Integrated gut metabolome and microbiome fingerprinting reveals that
dysbiosis precedes allergic inflammation in IgE-mediated pediatric cow's
milk allergy
Abstract
Background: IgE-mediated cow’s milk allergy (IgE-CMA) is one of the
first allergies to arise in early childhood and may result from exposure
to various milk allergens, of which β-lactoglobulin (BLG) and casein are
the most important. Understanding the underlying mechanisms behind
IgE-CMA is imperative for the discovery of novel biomarkers and the
design of innovative treatment and prevention strategies. Methods: We
report a longitudinal in vivo murine model, in which 2 mice
strains (BALB/c and C57Bl/6) were sensitized to BLG using either cholera
toxin or an oil emulsion (n=6 per group). After sensitization, mice were
challenged orally, their clinical signs monitored, antibody (IgE and
IgG1) and cytokine levels (IL-4 and IFN-γ) measured, and fecal samples
subjected to metabolomics. The results of the murine models were further
supported by fecal microbiome-metabolome data from our population of
IgE-CMA (n=24) and healthy (n=23) children (Trial: NCT04249973), on
which polar metabolomics, lipidomics and 16S rRNA metasequencing were
performed. In vitro gastrointestinal digestions and multi-omics
corroborated the microbial origin of proposed metabolic changes.
Results: During sensitization, we observed multiple microbially derived
metabolic alterations, most importantly bile acid, energy and tryptophan
metabolites, that preceded allergic inflammation. The latter was
reflected in a disturbed sphingolipid metabolism. We confirmed microbial
dysbiosis, and its causal effect on metabolic alterations in our patient
cohort, which was accompanied by metabolic signatures of low-grade
inflammation. Conclusion: Our results indicate that gut dysbiosis
precedes allergic inflammation and nurtures a chronic low-grade
inflammation in children on elimination diets, opening important new
opportunities for future prevention and treatment strategies.