Gut Microbiota Alteration is Characterized by a Proteobacteria and Fusobacteria Bloom in Kwashiorkor and a Bacteroidetes Paucity in Marasmus
Authors: Anthony Levasseur
Cheikh Sokhna
Matthieu Million
Frank Wieringa
Aldiouma Diallo
Maryam Tidjani Alou
Thi-Phuong-Thao Pham
Didier Raoult
Daouda Alhousseini
Dipankar Bachar
Souleymane Brah
Journal: Scientific Reports (2019)
Discipline: Multidisciplinary
Keywords: Kwashiorkor; Marasmus; Gut microbiota alteration; Proteobacteria; Fusobacteria
Affiliations: Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France., Institut de cancérologie Gustave Roussy Cancer Campus, Villejuif, France., Service de Médecine Interne et Générale, Hôpital de Niamey, Niamey, Niger., Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes IRD 198, Centre National de la Recherche Scientifique 7278, Aix-Marseille Université, Dakar, Senegal., Institut de Recherche pour le Développement (IRD) - IRD/UM/SupAgro, Montpellier, France., Aix-Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France. .

Abstract:  Kwashiorkor and marasmus are considered to be two different clinical diseases resulting from severe malnutrition, but this distinction has been questioned. In a previous study comparing children with kwashiorkor and healthy children from Niger and Senegal, we found a dramatic gut microbiota alteration with a predominant depletion of anaerobes and enrichment in Proteobacteria and Fusobacteria in kwashiorkor. However, it remained unknown whether this association was related to malnutrition or was a specific feature of kwashiorkor. In this continuation study, we added 7 new marasmus subjects and 71,162 new colonies from the same countries. Our results showed that, compared to marasmus, the kwashiorkor gut microbiota was characterized by an increased proportion of Proteobacteria (culturomics, Marasmus 5.0%, Kwashiorkor 16.7%, p &lt; 0.0001; metagenomics, Marasmus 14.7%, Kwashiorkor 22.0%, p = 0.001), but there was a decreased proportion of Bacteroidetes in marasmus (culturomics, Marasmus 0.8%, Kwashiorkor 6.5%, p = 0.001; metagenomics, Marasmus 5.4%, Kwashiorkor 7.0%, p = 0.03). Fusobacterium was more frequently cultured from kwashiorkor. All detected potential pathogenic species were enriched in the kwashiorkor gut microbiota. These results provide a biological basis to support the usage of an antibiotic therapy more effective in suppressing the overgrowth of bacterial communities resistant to penicillin, combined with antioxidants and probiotics for nutritional recovery therapies, particularly for kwashiorkor. 

Retracted: No

PubPeer comments:
 This paper is part of a set of papers, all from the Aix-Marseille Universitu00e9 Institut Hospitalo-Universitaire Mu00e9diterranu00e9e-Infection in Marseille, France, that all describe novel bacterial strains isolated in African countries, but without mentioning ethical approval by local authorities. In this particular paper, 22 study participants from Niger and Senegal are described, all children (aged 0-4 years old) that were either healthy (control group) or suffering of different types of malnutrition (marasmus or nutritional oedema). I was surprised to see no wording in this paper about local ethical approval, even though some authors are affiliated with institutions in Niger or Senegal. The Methods state that: *The study was approved by the ethics committee of the Institute Fu00e9du00e9ratif de Recherche 48 (IFR48), Marseille, France under agreement number 09-022. All experiments were performed in accordance with relevant guidelines and regulations of the institution.* But there is no wording about approval from institutions in Niger or Senegal. Could the authors please give some information about the local ethical approval status? ,