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Microbial composition and diversity were compared between subjects with DM and HCs and in association with several DM\u2010specific clinical variables, including myositis\u2010specific autoantibodies (MSAs). Differentially abundant microbial taxa and genes associated with clinical characteristics were identified, and functional analysis was performed using predicted metagenomics. Dietary intake was assessed using a 24\u2010hour dietary recall.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The fecal microbiome of 36 patients with DM and 26 HCs were analyzed. Patients with DM trended toward lower microbial diversity compared with HCs. The higher physician global damage score was significantly correlated with the lower microbial diversity in patients with DM. Patients with interstitial lung disease (ILD)\u2010associated MSA (antisynthetase antibody (ab), anti\u2010melanoma differentiation\u2010associated protein 5 ab, n\u00a0=\u00a012) had significant differences in microbial composition and lower microbial diversity compared with HCs. Differential abundance testing demonstrated a unique taxonomic signature in the ILD\u2010MSA subgroup, and predictive metagenomics identified functional alterations in a number of metabolic pathways. A significant increase in the relative abundance of Proteobacteria was positively correlated with multiple pathways involved in lipopolysaccharide synthesis and transport in the ILD\u2010MSA group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients with DM, particularly with ILD\u2010associated MSAs, have lower microbial diversity and a distinct taxonomic composition compared with HCs. Further studies are needed to validate our findings and elucidate specific pathogenetic mechanisms that link the gut microbiome to clinical and pathological features of DM.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr2.11436","type":"journal-article","created":{"date-parts":[[2022,5,26]],"date-time":"2022-05-26T03:44:47Z","timestamp":1653536687000},"page":"658-670","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Altered Gut Microbiome in Patients With Dermatomyositis"],"prefix":"10.1002","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7216-7219","authenticated-orcid":false,"given":"Sangmee Sharon","family":"Bae","sequence":"first","affiliation":[{"name":"University of California, Los Angeles School of Medicine  Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tien S.","family":"Dong","sequence":"additional","affiliation":[{"name":"David Geffen School of Medicine at 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