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. 2022 Feb 21;22:62. doi: 10.1186/s12883-022-02586-5

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© The Author(s) 2022

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 5 — Gut-Dysbiosis Predicts Disease Severity of Spinal-Onset ALS, whereas Oral-Dysbiosis Predicts Disease Severity of Bulbar-Onset ALS. A Linear regression analysis comparing fecal F/B ratio and ALS severity score (ALSFRS-R) for all ALS patients combined. The ALSFRS-R gives a total of 48 points, and a lower ALSFRS-R score indicates greater motor impairment (0 = worst function; 48 = best function)[7]. Spinal-onset ALS patients shown in red, bulbar-onset ALS patients in blue. Higher fecal F/B ratio was strongly associated with lower ALSFRS-R score (greater ALS severity) with distinct patterns between the two ALS subtypes. B Linear regression analysis comparing fecal F/B ratio and ALSFRS-R score for spinal-onset ALS patients alone. In spinal-onset ALS patients, higher fecal F/B ratio was strongly associated with lower ALSFRS-R score (greater ALS severity). C Linear regression analysis comparing fecal F/B ratio and ALSFRS-R score for bulbar-onset ALS patients alone. Bulbar-onset ALS patients displayed no significant association between fecal F/B ratio and ALSFRS-R score/ALS severity. D Linear regression analysis comparing oral F/B ratio and ALSFRS-R score for all ALS patients combined. Spinal-onset ALS patients shown in red, bulbar-onset ALS patients in blue. We observed no overall trend for association between oral F/B ratio and ALSFRS-R score with distinct patterns between the two ALS subtypes. E Linear regression analysis comparing oral F/B ratio and ALSFRS-R score for spinal-onset ALS patients alone. Spinal-onset ALS patients displayed no significant association between oral F/B ratio and ALSFRS-R score/ALS severity. F Linear regression analysis comparing oral F/B ratio and ALSFRS-R score for bulbar-onset ALS patients alone. In bulbar-onset ALS patients, lower oral F/B ratio was strongly associated with lower ALSFRS-R score (greater ALS severity). G Linear regression analysis comparing oral F/B ratio and bulbar/respiratory ALSFRS-R subscore for spinal-onset ALS patients alone. Bulbar/respiratory ALSFRS-R subscore (maximum score of 24) measures the severity of bulbar/respiratory symptoms. Lower subscore indicates more severe bulbar/respiratory symptoms[7]. Spinal-onset ALS patients displayed no significant association between oral F/B ratio and bulbar/respiratory ALSFRS-R subscore. H Linear regression analysis comparing oral F/B ratio and bulbar/respiratory ALSFRS-R subscore for bulbar-onset ALS patients alone. In bulbar-onset ALS patients, lower oral F/B ratio was strongly associated with lower bulbar/respiratory ALSFRS-R subscore. Statistics: Statistical significance was established using linear regression analysis and Spearman’s correlation coefficient (r) test