title: Microbiome perturbation by oral vancomycin reduces plasma concentration of two gut-derived uremic solutes, indoxyl sulfate and p-cresyl sulfate, in end-stage renal disease.
abstract: BACKGROUND
  Observational studies have suggested a relationship between the plasma concentration of indoxyl sulfate (IS) and p-cresyl sulfate (PCS), small gut-derived 'uremic solutes', and the high incidence of uremic cardiomyopathy in patients with end-stage renal disease (ESRD). IS and PCS are derived from the metabolism of dietary components (tryptophan and tyrosine) by gut bacteria. This pilot study was designed to examine the effects of a poorly absorbable antibiotic (vancomycin) on the plasma concentration of two gut-derived 'uremic solutes', IS and PCS, and on the composition of the gut microbiome.
  
  
  METHODS
  Plasma concentrations of IS and PCS were measured by MS-HPLC. The gut microbiome was assessed in stool specimens sequenced for the 16S rRNA gene targeting the V4 region.
  
  
  RESULTS
  The pre-dialysis mean plasma concentrations of both IS and PCS were markedly elevated. Following the administration of vancomycin (Day 0), the IS and PCS concentrations decreased at Day 2 or Day 5 and returned to baseline by Day 28. Following vancomycin administration, several changes in the gut microbiome were observed. Most striking was the decrease in diversity, a finding that was evident on Day 7 and was still evident at Day 28. There was little change at the phylum level but at the genus level, broad population changes were noted. Changes in the abundance of several genera appeared to parallel the concentration of IS and PCS.
  
  
  CONCLUSIONS
  These findings suggest that alteration of the gut microbiome, by an antibiotic, might provide an important strategy in reducing the levels of IS and PCS in ESRD.
authors.affiliation: Department of Medicine, New York University Langone Medical Center, New York, NY, USA.|Department of Microbiology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Lama
authors.initials: L
authors.lastname: Nazzal
authors.affiliation: Department of Medicine, New York University Langone Medical Center, New York, NY, USA.|Department of Microbiology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Roberts
authors.affiliation: Department of Medicine, New York University Langone Medical Center, New York, NY, USA.|Department of Microbiology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Prabhjot
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Medicine, New York University Langone Medical Center, New York, NY, USA.|Department of Microbiology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Jhawar
authors.affiliation: Department of Medicine, New York University Langone Medical Center, New York, NY, USA.|Department of Microbiology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Matalon
authors.affiliation: Department of Medicine, New York University Langone Medical Center, New York, NY, USA.|Department of Microbiology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Gao
authors.affiliation: Department of Medicine, New York University Langone Medical Center, New York, NY, USA.|Department of Microbiology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Holzman
authors.affiliation: Department of Medicine, New York University Langone Medical Center, New York, NY, USA.|Department of Microbiology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Len
authors.initials: L
authors.lastname: Liebes
authors.affiliation: Department of Medicine, New York University Langone Medical Center, New York, NY, USA.|Department of Microbiology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Blaser
authors.affiliation: Department of Medicine, New York University Langone Medical Center, New York, NY, USA.|Department of Microbiology, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Jerome
authors.initials: J
authors.lastname: Lowenstein
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D003408:Cresols / Q000097:blood*; D005260:Female; D000069196:Gastrointestinal Microbiome / Q000187:drug effects*; D006801:Humans; D007200:Indican / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000097:blood*; D008297:Male; D054892:Metagenome; D008875:Middle Aged; D058889:Molecular Typing; D010865:Pilot Projects; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D013463:Sulfuric Acid Esters / Q000097:blood*; D014640:Vancomycin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D003408:Cresols; D012336:RNA, Ribosomal, 16S; D013463:Sulfuric Acid Esters; C408690:4-cresol sulfate; D014640:Vancomycin; D007200:Indican
keywords: atherosclerosis; chronic renal failure; gut microbiome; indoxyl sulfate; p-cresyl sulfate