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1.
Gut Microbes ; 15(2): 2266627, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37853762

RESUMEN

Immigration to a highly industrialized nation has been associated with metabolic disease and simultaneous shifts in microbiota composition, but the underlying mechanisms are challenging to test in human studies. Here, we conducted a pilot study to assess the differential effects of human gut microbiota collected from the United States (US) and rural Thailand on the murine gut mucosa and immune system. Colonization of germ-free mice with microbiota from US individuals resulted in an increased accumulation of innate-like CD8 T cells in the small intestine lamina propria and intra-epithelial compartments when compared to colonization with microbiota from Thai individuals. Both TCRγδ and CD8αα T cells showed a marked increase in mice receiving Western microbiota and, interestingly, this phenotype was also associated with an increase in intestinal mucus thickness. Serendipitously, an accidentally infected group of mice corroborated this association between elevated inflammatory response and increased mucus thickness. These results suggest that Western-associated human gut microbes contribute to a pro-inflammatory immune response.


Asunto(s)
Microbioma Gastrointestinal , Humanos , Ratones , Animales , Inflamación , Proyectos Piloto , Mucosa Intestinal/metabolismo , Moco , Linfocitos T CD8-positivos
2.
Trends Genet ; 39(8): 587-592, 2023 08.
Artículo en Inglés | MEDLINE | ID: mdl-37244757
5.
mSystems ; 6(1)2021 02 23.
Artículo en Inglés | MEDLINE | ID: mdl-33622857

RESUMEN

Microbiome samples are inherently defined by the environment in which they are found. Therefore, data that provide context and enable interpretation of measurements produced from biological samples, often referred to as metadata, are critical. Important contributions have been made in the development of community-driven metadata standards; however, these standards have not been uniformly embraced by the microbiome research community. To understand how these standards are being adopted, or the barriers to adoption, across research domains, institutions, and funding agencies, the National Microbiome Data Collaborative (NMDC) hosted a workshop in October 2019. This report provides a summary of discussions that took place throughout the workshop, as well as outcomes of the working groups initiated at the workshop.

7.
Anim Microbiome ; 2(1): 16, 2020 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-33499991

RESUMEN

BACKGROUND: The gut microbiome harbors trillions of bacteria that play a major role in dietary nutrient extraction and host metabolism. Metabolic diseases such as obesity and diabetes are associated with shifts in microbiome composition and have been on the rise in Westernized or highly industrialized countries. At the same time, Westernized diets low in dietary fiber have been shown to cause loss of gut microbial diversity. However, the link between microbiome composition, loss of dietary fiber, and obesity has not been well defined. RESULTS: To study the interactions between gut microbiota, dietary fiber, and weight gain, we transplanted captive and wild douc gut microbiota into germ-free mice and then exposed them to either a high- or low-fiber diet. The group receiving captive douc microbiota gained significantly more weight, regardless of diet, while mice receiving a high-fiber diet and wild douc microbiota remained lean. In the presence of a low-fiber diet, the wild douc microbiota partially prevented weight gain. Using 16S rRNA gene amplicon sequencing we identified key bacterial taxa in each group, specifically a high relative abundance of Bacteroides and Akkermansia in captive douc FMT mice and a higher relative abundance of Lactobacillus and Clostridium in the wild douc FMT mice. CONCLUSIONS: In the context of our germ-free mouse experiment, wild douc microbiota could serve as a reservoir for microbes for cross-species transplants. Our results suggest that wild douc microbiota are tailored to diverse fiber diets and can prevent weight gain when exposed to a native diet.

8.
Clin Infect Dis ; 71(2): 419-421, 2020 07 11.
Artículo en Inglés | MEDLINE | ID: mdl-31679002

RESUMEN

Little is known about the effect of human migration on gut microbiome antibiotic resistance gene (ARG) carriage. Using deep shotgun stool metagenomics analysis, we found a rapid increase in gut microbiome ARG richness and abundance in women from 2 independent ethnic groups relocating from Thailand to the United States.


Asunto(s)
Emigración e Inmigración , Microbioma Gastrointestinal , Antibacterianos/farmacología , Farmacorresistencia Microbiana , Femenino , Microbioma Gastrointestinal/genética , Humanos , Metagenómica , Tailandia
9.
Cell Host Microbe ; 25(6): 789-802.e5, 2019 06 12.
Artículo en Inglés | MEDLINE | ID: mdl-31194939

RESUMEN

Diet is a key determinant of human gut microbiome variation. However, the fine-scale relationships between daily food choices and human gut microbiome composition remain unexplored. Here, we used multivariate methods to integrate 24-h food records and fecal shotgun metagenomes from 34 healthy human subjects collected daily over 17 days. Microbiome composition depended on multiple days of dietary history and was more strongly associated with food choices than with conventional nutrient profiles, and daily microbial responses to diet were highly personalized. Data from two subjects consuming only meal replacement beverages suggest that a monotonous diet does not induce microbiome stability in humans, and instead, overall dietary diversity associates with microbiome stability. Our work provides key methodological insights for future diet-microbiome studies and suggests that food-based interventions seeking to modulate the gut microbiota may need to be tailored to the individual microbiome. Trial Registration: ClinicalTrials.gov: NCT03610477.


Asunto(s)
Dieta , Microbioma Gastrointestinal , Microbiota , Adulto , Heces/microbiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Metagenómica , Persona de Mediana Edad , Adulto Joven
10.
Gigascience ; 8(5)2019 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-31042284

RESUMEN

The use of machine learning in high-dimensional biological applications, such as the human microbiome, has grown exponentially in recent years, but algorithm developers often lack the domain expertise required for interpretation and curation of the heterogeneous microbiome datasets. We present Microbiome Learning Repo (ML Repo, available at https://knights-lab.github.io/MLRepo/), a public, web-based repository of 33 curated classification and regression tasks from 15 published human microbiome datasets. We highlight the use of ML Repo in several use cases to demonstrate its wide application, and we expect it to be an important resource for algorithm developers.


Asunto(s)
Bases de Datos Genéticas , Microbiota/genética , Programas Informáticos , Algoritmos , Humanos , Aprendizaje Automático
11.
Cell ; 175(4): 962-972.e10, 2018 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-30388453

RESUMEN

Many US immigrant populations develop metabolic diseases post immigration, but the causes are not well understood. Although the microbiome plays a role in metabolic disease, there have been no studies measuring the effects of US immigration on the gut microbiome. We collected stool, dietary recalls, and anthropometrics from 514 Hmong and Karen individuals living in Thailand and the United States, including first- and second-generation immigrants and 19 Karen individuals sampled before and after immigration, as well as from 36 US-born European American individuals. Using 16S and deep shotgun metagenomic DNA sequencing, we found that migration from a non-Western country to the United States is associated with immediate loss of gut microbiome diversity and function in which US-associated strains and functions displace native strains and functions. These effects increase with duration of US residence and are compounded by obesity and across generations.


Asunto(s)
Pueblo Asiatico , Emigración e Inmigración , Microbioma Gastrointestinal , Adulto , Bacteroides/aislamiento & purificación , Fibras de la Dieta/metabolismo , Emigrantes e Inmigrantes , Humanos , Metagenoma , Obesidad/epidemiología , Obesidad/microbiología , Prevotella/aislamiento & purificación , Estados Unidos
12.
Sci Rep ; 8(1): 11159, 2018 07 24.
Artículo en Inglés | MEDLINE | ID: mdl-30042392

RESUMEN

Red-shanked doucs (Pygathrix nemaeus) are endangered, foregut-fermenting colobine primates which are difficult to maintain in captivity. There are critical gaps in our understanding of their natural lifestyle, including dietary habits such as consumption of leaves, unripe fruit, flowers, seeds, and other plant parts. There is also a lack of understanding of enteric adaptations, including their unique microflora. To address these knowledge gaps, we used the douc as a model to study relationships between gastrointestinal microbial community structure and lifestyle. We analyzed published fecal samples as well as detailed dietary history from doucs with four distinct lifestyles (wild, semi-wild, semi-captive, and captive) and determined gastrointestinal bacterial microbiome composition using 16S rRNA sequencing. A clear gradient of microbiome composition was revealed along an axis of natural lifestyle disruption, including significant associations with diet, biodiversity, and microbial function. We also identified potential microbial biomarkers of douc dysbiosis, including Bacteroides and Prevotella, which may be related to health. Our results suggest a gradient-like shift in captivity causes an attendant shift to severe gut dysbiosis, thereby resulting in gastrointestinal issues.


Asunto(s)
Cercopithecidae/fisiología , Microbioma Gastrointestinal/genética , Estado de Salud , Estado Nutricional/fisiología , Animales , Bacteroidetes/clasificación , Bacteroidetes/genética , Biodiversidad , Cloroplastos/genética , Dieta Vegana , Disbiosis , Especies en Peligro de Extinción , Heces/microbiología , Firmicutes/clasificación , Firmicutes/genética , Tracto Gastrointestinal/microbiología , Estilo de Vida , Metagenoma , Modelos Animales , ARN Ribosómico 16S/genética , Análisis de Secuencia de ARN , Estadísticas no Paramétricas
13.
Am J Clin Nutr ; 106(4): 1052-1061, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28814395

RESUMEN

Background: Emerging evidence suggests novel roles for bacterially derived vitamin K forms known as menaquinones in health and disease, which may be attributable in part to anti-inflammatory effects. However, the relevance of menaquinones produced by gut bacteria to vitamin K requirements and inflammation is undetermined.Objective: This study aimed to quantify fecal menaquinone concentrations and identify associations between fecal menaquinone concentrations and serum vitamin K concentrations, gut microbiota composition, and inflammation.Design: Fecal and serum menaquinone concentrations, fecal microbiota composition, and plasma and fecal cytokine concentrations were measured in 80 men and postmenopausal women (48 men, 32 women, age 40-65 y) enrolled in a randomized, parallel-arm, provided-food trial. After consuming a run-in diet for 2 wk, participants were randomly assigned to consume a whole grain-rich (WG) or a refined grain-based (RG) diet for 6 wk. Outcomes were measured at weeks 2 and 8.Results: The median total daily excretion of menaquinones in feces was 850 nmol/d but was highly variable (range: 64-5358 nmol/d). The total median (IQR) fecal concentrations of menaquinones decreased in the WG diet compared with the RG diet [-6.8 nmol/g (13.0 nmol/g) dry weight for WG compared with 1.8 nmol/g (12.3 nmol/g) dry weight for RG; P < 0.01)]. However, interindividual variability in fecal menaquinone concentrations partitioned individuals into 2 distinct groups based on interindividual differences in concentrations of different menaquinone forms rather than the diet group or the time point. The relative abundances of several gut bacteria taxa, Bacteroides and Prevotella in particular, differed between these groups, and 42% of identified genera were associated with ≥1 menaquinone form. Menaquinones were not detected in serum, and neither fecal concentrations of individual menaquinones nor the menaquinone group was associated with any marker of inflammation.Conclusion: Menaquinone concentrations in the human gut appear highly variable and are associated with gut microbiota composition. However, the health implications remain unclear. This trial was registered at clinicaltrials.gov as NCT01902394.


Asunto(s)
Citocinas/sangre , Dieta , Heces/química , Microbioma Gastrointestinal , Mucosa Intestinal/metabolismo , Vitamina K 2/metabolismo , Granos Enteros , Bacterias/crecimiento & desarrollo , Bacterias/metabolismo , Citocinas/metabolismo , Heces/microbiología , Conducta Alimentaria , Femenino , Manipulación de Alimentos , Humanos , Inflamación/sangre , Intestinos/microbiología , Masculino , Persona de Mediana Edad , Necesidades Nutricionales , Vitamina K/metabolismo , Vitamina K 2/sangre
14.
Am J Clin Nutr ; 105(3): 589-599, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-28179223

RESUMEN

Background: The effect of whole grains on the regulation of energy balance remains controversial.Objective: We aimed to determine the effects of substituting whole grains for refined grains, independent of body weight changes, on energy-metabolism metrics and glycemic control.Design: The study was a randomized, controlled, parallel-arm controlled-feeding trial that was conducted in 81 men and postmenopausal women [49 men and 32 women; age range: 40-65 y; body mass index (in kg/m2): <35.0]. After a 2-wk run-in period, participants were randomly assigned to consume 1 of 2 weight-maintenance diets for 6 wk. Diets differed in whole-grain and fiber contents [mean ± SDs: whole grain-rich diet: 207 ± 39 g whole grains plus 40 ± 5 g dietary fiber/d; refined grain-based diet: 0 g whole grains plus 21 ± 3 g dietary fiber/d] but were otherwise similar. Energy metabolism and body-composition metrics, appetite, markers of glycemic control, and gut microbiota were measured at 2 and 8 wk.Results: By design, body weight was maintained in both groups. Plasma alkylresorcinols, which are biomarkers of whole-grain intake, increased in the whole grain-rich diet group (WG) but not in the refined grain-based diet group (RG) (P-diet-by-time interaction < 0.0001). Beta ± SE changes (ΔWG compared with ΔRG) in the resting metabolic rate (RMR) (43 ± 25 kcal/d; P = 0.04), stool weight (76 ± 12 g/d; P < 0.0001), and stool energy content (57 ± 17 kcal/d; P = 0.003), but not in stool energy density, were higher in the WG. When combined, the favorable energetic effects in the WG translated into a 92-kcal/d (95% CI: 28, 156-kcal/d) higher net daily energy loss compared with that of the RG (P = 0.005). Prospective consumption (P = 0.07) and glycemia after an oral-glucose-tolerance test (P = 0.10) trended toward being lower in the WG than in the RG. When nonadherent participants were excluded, between-group differences in stool energy content and glucose tolerance increased, and between-group differences in the RMR and prospective consumption were not statistically significant.Conclusion: These findings suggest positive effects of whole grains on the RMR and stool energy excretion that favorably influence energy balance and may help explain epidemiologic associations between whole-grain consumption and reduced body weight and adiposity. This trial was registered at clinicaltrials.gov as NCT01902394.


Asunto(s)
Dieta , Fibras de la Dieta/farmacología , Metabolismo Energético , Conducta Alimentaria , Granos Enteros , Adiposidad , Glucemia/metabolismo , Fibras de la Dieta/uso terapéutico , Ingestión de Energía , Heces , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Masculino , Persona de Mediana Edad , Obesidad/dietoterapia , Posmenopausia , Resorcinoles/sangre
15.
Am J Clin Nutr ; 105(3): 635-650, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-28179226

RESUMEN

Background: Observational studies suggest an inverse association between whole-grain (WG) consumption and inflammation. However, evidence from interventional studies is limited, and few studies have included measurements of cell-mediated immunity.Objective: We assessed the effects of diets rich in WGs compared with refined grains (RGs) on immune and inflammatory responses, gut microbiota, and microbial products in healthy adults while maintaining subject body weights.Design: After a 2-wk provided-food run-in period of consuming a Western-style diet, 49 men and 32 postmenopausal women [age range: 40-65 y, body mass index (in kg/m2) <35] were assigned to consume 1 of 2 provided-food weight-maintenance diets for 6 wk.Results: Compared with the RG group, the WG group had increased plasma total alkyresorcinols (a measure of WG intake) (P < 0.0001), stool weight (P < 0.0001), stool frequency (P = 0.02), and short-chain fatty acid (SCFA) producer Lachnospira [false-discovery rate (FDR)-corrected P = 0.25] but decreased pro-inflammatory Enterobacteriaceae (FDR-corrected P = 0.25). Changes in stool acetate (P = 0.02) and total SCFAs (P = 0.05) were higher in the WG group than in the RG group. A positive association was shown between Lachnospira and acetate (FDR-corrected P = 0.002) or butyrate (FDR-corrected P = 0.005). We also showed that there was a higher percentage of terminal effector memory T cells (P = 0.03) and LPS-stimulated ex vivo production of tumor necrosis factor-α (P = 0.04) in the WG group than in the RG group, which were positively associated with plasma alkylresorcinol concentrations.Conclusion: The short-term consumption of WGs in a weight-maintenance diet increases stool weight and frequency and has modest positive effects on gut microbiota, SCFAs, effector memory T cells, and the acute innate immune response and no effect on other markers of cell-mediated immunity or systemic and gut inflammation. This trial was registered at clinicaltrials.gov as NCT01902394.


Asunto(s)
Bacterias/crecimiento & desarrollo , Dieta , Conducta Alimentaria , Microbioma Gastrointestinal , Tracto Gastrointestinal , Inflamación/metabolismo , Granos Enteros , Ácido Acético/metabolismo , Anciano , Bacterias/metabolismo , Biomarcadores/metabolismo , Mantenimiento del Peso Corporal , Butiratos/metabolismo , Defecación , Fibras de la Dieta/farmacología , Enterobacteriaceae/crecimiento & desarrollo , Enterobacteriaceae/metabolismo , Heces , Femenino , Tracto Gastrointestinal/inmunología , Tracto Gastrointestinal/metabolismo , Tracto Gastrointestinal/microbiología , Humanos , Inmunidad Innata , Inflamación/microbiología , Lipopolisacáridos , Masculino , Persona de Mediana Edad , Resorcinoles/sangre , Linfocitos T/metabolismo , Factor de Necrosis Tumoral alfa/metabolismo
16.
Nat Microbiol ; 1(11): 16140, 2016 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-27782139

RESUMEN

The early life microbiome plays important roles in host immunological and metabolic development. Because the incidence of type 1 diabetes (T1D) has been increasing substantially in recent decades, we hypothesized that early-life antibiotic use alters gut microbiota, which predisposes to disease. Using non-obese diabetic mice that are genetically susceptible to T1D, we examined the effects of exposure to either continuous low-dose antibiotics or pulsed therapeutic antibiotics (PAT) early in life, mimicking childhood exposures. We found that in mice receiving PAT, T1D incidence was significantly higher, and microbial community composition and structure differed compared with controls. In pre-diabetic male PAT mice, the intestinal lamina propria had lower Th17 and Treg proportions and intestinal SAA expression than in controls, suggesting key roles in transducing the altered microbiota signals. PAT affected microbial lipid metabolism and host cholesterol biosynthetic gene expression. These findings show that early-life antibiotic treatments alter the gut microbiota and its metabolic capacities, intestinal gene expression and T-cell populations, accelerating T1D onset in non-obese diabetic mice.


Asunto(s)
Antibacterianos/efectos adversos , Diabetes Mellitus Tipo 1/etiología , Microbioma Gastrointestinal/efectos de los fármacos , Penicilina V/efectos adversos , Animales , Antibacterianos/administración & dosificación , Colesterol/biosíntesis , Esquema de Medicación , Heces/microbiología , Microbioma Gastrointestinal/genética , Microbioma Gastrointestinal/fisiología , Expresión Génica/efectos de los fármacos , Predisposición Genética a la Enfermedad , Metabolismo de los Lípidos/efectos de los fármacos , Metaboloma/efectos de los fármacos , Ratones , Ratones Endogámicos NOD , Membrana Mucosa/efectos de los fármacos , Membrana Mucosa/inmunología , Obesidad , Penicilina V/administración & dosificación , ARN Ribosómico 16S , Linfocitos T Reguladores , Células Th17
17.
Cell Host Microbe ; 20(4): 515-526, 2016 Oct 12.
Artículo en Inglés | MEDLINE | ID: mdl-27693307

RESUMEN

Live bacteria (such as probiotics) have long been used to modulate gut microbiota and human physiology, but their colonization is mostly transient. Conceptual understanding of the ecological principles as they apply to exogenously introduced microbes in gut ecosystems is lacking. We find that, when orally administered to humans, Bifidobacterium longum AH1206 stably persists in the gut of 30% of individuals for at least 6 months without causing gastrointestinal symptoms or impacting the composition of the resident gut microbiota. AH1206 engraftment was associated with low abundance of resident B. longum and underrepresentation of specific carbohydrate utilization genes in the pre-treatment microbiome. Thus, phylogenetic limiting and resource availability are two factors that control the niche opportunity for AH1206 colonization. These findings suggest that bacterial species and functional genes absent in the gut microbiome of individual humans can be reestablished, providing opportunities for precise and personalized microbiome reconstitution.


Asunto(s)
Bifidobacterium longum/crecimiento & desarrollo , Portador Sano , Microbioma Gastrointestinal , Microbiota , Probióticos/administración & dosificación , Administración Oral , Humanos , Factores de Tiempo
18.
Proc Natl Acad Sci U S A ; 113(37): 10376-81, 2016 09 13.
Artículo en Inglés | MEDLINE | ID: mdl-27573830

RESUMEN

The primate gastrointestinal tract is home to trillions of bacteria, whose composition is associated with numerous metabolic, autoimmune, and infectious human diseases. Although there is increasing evidence that modern and Westernized societies are associated with dramatic loss of natural human gut microbiome diversity, the causes and consequences of such loss are challenging to study. Here we use nonhuman primates (NHPs) as a model system for studying the effects of emigration and lifestyle disruption on the human gut microbiome. Using 16S rRNA gene sequencing in two model NHP species, we show that although different primate species have distinctive signature microbiota in the wild, in captivity they lose their native microbes and become colonized with Prevotella and Bacteroides, the dominant genera in the modern human gut microbiome. We confirm that captive individuals from eight other NHP species in a different zoo show the same pattern of convergence, and that semicaptive primates housed in a sanctuary represent an intermediate microbiome state between wild and captive. Using deep shotgun sequencing, chemical dietary analysis, and chloroplast relative abundance, we show that decreasing dietary fiber and plant content are associated with the captive primate microbiome. Finally, in a meta-analysis including published human data, we show that captivity has a parallel effect on the NHP gut microbiome to that of Westernization in humans. These results demonstrate that captivity and lifestyle disruption cause primates to lose native microbiota and converge along an axis toward the modern human microbiome.


Asunto(s)
Microbioma Gastrointestinal/genética , Tracto Gastrointestinal/microbiología , Variación Genética , Primates/microbiología , Animales , Bacterias/clasificación , Bacterias/genética , Dieta , Humanos , Filogenia , Primates/genética , ARN Ribosómico 16S/genética
19.
Nat Biotechnol ; 34(9): 942-9, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-27454739

RESUMEN

Amplicon-based marker gene surveys form the basis of most microbiome and other microbial community studies. Such PCR-based methods have multiple steps, each of which is susceptible to error and bias. Variance in results has also arisen through the use of multiple methods of next-generation sequencing (NGS) amplicon library preparation. Here we formally characterized errors and biases by comparing different methods of amplicon-based NGS library preparation. Using mock community standards, we analyzed the amplification process to reveal insights into sources of experimental error and bias in amplicon-based microbial community and microbiome experiments. We present a method that improves on the current best practices and enables the detection of taxonomic groups that often go undetected with existing methods.


Asunto(s)
Replicación del ADN/genética , Biblioteca de Genes , Marcadores Genéticos/genética , Secuenciación de Nucleótidos de Alto Rendimiento/normas , Microbiota/genética , Reacción en Cadena de la Polimerasa/normas , Secuenciación de Nucleótidos de Alto Rendimiento/métodos , Reacción en Cadena de la Polimerasa/métodos , Guías de Práctica Clínica como Asunto , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
20.
Cell Host Microbe ; 17(5): 553-64, 2015 May 13.
Artículo en Inglés | MEDLINE | ID: mdl-25974298

RESUMEN

Antibiotics are by far the most common medications prescribed for children. Recent epidemiological data suggests an association between early antibiotic use and disease phenotypes in adulthood. Antibiotic use during infancy induces imbalances in gut microbiota, called dysbiosis. The gut microbiome's responses to antibiotics and its potential link to disease development are especially complex to study in the changing infant gut. Here, we synthesize current knowledge linking antibiotics, dysbiosis, and disease and propose a framework for studying antibiotic-related dysbiosis in children. We recommend future studies into the microbiome-mediated effects of antibiotics focused on four types of dysbiosis: loss of keystone taxa, loss of diversity, shifts in metabolic capacity, and blooms of pathogens. Establishment of a large and diverse baseline cohort to define healthy infant microbiome development is essential to advancing diagnosis, interpretation, and eventual treatment of pediatric dysbiosis. This approach will also help provide evidence-based recommendations for antibiotic usage in infancy.


Asunto(s)
Antibacterianos/uso terapéutico , Enfermedad , Disbiosis/inducido químicamente , Microbiota/efectos de los fármacos , Niño , Humanos , Lactante
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