Altered Tongue Coating Microbiota Drives Intestinal Inflammation in Patients with Inflammatory Bowel Disease

Yanqing Wang; Qian Xu; Jingyuan Wang; Meng Xue; Honghong Liu; Yifei Yang; Chao Ye; Shuling Wang; Gerong Zhang; Wenrui Guo; Wei Jiang; Eran Elinav; Shu Zhu; Guorong Zhang

doi:10.1016/j.eng.2026.02.016

Engineering ›› :202602016 DOI: 10.1016/j.eng.2026.02.016

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Altered Tongue Coating Microbiota Drives Intestinal Inflammation in Patients with Inflammatory Bowel Disease

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^a Department of Stomatology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China

^b Department of Anhui Provincial Clinical Laboratory Centre, Centre for Leading Medicine and Advanced Technologies of Institute of Health and Medcine, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China

^c Department of Digestive Disease, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China

^d Key Laboratory of Immune Response and Immunotherapy, School of Basic Medical Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China

^e School of Artificial Intelligence and Data Science, University of Science and Technology of China, Hefei 230001, China

^f National Clinical Research Center for Digestive Diseases, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China

^g Department of Molecular & Cell Biology, University of California, Berkeley, CA 94720, USA

^h Systems Immunology Department, Weizmann Institute of Science, Rehovot 76100, Israel

ⁱ Microbiome & Cancer Division, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany

Corresponding author:

^* zhushu@ustc.edu.cn (Shu Zhu),

zhgr@ustc.edu.cn (Guorong Zhang)

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Abstract

Emerging evidence highlights the oral-gut axis as an important contributor to the pathogenesis of inflammatory bowel disease (IBD); however, the specific role of the tongue coating microbiota remains poorly understood. To comprehensively delineate oral-gut microbial alterations in IBD, we analyzed tongue coating and fecal microbiota from 596 participants, including 278 patients with Crohn’s disease (CD), 91 with ulcerative colitis (UC), and 227 healthy controls (HCs), using 16S ribosomal RNA (rRNA) gene sequencing. Patients with IBD exhibited a distinct dysbiotic signature in tongue coating microbiota, characterized by increased abundances of Streptococcus, Prevotella, and Gemella in both CD and UC patients, alongside a CD-specific depletion of commensal taxa such as Neisseria and Fusobacterium compared with HCs. Notably, a similar oral microbial shift was observed in a spontaneous enteritis mouse model, which demonstrated enrichment of oral Streptococcus and concordant increases in Prevotella across both oral and intestinal niches. To establish causality, tongue coating microbiota from CD patients were transplanted into antibiotic-pretreated mice, resulting in significantly exacerbated colitis relative to recipients of HC-derived microbiota. Mechanistically, Streptococcus strains isolated from CD patients promoted Th1 cell polarization in vitro and aggravated colitis in vivo, implicating these orally derived pathobionts in the amplification of intestinal inflammation. Together, these findings identify the tongue coating microbiota as a previously underappreciated mediator of gut inflammation in IBD, support its potential utility as a non-invasive biomarker for CD, and provide mechanistic evidence that oral microbial dysbiosis can actively drive intestinal immune pathology.

Keywords

Tongue coating microbiota / Inflammatory bowel disease (IBD) / Oral-gut axis / Microbiota transplantation

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Yanqing Wang, Qian Xu, Jingyuan Wang, Meng Xue, Honghong Liu, Yifei Yang, Chao Ye, Shuling Wang, Gerong Zhang, Wenrui Guo, Wei Jiang, Eran Elinav, Shu Zhu, Guorong Zhang. Altered Tongue Coating Microbiota Drives Intestinal Inflammation in Patients with Inflammatory Bowel Disease. Engineering 202602016 DOI:10.1016/j.eng.2026.02.016

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