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Original Articles: Gastroenterology

Social Stress Affects Colonic Inflammation, the Gut Microbiome, and Short-chain Fatty Acid Levels and Receptors

Maltz, Ross M.∗,†,‡; Keirsey, Jeremy§; Kim, Sandra C.∗,||; Mackos, Amy R.; Gharaibeh, Raad Z.#,∗∗; Moore, Cathy C.#; Xu, Jinyu; Somogyi, Arpad§; Bailey, Michael T.†,‡

Author Information
Journal of Pediatric Gastroenterology and Nutrition: April 2019 - Volume 68 - Issue 4 - p 533-540
doi: 10.1097/MPG.0000000000002226

Abstract

What Is Known

  • Inflammatory bowel diseases and functional gastrointestinal disorders are worsened with stress exposure and both involve a dysbiotic microbiome.
  • Stress exposure has been shown to change the composition of the gut microbiome and worsen intestinal inflammation.

What Is New

  • Social stress induced an upregulation of GPR41 and was associated with colonic inflammation.
  • The relative abundances of short-chain fatty acid producing bacteria and short-chain fatty acid levels were significantly affected by exposure to social stress.
  • Negative associations between histopathology scores and the abundance of Parabacteroides in this study are similar to associations seen in inflammatory bowel disease patients.

Inflammatory bowel diseases (IBDs) and functional gastrointestinal disorders (FGIDs) involve disrupted homeostatic interactions between the gut microbiota and the host leading to heightened inflammatory responses (in IBD) (1) or altered pain perception and motility (in FGIDs) (2–4). The severity of IBD and self-reported health-related quality of life is often worsened during stressful periods (5–8). Likewise, associations between stressful life events and health-related quality of life have been found in patients with FGIDs (9,10).

The microbiota-gut-brain axis involves bidirectional interactions between the gastrointestinal mucosal immune system, commensal microbiota, and the brain (1,11). These host-microbe interactions can be significantly affected during stress exposure (12,13), but how stress leads to homeostatic imbalance in the intestines is not clear. Social stress, such as social disruption (SDR), significantly increases plasma levels of serum corticosterone, epinephrine, norepinephrine, and affects gut microbiome diversity (12,14–16). These changes in the gut microbiome can significantly affect immune system activity (17,18).

Gut microbes ferment carbohydrates to produce short-chain fatty acids (SCFAs), including acetic, propionic, and butyric acids, that affect mucosal inflammation through direct anti-inflammatory effects on CD4+ T cells and increases in the number of regulatory T cells (19,20). SCFAs can activate G protein–coupled receptors on gut epithelial cells, lamina propria leukocytes, and cells of the enteric nervous system (21,22). We hypothesized that stress would affect the production of SCFAs, the commensal gut microbiome, and the expression of SCFA receptors.

METHODS

Experimental Design

Male C57BL/6 mice (Charles River Laboratories), 6 to 8 weeks of age were housed 3 per cage on a 12-hour light/dark schedule (lights on 0600). Standard diet and water were provided ad libitum. All experimental procedures were approved by and performed in accordance with The Ohio State University Animal Care and Use Committee.

Mice were exposed to the SDR stress over a 2-hour period (1630–1830) for 6 consecutive days (23), which involves placing an aggressive male into the experimental animal's home cage. Immediately after the first exposure to SDR, ½ of the stress-exposed and ½ of non–stress-exposed mice were challenged with Citrobacter rodentium by oral gavage. Half of the mice were euthanized the morning after the sixth night of SDR (6 days postinfection) and remaining mice were euthanized 12 days postinfection. The non–stress-exposed mice were euthanized at identical times (Fig. 1A and B). The experiments were conducted as discovery and validation experiments with the discovery experiment consisting of 1 cage (3 mice) per group and the validation experiment consisting of 2 cages (6 mice) per group. A total of 8 different groups with data combined from discovery and validation experiments (for a total of 9 mice per group) are presented in the manuscript, with data from individual discovery and validation experiments shown in the supplement.

F1
FIGURE 1:
Experimental design. A and B, Mice were exposed to the stress for 6 nights in a row. After the first exposure to SDR, half of the stress exposed and half of non–stress-exposed mice were challenged with Citrobacter rodentium by oral gavage. Half of the mice exposed to SDR were euthanized the morning after the sixth night of SDR. The other mice exposed to SDR were euthanized on 12 days postchallenge. The non–stress-exposed mice were euthanized at the identical time points. N = 9 mice per group. SDR = social disruption.

Citrobacter rodentium

C rodentium is a Gram-negative bacterium that causes an effacing lesion to the brush border in mice similar to that in humans with enteropathogenic and enterohemorrhagic Escherichia coli(24). It induces mild/moderate inflammation in the descending colon (24) that is dependent upon the amount of C rodentium administered. C rodentium strain DBS120 (pCRP1::Tn5) was grown in Difco Lennox broth overnight. Mice in the infection group were challenged via oral gavage with 100 μL of C rodentium containing 3 × 106 CFU in PBS. Fecal shedding of C rodentium was determined on days 6 and 12 postinfection by plating stool on MacConkey agar with kanamycin (40 μg/mL).

Histopathology

Histopathology was scored in the distal colon in a blinded fashion using a validated scoring system; a score of 0 represented no inflammation and a score of 4 represented severe inflammation with lamina propria infiltration, architectural distortion, crypt abscesses, and ulcers (25).

Semiquantitative Real-time Polymerase Chain Reaction

RNA was isolated from proximal colons using TriZOL (26). Real-time polymerase chain reaction (PCR) was performed on the ABI Prism 7000 system (14). 18S was used as a housekeeping gene. SYBR green was used for GPR41, GPR43, GPR109A, IL-1β, IFNγ, IL-22, and REG3γ (Supplemental Table 1, Supplemental Digital Content, https://links.lww.com/MPG/B532). Data are expressed as a fold change from uninfected non–stress-exposed group, day 6.

Short-chain Fatty Acid Quantification

Fecal samples were lyophilized for 22 hours. Extraction and gas chromatography-mass spectrometry was performed as previously published (27). The gas chromatography-mass spectrometry consisted of a Trace Ultra gas chromatography with an AS3000 automatic liquid sampler coupled to a DSQ II mass spectrometer (Thermo Scientific, Waltham, MA). A Stabilwax-DA (Restek, cat no. 11023) highly polar column with polyethylene glycol stationary phase was installed. Split injection mode with split flow and split ratio set at 10. Ethyl acetate was run between every sample, and each sample was injected twice. Calculated amounts are the average from 2 injections. A standard curve was generated for acetic, butyric, and propionic acid at the beginning and standards were used throughout each run. SCFA identification was based on retention times (RTs) and electron ionization mass spectrometer spectra compared to The National Institute of Standards and Technology (NIST)/EPA/NIH mass spectral libraries (NIST Mass Spectral Search Program v2.0, 2005) (27).

The processing setup module in Xcalibur (Thermo Scientific, Waltham, MA) was used for rapid quantification of the absolute amount of SCFAs in each sample using data obtained from the standards. Target ions selected to generate extracted ion chromatograms for quantification of acetic, propionic, and butyric acids were m/z 60, 74, and 60. The ICIS peak detection algorithm was used to detect the highest peak in the expected RT range for acetic (RT = 4.08, 20-second window), propionic (RT = 4.75, 20-second window), and butyric acid (RT = 5.53, 30-second window). The quality of the peaks was validated by enabling the resolution, symmetry, and peak classification parameters.

Mucosa-associated Microbiome

The QIAamp DNA minikit protocol (Qiagen, Valencia, CA) was used for DNA recovery of the colonic midsection. DNA was amplified targeting the V3–4 hypervariable region of the 16S rRNA gene (F:5’TCGTCGGCAGCGTCAGATGTGTATAAGAGACAGCCTACGGGNGGCWGCAG; R:5’GTCTCGTGGGCTCGGAGATGTGTATAAGAGACAGGACTACHVGGGTATCTAATCC). Libraries were prepared (Nextera XT kit; Illumina) and equimolar samples pooled. Sequencing was performed via the Illumina MiSeq platform resulting in 34 million paired-end reads (MiSeq Reagent Kit v3 600 cycle; Illumina). Forward and reverse reads were merged using Quantitative Insights into Microbial Ecology version 1.9.1 with an overlap length of 40% and 95% similarity in the overlap region. Trimming and filtering at Q20 resulted in approximately 8 million reads. Closed reference OTU picking and green genes version 13.8 were used to produce OTUs incorporating 77% of the input reads. De novo OTU picking was performed using AbundantOTU+ version 0.92b, which incorporated 98% of the input reads after removing chimeric and contaminant OTUs. Taxa were retained if they had ≥0.005% of the total count (28). Linear mixed effect model followed by analysis of variance was conducted with group, infection, and day as fixed effects and cage as a random effect (29). All P values were false discovery rate corrected. Alpha diversity was assessed using Chao1 and Shannon diversity indices using rarefied counts. Beta diversity was assessed using principal coordinate analysis (PCoA) designed from Bray-Curtis dissimilarity using Log 10 normalized counts (29,30).

Statistical Analysis

Three-way analysis of variances were used with stress exposure (ie, stress vs no stress), infection exposure (ie, C rodentium vs no C rodentium), and sac day (ie, day 6 vs day 12) as the between-subjects variables. Modified Bonferroni method was used for multiplicity of significance tests between groups. Pearson correlation analysis was performed with multiple regression analysis to determine significant associations. An alpha level of P < 0.05 was set as the rejection criteria for the null hypothesis. All data were analyzed using SPSS statistical software version 21 (IBM Corp, Armonk, NY). Combined data and analyses are shown in the article's main text. Discovery and validation experimental data and analyses are shown in supplemental figures (Supplemental Digital Content, https://links.lww.com/MPG/B532).

RESULTS

Stress Exposure and Infection Affects Colonic Inflammation

Infection-challenged mice that were not exposed to the stress had low levels of C rodentium (approximately 1 × 104 CFU/g). Exposure to stress during infection, however, significantly increased C rodentium levels by approximately 100-fold on both day 6 and 12 postinfection (Fig. 2A; P < 0.05). Mice exposed to the infection and the stress did not exhibit any differences in stool consistency, weight differences, or observed overt behavioral changes.

F2
FIGURE 2:
Stress exposure increased Citrobacter rodentium levels and inflammation. A, C rodentium levels increased with stress (P < 0.05). B and C, iNOS and TNFα main effect of stress and infection exposure (P < 0.05). D, IL-1β main effect of stress exposure (P < 0.05). E, IFNγ P < 0.05 stress × infection interaction. F, IL-22 P < 0.05 stress × infection interaction. G, REG3γ P < 0.05 stress × infection interaction. H, Histopathology P < 0.05 versus no infection same day. I–K, Representative images: I, mild inflammation, infection exposed euthanized day 6. J, Moderate inflammation, infection, and stress exposed euthanized day 6. K, Severe inflammation, infection, and stress exposed euthanized day 12. 20× Magnification.

Stress exposure regardless of infection increased iNOS, TNFα, and IL-1β mRNA levels in the colon (Fig. 2B–D; P < 0.05). C rodentium also significantly increased iNOS and TNFα mRNA levels regardless of stress exposure (Fig. 2B,C; P < 0.05). In contrast, IFNγ, IL-22, and REG3γ mRNA expression were only increased in mice exposed to stress during infection (Fig. 2E–G; P < 0.05).

Exposure to the stress in the absence of C rodentium did not affect histopathology scores (Fig. 2H). Histopathology scores were, however, significantly increased in stress-exposed mice on day 6 and day 12 postinfection when compared to non–stress-exposed mice (P < 0.05), even though both groups of mice were challenged with the same dose of C rodentium. Mice exposed to stress and C rodentium had an average colonic pathology score of 3.17 on day 12, which was significantly different than all other groups (Fig. 2H; P < 0.05). On day 6 postinfection, histopathology scores were significantly higher in mice exposed to SDR during infection compared to mice not exposed to the stress (P < 0.05). Representative histologic sections are provided in Figure 2I–K. The effects of stress on colonic gene expression and histopathology were similar in both discovery and validation experiments (Supplemental Fig. 1, Supplemental Digital Content, https://links.lww.com/MPG/B532).

Short-chain Fatty Acid Levels and Receptors Are Influenced by Stress Exposure

SCFA levels were not significantly changed by C rodentium alone, but there were significant interactions between stress exposure and C rodentium on acetic and butyric acid (Fig. 3A,B; P < 0.05). In the absence of infection, acetic and butyric acid levels were reduced on day 6 in stress-exposed mice compared with nonstressed mice (P < 0.05). In mice exposed to stress during infection, acetic and butyric acid levels were, however, significantly increased in comparison to uninfected mice (P < 0.05). This increase persisted through day 12 for acetic acid (P < 0.05). Propionic acid levels were not affected by C rodentium, but were significantly increased in mice exposed to SDR regardless C rodentium challenge (Fig. 3C; P < 0.05).

F3
FIGURE 3:
C rodentium and stress exposure affects short-chain fatty acid (SCFA) levels and SCFA receptor expression. A, Acetic acid analysis P < 0.05 stress × infection interaction. B, Butyric acid analysis P < 0.05 stress × infection interaction. C, Propionic acid analysis main effect of stress (P < 0.05). D, GPR43 receptor expression quantitative polymerase chain reaction (qPCR) analysis main effect of infection exposure (P < 0.05). E, GPR41 receptor expression qPCR analysis P < 0.05 stress × infection interaction. F, GPR109A receptor expression qPCR analysis P < 0.05 stress × infection interaction.

Challenge with C rodentium reduced mRNA expression for the SCFA receptor GPR43 regardless of stress exposure (Fig. 3D; P < 0.05). The effects on GPR41 and GPR109A were, however, dependent on whether the mice were stress exposed during infection (Fig. 3E,F). GPR41 mRNA was significantly reduced on days 6 and 12 in infection-exposed mice not exposed to the stress versus infected-stress-exposed mice (P < 0.05). Infected-stress-exposed mice exposed GPR41 mRNA expression on day 12 was, however, significantly increased in comparison to all groups not exposed to stress (P < 0.05). GPR109A mRNA exposure was significantly reduced in mice challenged with C rodentium in the absence of stress exposure compared to infected-stress-exposed mice (P < 0.05). Although there was considerable variability when samples were analyzed separately based on whether they were collected as part of the discovery or validation experiments, the patterns of SCFA levels and receptor gene expression were similar in the replicate experiments (Supplemental Fig. 2, Supplemental Digital Content, https://links.lww.com/MPG/B532).

Stress Exposure and C rodentium Altered the Composition of the Mucosa-associated Microbiome

Alpha diversity, which measures species diversity within a sample, was assessed using the Shannon diversity index and Chao1 index. It was only significantly affected by infection and it was lower in mice infected with C rodentium compared to mice that were not infected (Fig. 4A,B; P < 0.05). Alpha diversity was not significantly affected by stress exposure.

F4
FIGURE 4:
Stress exposure and infection effected alpha and beta diversity. A, Shannon diversity index (SDI) decreased when exposed to the infection ( P < 0.05). B, Chao1 diversity decreased when exposed to the infection ( P < 0.05). C, All samples depicted on a PCoA separated by stress exposure. Mice exposed to the stress (black circle around) clustered separately from not exposed to the stress regardless of infection, significant PCoA axis 1 and 2 (P < 0.05). D, All samples depicted on a PCoA separated by infection. Mice challenged with the infection clustered separately from mice not exposed to the infection (black circle around) regardless of stress exposure had a significant PCoA axis 1 and 2 (P < 0.05).

Beta diversity was significantly different in stress-exposed mice. The samples clustered separately from mice not exposed to the stress regardless of C rodentium (Fig. 4C) with significant differences on PCoA axis 1 and 2 (P < 0.05). When samples were classified only based upon infection, it was evident that infected mice clustered separately from uninfected mice on PCoA axis 1 and 2 (Fig. 4D; P < 0.05).

Taxonomic analyses at the genus level showed main effects of stress exposure on the relative abundances of Akkermansia, Anaerostipes, Butyricicoccus, Coprococcus, Parabacteroides, and SMB53 that were decreased in stress-exposed mice (Supplemental Fig. 3A–F, Supplemental Digital Content, https://links.lww.com/MPG/B532; P < 0.05). Bacteroides and Butyricimonas relative abundances were decreased with stress exposure and infection exposure (Supplemental Fig. 3G and H, Supplemental Digital Content, https://links.lww.com/MPG/B532; P < 0.05). There were also main effects of stress exposure on the relative abundances of Odoribacter, Sutterella, AF12, Helicobacter, and Prevotella that were increased in stress-exposed mice (Supplemental Fig. 3I and J and Supplemental Fig. 4A–C, Supplemental Digital Content, https://links.lww.com/MPG/B532; P < 0.05). AF12, Helicobacter, and Prevotella relative abundances were also decreased with a main effect of infection exposure (P < 0.05). Anaerococcus, Anaeroplasma, Bradyrhizobium, Enhydrobacter, Mucispirillum, Oscillospira, Peptoniphilus, and Roseburia relative abundances decreased with infection exposure (Supplemental Fig. 4D–K, Supplemental Digital Content, https://links.lww.com/MPG/B532; P < 0.05). Enterobacter, Flavobacterium, Flexispira, and Trabulsiella relative abundances were increased in infected mice (Supplemental Fig. 4L–O, Supplemental Digital Content, https://links.lww.com/MPG/B532; P < 0.05). Similar patterns were evident in both discovery and validation experiments (Supplemental Figs. 5–8, Supplemental Digital Content, https://links.lww.com/MPG/B532).

Multiple regression analysis indicated that the expression of GPR41 was positively associated with inflammatory cytokines TNFα and iNOS (P < 0.001) and colonic histopathology scores (P < 0.001). Propionic acid was also positively associated with inflammatory cytokines TNFα and iNOS (P < 0.001) and colonic histopathology scores (P < 0.01), but not associated with GPR41. Analyses were performed to determine whether specific genera were associated with SCFA levels and histopathology scores. Sequences classified at the genus level were normalized by finding the square root of the proportion of total sequences, followed by the arcsine of the square root. Propionic acid was positively correlated with Sutterella (P < 0.001), whereas butyric acid correlated with Anaerofustis, Anaerotruncus, Butyricicoccus, Clostridium, Coprococcus, Dehalobacterium, Dorea, Oscillospira, and Ruminococcus (P < 0.006). Increases in the percentages of Dehalobacterium, and Dorea were associated with higher concentrations of acetic acid (P < 0.006). In addition, there was a negative association between Parabacteroides and histopathology scores (P < 0.01).

DISCUSSION

Stress exposure has a profound effect on microbiome diversity, multiple genera, and mucosal inflammation, which are significantly affected when mice are challenged with C rodentium(5–7,13,31,32). Stress before pathogen challenge increased the susceptibility to, and severity of, colonic inflammation (14). Although C rodentium levels were increased, stress led to dysregulation of the colonic inflammatory response, which was not directly related to pathogen load. In our previous study, we showed that administering the probiotic Lactobacillus reuteri prevented the exacerbating effects of stress on colonic inflammation, even though pathogen levels remained high in stress-exposed mice (18). This suggests that an increase in pathogen load is not the only factor contributing to excessive inflammatory responses. In fact, using experimental fecal transplants, we have found that the gut microbiota contribute to dysregulation of mucosal inflammatory responses during stress (17). In the current study, stress during infection increased inflammation and this was negatively associated with the abundance of Parabacteroides. Interestingly, similar inverse associations have been seen in patients with IBD where the abundance of Parabacteroides was decreased in patients with inflammation vs healthy control groups (33). The negative association between Parabacteroides and degree of inflammation suggests this genus has protective effects in the colon, but the exact effects are not known.

Changes in the microbiome in stress exposed mice could also be due to contamination/coprophagy of aggressor stool. Helicobacter was increased in stress-exposed mice, and some species of Helicobacter can exacerbate colonic inflammation (34). We cannot rule out that this increase in Helicobacter is not due to direct contamination from the aggressor because the microbiome of the aggressor was not assessed. It is known that Helicobacter growth can be increased by stress-induced hormones such as epinephrine and norepinephrine (35). Other stress paradigms, such as prolonged restraint, which do not involve contamination from other mice, also affect microbiome composition (36). Thus, we do not believe that all of the effects of stress exposure on microbial community composition are due to contamination/coprophagy of aggressor stool and follow-up research is necessary to understand the factors that lead to the increase in Helicobacter.

Stress led to a decrease in known SCFA producing genera Anaerostipes, Butyricicoccus, Coprococcus, Parabacteroides, and Butyricimonas, but an increase in Odoribacter(37–41), whereas infection led to a significant decrease in known SCFA producers Butyricimonas, Anaerococcus, and Roseburia(39,41,42) and increase in Enterobacter. Several studies have suggested that SCFAs play a protective role in the intestines. For example, intestinal inflammation improved in mice treated with butyric and acetic acid (43), and clinically, SCFA enemas have been successfully used to treat diversion colitis and proctosigmoiditis (44,45). The benefits of SCFAs are likely due to an increase in regulatory T cells, because SCFAs given to germ-free mice cause an increase in regulatory T cells (20,46).

We showed that exposure to stress leads to a decrease in butyric and acetic acid levels, and an increase in propionic acid levels after 6 days of stress exposure, but only in the absence of the infection. In contrast, mice exposed to stress during infection had an increase in SCFA levels, particularly on day 6. This was somewhat surprising given the importance of SCFAs in other models, and clinical cases, of colonic inflammation. We have also seen similar results when mice are exposed to a restraint stress, which led to decreases in acetic, butyric, and propionic acids in the absence of infection, but increases during infection (36). These unexpected results may be due to the nature of the C rodentium challenge. Inflammation starts in the cecum and spreads distally to cause mild/moderate colonic hyperplasia in the descending colon (24). In mice, the cecum is a key location for microbial fermentation; thus, murine models of colitis that cause pancolitis may affect SCFA production to a greater degree than C rodentium–induced colitis, a hypothesis worth testing in future studies.

In our study, receptor expression, rather than SCFA levels, were more directly related to the severity of colonic inflammation. SCFAs exert their mechanism of action via G protein–coupled receptors and through inhibition of histone deacetylases (43,47). Stress exposure during infection significantly changed SCFA receptor expression. Infection led to a downregulation of GPR41, GPR43, and GPR109A receptor expression. These mice had little evidence of inflammation. Mice exposed to stress during infection, however, had significant increases in SCFA receptors and intestinal inflammation, suggesting that SCFA receptors play a role in stress-induced exacerbation of colonic inflammation. In particular, GPR41 had a positive association with TNFα and iNOS mRNA, and histopathology. Our results suggest that stress-induced upregulation of GPR41 contributes to enhanced disease pathology in C rodentium–challenged mice. A proinflammatory role of GPR41 is consistent with studies in GPR41–/– mice showing significant improvements in colonic inflammation (22).

It is not yet clear why SCFA levels did not significantly decrease in the colon when the relative abundance of SCFA-producing taxa was significantly reduced. This may, however, reflect a strong limitation of studies that use 16S rRNA gene sequencing to access the mucosa-associated microbiome. Although 16S rRNA gene sequencing can identify differences in community diversity and the relative abundance of specific bacterial genera, it is often not predictive of bacterial function/activity (48). Future studies will use additional methods to identify microbial gene functions and metabolic activities.

The samples for this study were collected during 2 experiments, a discovery experiment and a follow-up validation experiment, and data from the experiments were combined for our primary analysis. Although the majority of findings showed the same patters when discovery, validation, and combined data were assessed, the results from the discovery samples (which contained an n = 3) did not match the validated samples when comparing Citrobacter quantification, butyric acid, propionic acid, and GPR109A. When considered together, the findings support previous findings indicating that stress-induced changes of the mucosa-associated microbiome influence colonic immune responses. Because the exploratory nature of this study, further in depth investigations is warranted to confirm the important implications for gastrointestinal illnesses and conditions that are associated with differences in the gut microbiome (such as IBD or FGIDs) and are often worsened during stressful periods. It was predicted that bacterial-produced SCFAs would be directly correlated with disease severity. Only changes in the SCFA receptor GPR41 were, however, directly related to colonic inflammation. Our results, along with findings that GPR41−/− mice have reduced colonic inflammation (22) have led us to surmise GPR41 plays an important role in linking the gut microbiome to stress-induced exacerbation of colonic inflammation. Ongoing studies are utilizing additional models of murine inflammation that are similar to IBD, and are prospectively assessing IBD and FGID patients, to better understand the effects of stress on the microbiome and metabolome.

REFERENCES

1. Sartor RB. Microbial influences in inflammatory bowel diseases. Gastroenterology 2008; 134:577–594.
2. Crouzet L, Gaultier E, Del’Homme C, et al. The hypersensitivity to colonic distension of IBS patients can be transferred to rats through their fecal microbiota. Neurogastroenterol Motil 2013; 25:e272–e282.
3. Murakami T, Kamada K, Mizushima K, et al. Changes in intestinal motility and gut microbiota composition in a rat stress model. Digestion 2017; 95:55–60.
4. O’Mahony SM, Felice VD, Nally K, et al. Disturbance of the gut microbiota in early-life selectively affects visceral pain in adulthood without impacting cognitive or anxiety-related behaviors in male rats. Neuroscience 2014; 277:885–901.
5. Bernstein CN, Singh S, Graff LA, et al. A prospective population-based study of triggers of symptomatic flares in IBD. Am J Gastroenterol 2010; 105:1994–2002.
6. Traue HC, Kosarz P. Everyday stress and Crohn's disease activity: a time series analysis of 20 single cases. Int J Behav Med 1999; 6:101–119.
7. Mardini HE, Kip KE, Wilson JW. Crohn's disease: a two-year prospective study of the association between psychological distress and disease activity. Dig Dis Sci 2004; 49:492–497.
8. Herzer M, Denson LA, Baldassano RN, et al. Patient and parent psychosocial factors associated with health-related quality of life in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2011; 52:295–299.
9. Devanarayana NM, Mettananda S, Liyanarachchi C, et al. Abdominal pain-predominant functional gastrointestinal diseases in children and adolescents: prevalence, symptomatology, and association with emotional stress. J Pediatr Gastroenterol Nutr 2011; 53:659–665.
10. Devanarayana NM, Rajindrajith S, Benninga MA. Op-20 the association between adverse life events and abdominal pain-predominant functional gastrointestinal disorders. J Pediatr Gastroenterol Nutr 2015; 61:517–518.
11. Kostic AD, Xavier RJ, Gevers D. The microbiome in inflammatory bowel disease: current status and the future ahead. Gastroenterology 2014; 146:1489–1499.
12. Bailey MT, Dowd SE, Galley JD, et al. Exposure to a social stressor alters the structure of the intestinal microbiota: implications for stressor-induced immunomodulation. Brain Behav Immun 2011; 25:397–407.
13. Galley JD, Nelson MC, Yu Z, et al. Exposure to a social stressor disrupts the community structure of the colonic mucosa-associated microbiota. BMC Microbiol 2014; 14:189.
14. Bailey MT, Dowd SE, Parry NM, et al. Stressor exposure disrupts commensal microbial populations in the intestines and leads to increased colonization by Citrobacter rodentium. Infect Immu 2010; 78:1509–1519.
15. Bailey MT, Lubach GR, Coe CL. Prenatal stress alters bacterial colonization of the gut in infant monkeys. J Pediatr Gastroenterol Nutr 2004; 38:414–421.
16. Hanke ML, Powell ND, Stiner LM, et al. Beta adrenergic blockade decreases the immunomodulatory effects of social disruption stress. Brain Behav Immun 2012; 26:1150–1159.
17. Galley JD, Parry NM, Ahmer BM, et al. The commensal microbiota exacerbate infectious colitis in stressor-exposed mice. Brain Behav Immun 2017; 60:44–50.
18. Mackos AR, Galley JD, Eubank TD, et al. Social stress-enhanced severity of Citrobacter rodentium-induced colitis is CCL2-dependent and attenuated by probiotic Lactobacillus reuteri. Mucosal Immunol 2016; 9:515–526.
19. Cummings JH, Pomare EW, Branch WJ, et al. Short chain fatty acids in human large intestine, portal, hepatic and venous blood. Gut 1987; 28:1221–1227.
20. Smith PM, Howitt MR, Panikov N, et al. The microbial metabolites, short-chain fatty acids, regulate colonic Treg cell homeostasis. Science 2013; 341:569–573.
21. Thangaraju M, Cresci GA, Liu K, et al. GPR109A is a G-protein-coupled receptor for the bacterial fermentation product butyrate and functions as a tumor suppressor in colon. Cancer Res 2009; 69:2826–2832.
22. Kim MH, Kang SG, Park JH, et al. Short-chain fatty acids activate GPR41 and GPR43 on intestinal epithelial cells to promote inflammatory responses in mice. Gastroenterology 2013; 145:396.e1–10–406.e1–10.
23. Avitsur R, Stark JL, Sheridan JF. Social stress induces glucocorticoid resistance in subordinate animals. Hormon Behav 2001; 39:247–257.
24. Borenshtein D, Nambiar PR, Groff EB, et al. Development of fatal colitis in FVB mice infected with Citrobacter rodentium. Infect Immun 2007; 75:3271–3281.
25. Rath HC, Herfarth HH, Ikeda JS, et al. Normal luminal bacteria, especially Bacteroides species, mediate chronic colitis, gastritis, and arthritis in HLA-B27/human beta2 microglobulin transgenic rats. J Clin Invest 1996; 98:945–953.
26. Mackos AR, Eubank TD, Parry NM, et al. Probiotic Lactobacillus reuteri attenuates the stressor-enhanced severity of Citrobacter rodentium infection. Infection Immun 2013; 81:3253–3263.
27. Garcia-Villalba R, Giménez-Bastida JA, García-Conesa MT, et al. Alternative method for gas chromatography-mass spectrometry analysis of short-chain fatty acids in faecal samples. J Sep Sc 2012; 35:1906–1913.
28. Bokulich NA, Subramanian S, Faith JJ, et al. Quality-filtering vastly improves diversity estimates from Illumina amplicon sequencing. Nat Methods 2013; 10:57–59.
29. McCafferty J, Mühlbauer M, Gharaibeh RZ, et al. Stochastic changes over time and not founder effects drive cage effects in microbial community assembly in a mouse model. ISME J 2013; 7:2116–2125.
30. Arthur JC, Gharaibeh RZ, Mühlbauer M, et al. Microbial genomic analysis reveals the essential role of inflammation in bacteria-induced colorectal cancer. Nat Commun 2014; 5:4724.
31. Galley JD, Mackos AR, Varaljay VA, et al. Stressor exposure has prolonged effects on colonic microbial community structure in Citrobacter rodentium-challenged mice. Sci Rep 2017; 7:45012.
32. Sartor RB. Genetics and environmental interactions shape the intestinal microbiome to promote inflammatory bowel disease versus mucosal homeostasis. Gastroenterology 2010; 139:1816–1819.
33. Zitomersky NL, Atkinson BJ, Franklin SW, et al. Characterization of adherent bacteroidales from intestinal biopsies of children and young adults with inflammatory bowel disease. PLoS One 2013; 8:e63686.
34. Li X, Fox JG, Whary MT, et al. SCID/NCr mice naturally infected with Helicobacter hepaticus develop progressive hepatitis, proliferative typhlitis, and colitis. Infect Immun 1998; 66:5477–5484.
35. Doherty NC, Tobias A, Watson S, et al. The effect of the human gut-signalling hormone, norepinephrine, on the growth of the gastric pathogen Helicobacter pylori. Helicobacter 2009; 14:223–230.
36. Maltz RM, Keirsey J, Kim SC, et al. Prolonged restraint stressor exposure in outbred CD-1 mice impacts microbiota, colonic inflammation, and short chain fatty acids. PLoS One 2018; 13:e0196961.
37. Zhang Q, Wu Y, Wang J, et al. Accelerated dysbiosis of gut microbiota during aggravation of DSS-induced colitis by a butyrate-producing bacterium. Sci Rep 2016; 6:27572.
38. Eeckhaut V, Machiels K, Perrier C, et al. Butyricicoccus pullicaecorum in inflammatory bowel disease. Gut 2013; 62:1745–1752.
39. Sakamoto M, Takagaki A, Matsumoto K, et al. Butyricimonas synergistica gen. nov., sp. nov. and Butyricimonas virosa sp. nov., butyric acid-producing bacteria in the family ’Porphyromonadaceae’ isolated from rat faeces. Int J Syst Evol Microbiol 2009; 59:1748–1753.
40. Clarke JM, Topping DL, Christophersen CT, et al. Butyrate esterified to starch is released in the human gastrointestinal tract. Am J Clin Nutr 2011; 94:1276–1283.
41. Zhong Y, Nyman M, Fak F. Modulation of gut microbiota in rats fed high-fat diets by processing whole-grain barley to barley malt. Mol Nutr Food Res 2015; 59:2066–2076.
42. Imai K, Yamada K, Tamura M, et al. Reactivation of latent HIV-1 by a wide variety of butyric acid-producing bacteria. Cell Mol Life Sci 2012; 69:2583–2592.
43. Maslowski KM, Vieira AT, Ng A, et al. Regulation of inflammatory responses by gut microbiota and chemoattractant receptor GPR43. Nature 2009; 461:1282–1286.
44. Senagore AJ, MacKeigan JM, Scheider M, et al. Short-chain fatty acid enemas: a cost-effective alternative in the treatment of nonspecific proctosigmoiditis. Dis Colon Rectum 1992; 35:923–927.
45. Kiely EM, Ajayi NA, Wheeler RA, et al. Diversion procto-colitis: response to treatment with short-chain fatty acids. J Pediatr Surg 2001; 36:1514–1517.
46. Mishiro T, Kusunoki R, Otani A, et al. Butyric acid attenuates intestinal inflammation in murine DSS-induced colitis model via milk fat globule-EGF factor 8. Lab Invest 2013; 93:834–843.
47. Macia L, Tan J, Vieira AT, et al. Metabolite-sensing receptors GPR43 and GPR109A facilitate dietary fibre-induced gut homeostasis through regulation of the inflammasome. Nat Commun 2015; 6:6734.
48. Su Y, Chen X, Liu M, et al. Effect of three lactobacilli with strain-specific activities on the growth performance, faecal microbiota and ileum mucosa proteomics of piglets. J Anim Sci Biotechnol 2017; 8:52.
Keywords:

Citrobacter rodentium; colitis; GPR41; microbiome; Parabacteroides; social disruption stress

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