Compositional and Temporal Changes in the Gut Microbiome of Pediatric Ulcerative Colitis Patients Are Linked to Disease Course

Cell Host Microbe. 2018 Oct 10;24(4):600-610.e4. doi: 10.1016/j.chom.2018.09.009.


Evaluating progression risk and determining optimal therapy for ulcerative colitis (UC) is challenging as many patients exhibit incomplete responses to treatment. As part of the PROTECT (Predicting Response to Standardized Colitis Therapy) Study, we evaluated the role of the gut microbiome in disease course for 405 pediatric, new-onset, treatment-naive UC patients. Patients were monitored for 1 year upon treatment initiation, and microbial taxonomic composition was analyzed from fecal samples and rectal biopsies. Depletion of core gut microbes and expansion of bacteria typical of the oral cavity were associated with baseline disease severity. Remission and refractory disease were linked to species-specific temporal changes that may be implicative of therapy efficacy, and a pronounced increase in microbiome variability was observed prior to colectomy. Finally, microbial associations with disease-associated serological markers suggest host-microbial interactions in UC. These insights will help improve existing treatments and develop therapeutic approaches guiding optimal medical care.

Keywords: 5ASA; colectomy; corticosteroids; disease course; gut microbiome; host-microbial interactions; pediatric ulcerative colitis; response to therapy; serological markers; treatment-naive.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Child
  • Child, Preschool
  • Clostridiales / genetics
  • Cohort Studies
  • Colectomy
  • Colitis, Ulcerative / blood
  • Colitis, Ulcerative / diagnosis*
  • Colitis, Ulcerative / drug therapy
  • Colitis, Ulcerative / microbiology*
  • Disease Progression*
  • Feces / microbiology*
  • Female
  • Gastrointestinal Microbiome / genetics*
  • Humans
  • Leukocyte L1 Antigen Complex / analysis
  • Longitudinal Studies
  • Male
  • Mesalamine / therapeutic use
  • Time Factors


  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents, Non-Steroidal
  • Leukocyte L1 Antigen Complex
  • Mesalamine

Supplementary concepts

  • Pediatric ulcerative colitis