Altered oral microbiota in chronic hepatitis B patients with different tongue coatings

AIM To elucidate tongue coating microbiota and metabolic differences in chronic hepatitis B(CHB) patients with yellow or white tongue coatings.METHODS Tongue coating samples were collected from 53 CHBpatients(28 CHB yellow tongue coating patients and 25 CHB white tongue coating patients) and 22 healthy controls.Microbial DNA was extracted from the tongue samples,and the bacterial 16 S ribosomal RNA gene V3 region was amplified from all samples and sequenced with the Ion Torrent PGM^(TM)sequencing platform according to the standard protocols.The metabolites in the tongue coatings were evaluated using a liquid chromatographymass spectrometry(LC-MS) platform.Statistical analyses were then performed.RESULTS The relative compositions of the tongue coating microbiotas and metabolites in the CHB patients were significantly different from those of the healthy controls,but the tongue coating microbiota abundances and diversity levels were not significantly different.Compared with the CHB white tongue coating patients,the CHB yellow tongue coating patients had higher hepatitis B viral DNA(HBV-DNA) titers(median 21210 vs 500,respectively,P = 0.03) and a significantly lower level of Bacteroidetes(20.14% vs 27.93%,respectively,P = 0.013) and higher level of Proteobacteria(25.99% vs 18.17%,respectively,P = 0.045) in the microbial compositions at the phylum level.The inferred metagenomic pathways enriched in the CHB yellow tongue coating patients were mainly those involved in amino acid metabolism,which was consistent with the metabolic disorder.The abundances of bacteria from Bacteroidales at the order level were higher in the CHB white tongue coating patients(19.2% vs 27.22%,respectively,P = 0.011),whereas Neisseriales were enriched in the yellow tongue coating patients(21.85% vs 13.83%,respectively,P = 0.029).At the family level,the abundance of Neisseriaceae in the yellow tongue patients was positively correlated with the HBV-DNA level but negatively correlated with the S-adenosyl-L-methionine level.CONCLUSION This research illustrates specific clinical features and bacterial structures in CHB patients with different tongue coatings,which facilitates understanding of the traditional tongue diagnosis.

Chinese Herbal Medicine-induced Liver Injury

The widespread use of Chinese herbal medicine (CHM) and the associated adverse reactions has attracted the attention of researchers and physicians.Reports have shown that several types of CHM can cause liver injury,with increasing numbers of cases reported every year.The difficulty in characterizing CHM-induced liver injury stems from clinical manifestations,diagnosis and pathogenesis.The clinical manifestations are varied,but gastrointestinal symptoms are the majority.The Council for International Organizations of Medical Sciences scale is currently the most commonly used method for assessing causality in cases of medicine-induced liver injury with excellent sensitivity,specificity and predictive validity.However,the pathogenesis of CHM-induced liver injury is not well understood.The classic view encompasses a contribution from "toxic metabolites" that either elicit an immune response or directly affect cellular biochemical processes or functions.In addition,poor quality and inappropriate clinical use of CHMs contribute to safety concerns.To ensure the safe use of CHMs and decrease the number of hepatotoxic cases,clinicians,researchers and pharmaceutical companies should share responsibility by regulating clinical use,strengthening basic toxicology research and establishing a strict quality control system.

Potential Role of EGF and EGFR in Tongue Coating Formation

Tongue coating, as a sensitive index of the physiological and pathological changes of human organs, is an important basis for the Traditional Chinese Medicine(TCM) syndrome differentiation and treatment. Mechanism of the formation and change of tongue coating is an important scientific problem. In recent years, researches indicated that in addition to apoptosis related genes, epidermal growth factor(EGF) and epidermal growth factor receptor(EGFR) also contribute to tongue coating formation. In this paper, we summarized recent studies on the potential role of EGF and EGFR in regulating the formation of tongue coating to provide some reference for the further investigations on tongue coating formation mechanisms.