title: The duodenal microbiota composition of adult celiac disease patients is associated with the clinical manifestation of the disease.
abstract: BACKGROUND
  Celiac disease is classically manifested in the gastrointestinal (GI) tract but extraintestinal symptoms, such as dermatitis herpetiformis (DH), are also common. Besides several well-known shared genetic risk factors and an environmental trigger, gliadin, factors determining the clinical outcome of the disease are not known. In this study, the role of duodenal microbiota in the celiac disease outcome was studied by analyzing mucosa-associated microbiota in celiac disease patients with a variety of intestinal and extraintestinal symptoms.
  
  
  METHODS
  Microbiota in duodenal biopsy samples obtained from 33 patients with celiac disease with GI, DH, anemia, or mixed symptoms, as well as screen-detected asymptomatic celiac disease and 18 control subjects were analyzed using PCR denaturing gradient gel electrophoresis and a subset of samples additionally by the 16S ribosomal RNA gene sequencing.
  
  
  RESULTS
  The composition and diversity of mucosal microbiota was associated with the manifestation of celiac disease when analyzed using PCR denaturing gradient gel electrophoresis and the 16S ribosomal RNA gene sequencing. The patients with celiac disease with GI symptoms or anemia had lower microbial diversity than those with DH. Moreover, the patients with GI symptoms had different intestinal microbiota composition and structure, dominated by Proteobacteria, in comparison to those with DH or control subjects (patients with dyspepsia). The relatively similar intestinal microbiota composition in the control subjects and those with DH was characterized by the high abundance of Firmicutes.
  
  
  CONCLUSIONS
  The two common outcomes of celiac disease, classical GI and extraintestinal manifestations, had marked differences on the diversity and composition of intestinal microbiota. This association suggested that intestinal microbiota may have a role in the manifestation of the disease.
authors.affiliation: Finnish Red Cross Blood Service, Helsinki, Finland. pirjo.wacklin@bts.redcross.fi
authors.forename: Pirjo
authors.initials: P
authors.lastname: Wacklin
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
authors.forename: Elina
authors.initials: E
authors.lastname: Tuovinen
authors.forename: Pekka
authors.initials: P
authors.lastname: Collin
authors.forename: Katri
authors.initials: K
authors.lastname: Lindfors
authors.forename: Jukka
authors.initials: J
authors.lastname: Partanen
authors.forename: Markku
authors.initials: M
authors.lastname: Mäki
authors.forename: Jaana
authors.initials: J
authors.lastname: Mättö
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000740:Anemia / Q000209:etiology* / Q000473:pathology; D044822:Biodiversity; D016022:Case-Control Studies; D002446:Celiac Disease / Q000150:complications / Q000235:genetics / Q000382:microbiology*; D003874:Dermatitis Herpetiformis / Q000209:etiology* / Q000473:pathology; D004386:Duodenum / Q000382:microbiology*; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D054892:Metagenome; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D055815:Young Adult
chemical_list: D012336:RNA, Ribosomal, 16S