Impact of altering gut microbiota metabolism on osteomyelitis severity in obesity-related type 2 diabetes
Authors: Bui Tina I. , Gill Ann Lindley , Mooney Robert A. , Gill Steven R. 
Published: January 2022

ABSTRACTStaphylococcus aureusis an opportunistic pathogen causing osteomyelitis through hematogenous seeding or contamination of implants and open wounds following orthopedic surgeries. The severity ofS. aureus-mediated osteomyelitis is enhanced in obesity-related type 2 diabetes (obesity/T2D) due to chronic inflammation impairing both adaptive and innate immunity. Obesity-induced inflammation is linked to gut dysbiosis, with modification of the gut microbiota by high-fiber diets leading to a reduction in the symptoms and complications of obesity/T2D. However, our understanding of the mechanisms by which modifications of the gut microbiota alter host infection responses is limited. To address this gap, we monitored tibialS. aureusinfections in obese/T2D mice treated with the inulin-like fructan fiber, oligofructose. Treatment with oligofructose significantly decreasedS. aureuscolonization and lowered proinflammatory signaling post-infection in obese/T2D mice, as observed by decreased circulating inflammatory cytokines (TNF-α) and chemokines (IP-10, KC, MIG, MCP-1, and RANTES), indicating partial reduction in inflammation. Oligofructose markedly shifted diversity in the gut microbiota of obese/T2D mice mice, with notable increases in the anti-inflammatory bacterium,Bifidobacterium pseudolongum. Analysis of the cecum and plasma metabolome suggested polyamine production was increased, specifically spermine and spermidine. Oral administration of these polyamines to obese/T2D mice resulted in reduced infection severity similar to oligofructose supplementation, suggesting polyamines can mediate the beneficial effects of fiber on osteomyelitis severity. These results demonstrate the contribution of gut microbiota metabolites to the control of bacterial infections distal to the gut and polyamines as an adjunct therapeutic for osteomyelitis in obesity/T2D.ImportanceIndividuals with obesity-related type 2 diabetes (obesity/T2D) are at a five times increased risk for invasiveStaphylococcus aureusosteomyelitis (bone infection) following orthopedic surgeries. With increasing antibiotic resistance and limited discoveries of novel antibiotics, it is imperative we explore other avenues for therapeutics. In this study, we demonstrated that the dietary fiber oligofructose markedly reduced osteomyelitis severity and hyperinflammation following acute implant-associated osteomyelitis in obese/T2D mice. Reduced infection severity is associated with changes in gut microbiota composition and metabolism as indicated by increased production of natural polyamines in the gut and circulating plasma. This work identifies a novel role for the gut microbiome in mediating control of bacterial infections and polyamines as beneficial metabolites involved in improving the obesity/T2D host response to osteomyelitis. Understanding the impact of polyamines on host immunity and mechanisms behind decreasing susceptibility to severe implant-associated osteomyelitis is crucial to improving treatment strategies for this patient population.