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Compared with BC subjects, PDC subjects have distinct gut microbiota and serum metabolite profiles. Decreases in F. plautii and phytosphingosine were associated with higher PDC scores. The bacteria F. plautii biosynthesizes phytosphingosine. F. plautii and serum phytosphingosine levels decreased in PDC subjects with normal metabolic indices. Fecal transplantation from PDC subjects with normal metabolic indices accelerated the development of metabolic disorders in mice. F. plautii or phytosphingosine significantly improved metabolic disorders and PDC phenotypes. Phytosphingosine produced by F. plautii binds to PPARalpha and activates the nuclear transcription of PPARalpha.

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