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Further analysis indicated that among the 19 overgrown bacterial families, 12 possessed the urease gene ( Alteromonadaceae , Clostridiaceae , Cellulomonadaceae , Enterobacteriaceae , Dermabacteraceae , Halomonadaceae , Micrococcaceae , Moraxellaceae , Methylococcaceae , Pseudomonadaceae , Polyangiaceae , and Xanthomonadaceae ), 5 harbored the uricase gene ( Dermabacteraceae , Cellulomonadaceae , Xanthomonadaceae , Micrococcaceae , and Polyangiaceae ) producing ammonia that is harmful to the intestinal epithelium, and 3 expressed the tryptophanase gene necessary for the conversion of tryptophan into indole, which is then metabolized by the liver into uremic toxins ( Enterobacteriaceae , Clostridiaceae , and Verrucomicrobiaceae ) (Wong et al., 2014)

Cureus 17 (4), e81891

Results are expected 20272028 and will be critical for NHS NICE appraisal and reimbursement decisions