背景:肠道菌群失调与HIV感染和糖尿病有关,但是它与糖尿病的代谢和炎症反应相互作用,特别是在艾滋病毒感染的背景下,尚不清楚。
方法:我们首先进行了横截面关联分析,以表征肠道微生物,循环代谢物,和免疫/炎症蛋白特征与糖尿病相关的多达493名妇女(〜146名流行糖尿病和69.9%HIV+)的妇女机构间HIV研究。然后对694名参与者(391名来自WIHS的女性和303名来自多中心AIDS队列研究的男性;记录了166例事件)进行了12年的随访,以确定已识别的代谢物与糖尿病事件的关联。进行了中介分析,以探索肠道细菌-糖尿病关联是否由改变的代谢物和蛋白质解释。
结果:确定了七个肠道细菌属与糖尿病相关(FDR-q<0.1),与志贺氏菌呈正相关,埃希氏菌,Megasphaera,和乳酸菌,和Adlercreutzia的逆关联,Ruminococus,和肠杆菌.重要的是,大多数物种的联系,尤其是Adlercreutzia和Ruminococus,在很大程度上独立于抗糖尿病药物的使用。同时,18种蛋白质和76种代谢物,包括3种微生物衍生的代谢物(三甲胺N-氧化物,苯乙酰谷氨酰胺(PAGln),咪唑丙酸(IMP)),50脂质(例如,二自由基甘油(DGs)和三自由基甘油(TGs)和23种非脂质代谢物,与糖尿病相关(FDR-q<0.1),大多数显示出正相关,其中一半以上(59/76)与糖尿病相关。在调解分析中,几种蛋白质,特别是白细胞介素18受体1和骨保护素,IMP和PAGln部分介导观察到的细菌属-糖尿病关联,特别是对于阿德克鲁和埃希氏菌。许多与糖尿病相关的代谢物和蛋白质在HIV中发生了改变,但是HIV对他们与糖尿病的关系没有观察到影响。
结论:在有和没有艾滋病毒的个体中,多个肠道细菌属,血液代谢产物,促炎蛋白与糖尿病相关。观察到的代谢产物和蛋白质在属糖尿病关联中的介导作用强调了在HIV感染背景下肠道菌群失调和糖尿病之间的联系中炎症和代谢扰动的潜在参与。
BACKGROUND: Gut dysbiosis has been linked with both HIV infection and diabetes, but its interplay with metabolic and inflammatory responses in diabetes, particularly in the context of HIV infection, remains unclear.
METHODS: We first conducted a cross-sectional association analysis to characterize the gut microbial, circulating metabolite, and immune/inflammatory protein features associated with diabetes in up to 493 women (~ 146 with prevalent diabetes with 69.9% HIV +) of the Women\'s Interagency HIV Study. Prospective analyses were then conducted to determine associations of identified metabolites with incident diabetes over 12 years of follow-up in 694 participants (391 women from WIHS and 303 men from the Multicenter AIDS Cohort Study; 166 incident cases were recorded) with and without HIV infection. Mediation analyses were conducted to explore whether gut bacteria-diabetes associations are explained by altered metabolites and proteins.
RESULTS: Seven gut bacterial genera were identified to be associated with diabetes (FDR-q < 0.1), with positive associations for Shigella, Escherichia, Megasphaera, and Lactobacillus, and inverse associations for Adlercreutzia, Ruminococcus, and Intestinibacter. Importantly, the associations of most species, especially Adlercreutzia and Ruminococcus, were largely independent of antidiabetic medications use. Meanwhile, 18 proteins and 76 metabolites, including 3 microbially derived metabolites (trimethylamine N-oxide, phenylacetylglutamine (PAGln), imidazolepropionic acid (IMP)), 50 lipids (e.g., diradylglycerols (DGs) and triradylglycerols (TGs)) and 23 non-lipid metabolites, were associated with diabetes (FDR-q < 0.1), with the majority showing positive associations and more than half of them (59/76) associated with incident diabetes. In mediation analyses, several proteins, especially interleukin-18 receptor 1 and osteoprotegerin, IMP and PAGln partially mediate the observed bacterial genera-diabetes associations, particularly for those of Adlercreutzia and Escherichia. Many diabetes-associated metabolites and proteins were altered in HIV, but no effect modification on their associations with diabetes was observed by HIV.
CONCLUSIONS: Among individuals with and without HIV, multiple gut bacterial genera, blood metabolites, and proinflammatory proteins were associated with diabetes. The observed mediated effects by metabolites and proteins in genera-diabetes associations highlighted the potential involvement of inflammatory and metabolic perturbations in the link between gut dysbiosis and diabetes in the context of HIV infection.