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Correspondence
Comment on: ‘Metagenome-wide association study of gut microbiome revealed novel aetiology of rheumatoid arthritis in the Japanese population’ by Kishikawa et al
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  1. Kaori Kitamura1,
  2. Hiroshi Shionoya1,
  3. Kuniaki Terato2,
  4. Suguru Suzuki1,
  5. Richio Fukai3,
  6. Shinichi Uda4,
  7. Chiyuki Abe5,
  8. Hiromitsu Takemori6,
  9. Keita Nishimura7,
  10. Hisashi Baba8,
  11. Takaki Waritani2,
  12. Kou Katayama9
  1. 1 Research Lab Section 5, Asama Chemical Co Ltd, Tokyo, Japan
  2. 2 Research and Development, Chondrex, Inc, Redmond, Washington, USA
  3. 3 Pharmacology, Fukai Pharmacy, Asahikawa, Hokkaido, Japan
  4. 4 Rheumatology, Uda Clinic of Rheumatology, Fukuyama, Hiroshima, Japan
  5. 5 Rheumatology, Abe Clinic Internal Medicine, Tokyo, Japan
  6. 6 Rheumatology, Aomori Prefectural Central Hospital, Aomori, Aomori, Japan
  7. 7 Rheumatology, Teikyo University School of Medicine, Tokyo, Japan
  8. 8 Company Rheu・Con, Osaka, Japan
  9. 9 Rheumatology, Katayama Orthopedic Rheumatology Clinic, Asahikawa, Hokkaido, Japan
  1. Correspondence to Dr Kou Katayama, Rheumatology, Katayama Orthopedic Rheumatology Clinic, Asahikawa, Hokkaido 078-8243, Japan; kou{at}kata-rheum.or.jp

https://doi.org/10.1136/annrheumdis-2020-217808

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    The recent paper from Kishikawa et al 1 provides an extremely important new insight on the concept of oral-gut microbiome axis and rheumatoid arthritis (RA) pathogenesis.

    Alterations in the gut microbiome at mucosal sites have been implicated in the pathogenesis of RA.2–4 Increasing evidence suggests a link between RA and periodontal infections caused by Porphyromonas gingivalis (Pg).5 Oral infection by Pg in an animal model revealed increased serum levels of lipopolysaccharide (LPS), dysbiosis and aggravation of arthritis.6 7 Therefore, the pathogenesis of RA is considered to be associated with the immunomodulatory activity of oral and gut microbiome.8 However, few studies have explored the relationship between the oral-gut microbiome axis and RA pathogenesis.

    We previously investigated the relationship between RA disease activity using activity indices and biomarkers; the total bacterial counts and the counts of five well-known gut bacteria species; LPS-related biomarkers and IgG and IgA anti-Pg-LPS antibodies in 87 patients with established RA showing inadequate responses to conventional synthetic disease-modifying antirheumatic drugs or exhibiting severe complications.9 (online supplementary table 1)

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    [annrheumdis-2020-217808supp001.pdf]

    Little significant relationship was observed between the counts of the total bacteria, five species of bacteria and activity indices and biomarkers.(table 1) The levels of LPS-related biomarkers, particularly serum LPS-binding protein (LBP), were positively correlated with activity indices and biomarkers, suggesting that bacterial LPS-LBP complexes from the gut microbiome may activate nuclear factor κB via toll-like receptor 4 and may initiate and …

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