Urinary stone disease (USD) has known associations with the gut microbiota. Approximately 80% of kidney stones contain oxalate as a primary constituent and diverse oxalate-degrading bacteria exist within the human gut that may protect against USD. While bacteriotherapy represents a promising strategy to eliminate oxalate and reduce the risk of USD, oxalate-degrading probiotics have had limited success. To identify limitations of oxalate-degrading probiotics and refine development of bacteriotherapies to prevent USD, we review the literature associated with the gut microbiota and USD.
A literature search was performed to identify publications that examine the role of oxalate-degrading bacteria or the whole gut microbiota in oxalate metabolism and the pathophysiology of USD. We conducted a meta-analysis of studies that examined the association of the whole gut microbiota with USD. In addition, we evaluated the gut microbiota of healthy individuals and those with co-morbidities related to USD using publically available data from the American Gut Project (AGP).
Studies on O. formigenes reveal that colonization by this species is not a good predictor of USD risk nor urinary oxalate excretion. The species of oxalate-degrading bacteria used in probiotics and duration of administration does not impact efficacy or persistence. Studies focused on the whole gut microbiota reveal broad shifts in the gut microbiota associated with USD and a diverse microbial network is associated with oxalate metabolism. AGP data analysis demonstrated a strong overlap in microbial genera depleted in diseased individuals among USD and co-morbidities.
The associations between the gut microbiota and USD extend beyond individual functional microbial species. Common shifts in the gut microbiota may facilitate the onset of USD and/or co-morbidities. The successful development of bacteriotherapies to inhibit USD will need to incorporate strategies that target a broad diversity of bacteria rather than focus on few specialist species.
Journal of endourology. 2018 May 29 [Epub ahead of print]
Carlos Alfredo Batagello, Manoj Monga, Aaron W Miller
Cleveland Clinic, 2569, Glickman Urological and Kidney Institute , 9500 Euclid Ave , Cleveland, Ohio, United States , 44195., Cleveland Clinic, Urology, Cleveand, Ohio, United States ; ., Cleveland Clinic, 2569, Glickman Urological and Kidney Institute, Cleveland, Ohio, United States.