China’s contribution to gut microbiota research

Gut microbiota research is a hot topic. With the advancement of high throughput sequencing technology, gut microbiota provides a sally port for the pathogenesis of diseases, the mechanism of drug action and the strategy of treatment selection. The transformation potential of gut microbiota research is gradually being valued. This paper focuses on the study of gut microbiota, highlights the contribution of China and puts forward some views in this fi eld. Review Article China’s contribution to gut microbiota research Honggang Wang and Xiaozhong Yang* Department of Gastroenterology, The Affi liated Huaian No.1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, 223300, People’s Republic of China, China Received: 17 April, 2020 Accepted: 20 April, 2020 Published: 22 April, 2020 *Corresponding author: Xiaozhong Yang, Professor, Department of Gastroenterology, The Affi liated Huaian No.1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, 223300, People’s Republic of China, China, Tel: +86 0517 84922766; Fax: +86 0517 84922768; E-mail:

The intestinal-hepatic axis has specifi cally become a signifi cant research topic in recent years. The enterococci occurring in quail are commonly found in the intestines of healthy people. However, some studies have found that the bacteria can migrate to the liver, mesentery and other tissues and organs, resulting in autoimmune hepatitis [5].
This fi nding suggests that intestinal bacteria may translocate to lymph nodes and liver through the damaged intestinal mucosal barrier, triggering the occurrence of diseases in extraintestinal organs. Intestinal microorganisms also interact with the nervous, immune, endocrine and other major systems through intestinal-brain axis pathways, to regulate the various functions of our body. This fl ora-host "communication" is essential for maintaining our health. The main pathological feature of Parkinson's disease is the accumulation of misfolded -synuclein in the brain. Some researchers have hypothesized that pathological -synuclein can spread from the intestine to the brain through the vagus nerve [6,7] . This concept laid a good foundation for the idea of "intestinal treatment of encephalopathy". More and more researchers have gradually recognized that the pathogenesis of chronic diseases should be The research on gut microbiota has become an important focus in recent years. There are tens of trillions of bacteria living in the human intestinal tract, which play an important role in digestion and absorption, nutritional metabolism, and immune regulation [1]. Right from birth gut microbiota become an indispensable part of our lives [2,3]. studied from the perspective of gut microbiota [8]. Imbalanced gut microbiota is associated with the progression of many other diseases, such as infl ammatory bowel disease [9], primary biliary cholangitis [10], autism [11], Alzheimer's disease [12], nephropathy [13], psoriasis [14], obesity [15], diabetes [16], and atherosclerosis [17]. The intestine-liver axis, intestinebrain axis, intestine-kidney axis and intestine-skin axis are associated with the occurrence and development of disease.
The ultimate goal of fl ora research is not just to explain the association between the fl ora and disease, but to explore new ways for clinical diagnosis and treatment of diseases. In the future, FMT, strain development, probiotics and clinical application of targeted antibiotics will be paid more attention.  [24]. In fact, we carried out an early clinical study on FMT for Parkinson's disease, and it is the fi rst such study in the world [25]. We believe that more high-quality research data will be published. The application of FMT in extra-intestinal diseases has received unprecedented attention [26,27]. Of the 367 clinical studies involving FMT, 84 (24%) were registered in China [28]. This is an important by combining modern medicine with molecular biology techniques. The types of probiotics marketed are limited, and the development of new probiotics needs to be accelerated. Technological advances limit the clinical transformation of fl ora research. Akkermansia muciniphila, a type of bacteria in the human intestinal tract, contribute to lose weight and resist cancer, etc. [29,30]. Recently, Wang, et al. have reported that pasteurised A. muciniphila or a specifi c outer membrane protein (Amuc_1100) can blunt colitis and CAC through the modulation of CD8 + cytotoxic T lymphocytes [31]. This provides new ideas for the treatment of infl ammatory bowel disease in the future. However, due to the limitations of isolation and culture technology, there are many limitations in its clinical transformation and application. The progress of methodology, strain screening, commercial production and clinical trial demonstration will all accelerate the pace of clinical application.
We propose some views on microbiota research. First, gut microbiota-related research will continue to grow. Recent studies have found that enzymes produced by gut microbiota can remove A antigen from red blood cells and thereby transform A blood into omnipotent O blood [32]. This important fi nding may alleviate the current situation of insuffi cient blood supply in the future. Such studies have challenged our superfi cial understanding of microbiota. Human understanding of the relationship with gut microbiota is in its infancy but is expected to dramatically continue. Second, advances in methodology will promote the clinical transformation of fl ora research. The clinical value of FMT is likely groundbreaking in its time and has been gradually recognized. but the current methodology limits the clinical transformation. FMT includes strict donor screening, optimized fecal bacteria preparation methods, and appropriate ways of fl ora transplantation [33]. Zhang, et al. invented Intelligent Fecal Microbiota Separation System (GenFMTer) and Transendoscopic Enteral Tubing (TET), which promoted the clinical transformation of microbial transplantation research [34]. Third, microfl ora research brings opportunities for the development of Traditional Chinese Medicine (TCM). It is diffi cult for international researchers to recognize fully the theory of TCM's holistic conditioning of the human body. In fact, there is a dynamic relationship between the intestinal tract and brain, lung, liver and kidney to maintain normal physiological activities. From the perspective of TCM, we can better understand gut microbiota. Cordyceps sinensis and Ganoderma lucidum extracts can treat obesity and type II diabetes by regulating gut microbiota [35,36]. We have found that Gynura segetum herb can also help optimize the gut microbiota structure, but the toxic components of pyrrolidine alkaloids limit its clinical application (data are not yet published). It can be seen that the regulating effect of TCM on gut microbiota is a problem worthy of attention. The study of gut microbiota and its metabolomics may provide ideas for the development of TCM. From ancient to modern times, from TCM to integrative medicine, from phenomenological to causal, from disease diagnosis to therapeutic targets, from cognitive limitations to clinical transformation, gut microbiota research has been both a challenge and an opportunity.
Recently, Chinese scientists highlighted seven facts and fi ve initiatives for gut microbiome research [37]. The facts Citation: Wang  include that (1) the gut microbiome is the leading edge of scientifi c research; (2) basic and translational research of the gut microbiome is expanding globally; (3) the gut microbiome contributes to health and diseases; (4) gut dysbiosis is only one factor in disease; (5) gut microbiome research is still at its infancy; (6) chaos and confl ict of interest exist in gut microbiome research; (7) self-purifi cation and discipline mechanisms exist in gut microbiome research, and the initiatives include that (1) follow the normative ethical principles to carry out research; (2) avoid hype and packaging; (3) disclose confl ict of interest and reveal safety and risk issues actively; (4) abide by laws and disciplines and adhere to evidence-based scientifi c rules; (5) actively participate in science popularization and education and promote public participation.
In summary, China's contribution is very important, mainly in the original use of gut microbiota, the progress of gut microbiota with diseases, and the clinical application of FMT. China will continue to contribute to the global research of intestinal fl ora.

Author contributions
Xiao-Zhong Yang designed the research; Hong-Gang Wang wrote the paper.

Funding
This paper was funded by the Jiangsu Provincial Health