Table 2.6 | BLAST hit summary. The table represents summary of SEQMATCH tool based percentage BLAST hits to the deposited unculturable and culturable bacterial isolate sequences at RDP-II. £Sequence homology above 97% denotes similarity at species level. ¥Sequence homology below 97% denotes novel species. - 38 - Figure 2.6 | Phylum based comparison. The heat map describes the percentage distribution of fecal microbiota across the subjects understudy. Individuals are represented in top portion of the map and the obtained phyla are indicated at the extreme left. 2.3.3. Comparative microbial composition at Phylum, Genus, and Species level Microbial composition was determined using SEQMATCH tool at RDP-II database. SEQMATCH-based BLAST hit summary is presented in Table 2.6. Phylum based comparison is shown in Figure 2.6. At phylum level, all the individuals exhibited a dominance of bacteria of phyla, Bacteroidetes and Firmicutes, which corroborates with earlier reports [17,19,40]. Additionally, phyla such as Proteobacteria and Actinobacteria were also recorded but in less numbers. Some of the sequences referred to as “unclassified bacteria” remained unidentified, which could be putative novel bacteria. At phylum level, no defined distribution of these bacteria was seen based on the percentage distribution of sequences (Figure 2.6). However, RT-PCR based quantification of Firmicutes 16S rRNA gene copies demonstrates a positive correlation (Figure 2.7, P=0.0285, Spearman’s r=0.4895) with BMI, which substantiated an earlier report [19]. - 39 - Figure 2.7 | Real-time PCR based assessment of the dominant phyla. The graph presents real-time PCR based distribution of Bacteroidetes (P=0.7886, Spearman’s r=0.06403) and Firmicutes (P =0.0373, Spearman’s r=0.4684) 16S gene copies are normalized to the quantity of input DNA and BMI of the individuals understudy. Linear regression is also shown. Differences in bacterial distribution were clearly illustrated by the comparison of 16S rRNA gene libraries at genus level (Figure 2.8). All the individuals exhibited a variety of genera. Although, Prevotella genus dominated the libraries, bacteria of genus Bacteroides were seen to be dominant in obese and SG treated-obese individuals in comparison to normal and lean except L3 (For representative closest Culturable isolate BLAST hits, please refer Appendix 2). This was confirmed by means of RT-PCR (Figure 2.9), which demonstrated a positive correlation between Bacteroides distribution and BMI. These well-known bacteria have numerous beneficial and adverse effects on human health [41]. Their large genomes encompass an enriched set of enzymatic machinery for digestion of indigestible carbohydrates [39]. These are efficient polysaccharide (cellulose, - - 40 - Figure 2.8 | Genus based comparison. The heat map describes the percentage distribution of fecal microbiota across the subjects understudy. The intensity of red color represents the extent of distribution. - 41 - Figure 2.9 | Real-time PCR based assessment of Bacteroides genus. The graph presents real-time PCR based percentage distribution of Bacteroides (P =0.0020 Spearman’s r=0.6491) 16S gene copies and BMI of the individuals understudy. Linear regression is also shown. Table 2.7 | Utilization of polysaccharide substrates among Bacteroides spp. (Adopted from reference 62) - 42 - Figure 2.10|Proteome involved in Carbohydrate metabolism. Large numbers of glycoside hydrolases are present in the bacteria of genus Bacteroides. L.=Lactobacillus, B.=Bacteroides, Bi.=Bifidobacterium, and H.=Homo. hemicellulose, starch and pectin) foragers (refer Table 2.7 and Figure 2.10). Surprisingly, some Firmicutes also show an enriched set of glycoside hydrolases, e.g., Eubacterium rectale [18]. However, we did not find dominance of this bacterium in any of the obese individuals under study. Interestingly, Bacteroides were earlier correlated to weight gain and diabetes in pregnant women [22] and in diabetes prone rats [42], respectively. These bacteria are also shown to be associated with ulcerative colitis [42,43]. Moreover, some of the Bacteroides species produce faecapentaenes [44], which is a potent in vitro mutagen. Butyrate-producing bacteria such as Faecalibacterium were seen in low but comparatively higher percentages in the normal gut in comparison to the others. These bacteria actively participate in butyrate synthesis, which acts as an energy source for colonocytes and is known to exhibit beneficial effects on gut health [45]. Faecalibacterium prausnitzii is shown to have anti-inflammatory properties and epidemiology of Crohn’s disease [46]. Reduced levels of this bacterium and lower levels of butyrate in the obese may put them at risk of inflammatory disorders of GIT. Some lean and almost all the obese individuals exhibited dominant presence of the bacteria of family Ruminococcaceae, which remain unclassified and unidentified. Many - 43 - other species belonging to genera, "Lachnospiraceae Incertae Sedis", Veillonella, Streptococcus, Ruminococcus, Porphyromonas, Parabacteroides, Mitsuokella, Megamonas, Eubacterium, and Coprococcus were also found in the individuals understudy but in low abundance. For the list of identified closest Culturable reference bacterial isolate sequences please refer Appendix 4. 2.3.4. Archaeal distribution To assess the distribution of archaea in the groups understudy, RT-PCR based assay was carried out. As reported earlier [25,47], a significantly high archaeal density was observed in obese individuals, however, treated-obese showed a significant decrease (Figure 2.11). Figure 2.11|Distribution of archaeal 16S rRNA gene copies among the groups under study. The graph presents real-time PCR based distribution of Archaeal 16S rRNA gene copies in the groups understudy. Linear regression is also shown (*P=0.0341 #P=0.0596). Normal and lean individuals showed a very low Archaeal DNA amplification with some individuals showing no amplification at all. Methanobrevibacter smithii, a predominant methanogenic archaeon of human gut [48], produces elevated amounts of SCFAs (especially acetate and propionate) in consortium with Bacteroides thetaiotaomicron. This disturbs energy balance leading to increased adiposity in mice [47]. Especially, propionate is gluconeogenic [49] and acetate stimulates hepatic de novo lipogenesis [47]. Such a phenomenon can also be speculated in the human subjects understudy. In the obese individuals understudy, the dominance of H 2 producing and polysaccharide - 44 - foraging bacterial species such as Prevotella [50,51] and Bacteroides [25,47], along with methanogenic archaea results in increased glucose and SCFA supply, thereby leading to perturbations in the host metabolism. Elevated glucose levels with increased adiposity are renowned hallmarks of obesity [5,25]. Comparatively lower occurrences of bacteria of genus, Bacteroides and domain, Archaea in lean, normal, and treated-obese individuals indicate a reversal of above discussed alteration in metabolism, thereby leading to a normal or restoring BMI. 2.4. Conclusions 1. Human gut of Indian origin is dominated by the bacteria of Phyla, Bacteroidetes and Firmicutes. 2. Every individual has a unique and personalized microbiota. 3. At phylum level, Firmicutes seem to correlate with BMI. 4. Obese individuals show an increased prevalence of bacteria of genus, Bacteroides and domain, archaea. Treated-obese individuals with regressing BMI, who have undergone surgical intervention, exhibited reduced Bacteroides sequences and archaeal population. 5. Based on diversity indices, there seems to be no difference in the microbial diversity among the groups under study. 6. Bacteria of Genus Prevotella dominated the gut microbial diversity in the individuals understudy with a variable percentage of other bacterial species found in human gut. - 45 - 7. Many sequences in each library remained unclassified at various taxonomic levels, which indicate existence of novel bacteria, bacterial genera, and bacterial species in the Indian gut. 2.5. References 1. Deepa M, Farooq S, Deepa R, Manjula D, Mohan V: Prevalence and significance of generalized and central body obesity in an urban Asian Indian population in Chennai, India (CURES: 47). Eur J Clin Nutr 2009, 63: 259-267. 2. 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