Recent studies have demonstrated that the microbiome of patients with UC differ from healthy controls [18] because the mucosal inflammation in UC changes the mucosa-associated microbiota (MAM). Ulceration of the colonic epithelium further aggravates this condition, which perpetuates the cycle. Nishino et al. [19] reported that the relative abundance of Firmicutes and Proteobacteria in intestinal surface mucus was different among patients with UC and Crohn's disease, and normal controls. Fecal microbiota transplantation (FMT), probiotics, prebiotics, or synbiotics have been shown to be effective for UC [20, 21]; however, the pathogenesis of UC must be clarified before new therapeutic microbiome-based strategies are introduced.
The gut microbiome differs depending on the location in the large intestine. As such, we only collected samples from a single site, the lower rectum. Our endoscopic samples demonstrated a large amount of human DNA but little bacterial DNA [22]. Among the sampling techniques, brush catheter sampling has been reported to provide more bacterial DNA than biopsies, even if the amount of DNA obtained through brush catheter sampling is lower. We also expected that the brush catheter would acquire a smaller sample of proteins, which would make protein analysis difficult.
The colonic mucus layer has inner and outer layers. Both layers have the same protein profile; however, the inner mucus layer is denser and does not contain any bacteria or bacterial metabolites [11]. Therefore, the microbiome data is not expected to change, even if a larger proportion of the inner layer is sampled. In contrast, there is a difference in the microbiome of the mucus layer and intestinal fluid [23]. Each of our sampling techniques may have collected different proportions of mucus and intestinal fluid content, which would explain the difference in the microbiome data identified in our study. While both brushes scrape the mucus layer to collect a sample, the net catheter scrapes over a larger area, which may catch more intestinal fluid and mucus than the brush catheter.
Lavelle et al. also analyzed whether biopsy, brush, and laser capture microdissection affected the MAM data in five patients with UC and four controls [24]. Similar to our results, Lavelle et al. detected large inter-patient variabilities. While they were not able to identify definite UC-causing bacteria, their data did show higher relative abundance of Coriobacteriaceae, Bacteroidaceae, Ruminococcaceae [25], and Family XIII Incertae sedis in the mucosa of patients with US than in controls.
Our sample also showed a great variation among patients. Therefore, it was difficult to compare between patients in our study as well. However, comparison of brush and net proteins may suggest an association with activity. Abnormalities in mucus production have been reported in active UC. Abnormalities of the mucus system have been described in active UC. Reduction of MUC2 and FCGBP in the colonic mucus occurs prior to the onset of Reduction of MUC2 and FCGBP in the colonic mucus occurs prior to the onset of inflammation of UC and has been suggested to be related to the pathogenesis of UC. Mucins, component of mucus are classified into two different types: transmembrane mucins and gel-forming mucins. MUC2 and MUC5B are gel-forming MUC2 and MUC5B are gel-forming secreted mucins and MUC13 is transmembrane mucin. Both types of mucins are secreted by the goblet cells. In samples from patients with active ulcerative colitis, more than twice as much protein associated with mucus was detected in the net. On the other hand, brush samples collected more protein associated with mucus in patient 2, who had less active disease. This may indicate that the relatively weak horizontal force of the net may cause the mucus to peel off easier. In other words, these differences indicate mucosal weakness, which may be associated with higher symptom scores.
Nishino et al. [19] showed that Bifidobacterium levels were higher in UC patients than in healthy controls using brush samples. Lavelle A [24] also showed that UC patients had higher Bifidobacterium than controls and also showed higher abundance in Mucus than in Lumen. This is in agreement with our finding that only highly active patients had higher relative abundance of Bifidobacterium. The lower abundance of Lachnospira, a butyrate-producing bacterium collected by netting in less active UC patients than in brushes may indicate that the bacterium has settled in a deeper mucosal layer. On the other hand, in active UC patients, Staphylococcus Dialister, a resident oral bacterium, was collected more abundantly by brushes than nets, which may indicate that the bacterium resides in the deep mucosal layer.
Studies have proposed that patients with UC have different microbiomes compared to healthy controls, but whether this is the cause or result of the disease process remains unknown. Various bacteria have been also been identified as the possible triggers for UC, but these have yet to be proven. FMT has been suggested as an effective therapy for UC because it increases the production of short-chain fatty acids, particularly butyric acid [26]. Butyric acid decreases intestinal permeability and maintains the integrity of the intestinal epithelium, which reduces overall disease severity [27]. Our analysis was able to identify genus Butyricicoccus bacteria, a butyric acid bacterium, in our samples. Rothia and Streptococcus are commonly found in the oral cavity and are expected to be present near the mucosal lumen surface. Net catheter sampling has high potentials for future research because it can collect more bacteria.
Our study also demonstrated that net and brush catheter sampling collected the same types and amounts of mucosal proteins and inflammatory markers, except for leucine-rich alpha-2-glycoprotein (LRG) [28], which was detected in the brush catheter samples alone. As mentioned previously, the brush catheter collects samples perpendicular to the intestinal mucosa and is more likely to obtain portions of the inner mucus layer. This presumes that LRG may be more predominant in the inner layer rather than the mucosal surface.
This study has several limitations. First, our sample size was small. Second, we tried to perform a multi-omics analysis; however, there were significant differences in the microbiomes among the patients, which made the analysis impossible. Lastly, we did not analyze the proteins that were only detected in small amounts.
In conclusion, our study demonstrated the bacterial and protein content of intestinal mucosal samples taken with net and brush catheters among patients with UC. Brush catheters were more likely to acquire samples from the inner mucus layer, whereas net catheters were more likely to collect larger samples that include the outer mucus layer and intestinal fluid.