Wine Eytan
Division of Pediatric Gastroenterology and Nutrition, Departments of Pediatrics and Physiology, University of Alberta, Edmonton, Alta., Canada.
Dig Dis. 2014;32(4):403-9. doi: 10.1159/000358146. Epub 2014 Jun 23.
BACKGROUND/AIM: It is now clear that intestinal microbes are involved in many aspects of inflammatory bowel diseases (IBD) and that understanding how microbes lead to disease could present novel opportunities for diagnosis and treatment. Microbes are linked to most disease-associated genetic polymorphisms and are critical mediators of environmental effects (through food, hygiene, and infection). This paper reviews recent findings and future implications for targeting microbes in IBD.
A comprehensive review of the literature is presented, with specific focus on how treating microbes could alter patient care in the future.
Human and animal-based research supports the central role of microbes in IBD pathogenesis at multiple levels. Antibiotics, probiotics, diet, and potentially fecal transplantation are all potential treatments for IBD. Animal models of IBD only develop in the presence of microbes and co-housing mice genetically susceptible to gut inflammation with normal mice can lead to the development of bowel injury. Key papers have used microbial sequencing and metagenomics to study the role of microbes in IBD and we are now on the cusp of expanding into clinically relevant fields, such as diagnosis and therapeutics. However, many challenges still remain in understanding how microbes can be manipulated to prevent or treat disease.
In the future, we may be able to predict risk of disease, define biological subtypes, establish tools for prevention, and even cure IBD using microbes or their products. A broad spectrum of therapeutic tools, spanning from fecal transplantation, probiotics, prebiotics, microbial products to microbe-tailored diets, may replace current IBD treatments.
背景/目的：目前已经明确，肠道微生物参与了炎症性肠病（IBD）的多个方面，了解微生物如何引发疾病可能为诊断和治疗带来新的机遇。微生物与大多数疾病相关的基因多态性有关，并且是环境影响（通过食物、卫生和感染）的关键介导因素。本文综述了针对IBD中微生物的最新研究发现及其未来意义。
对文献进行全面综述，特别关注治疗微生物如何在未来改变患者护理。
基于人类和动物的研究支持微生物在IBD发病机制的多个层面上发挥核心作用。抗生素、益生菌、饮食以及潜在的粪便移植都是IBD的潜在治疗方法。IBD动物模型仅在有微生物存在的情况下才会发展，将对肠道炎症易感的基因小鼠与正常小鼠共同饲养可导致肠道损伤的发生。关键文献已使用微生物测序和宏基因组学来研究微生物在IBD中的作用，我们现在正处于向临床相关领域（如诊断和治疗学）拓展的边缘。然而，在理解如何操纵微生物以预防或治疗疾病方面仍存在许多挑战。
未来，我们或许能够利用微生物或其产物预测疾病风险、定义生物学亚型、建立预防工具，甚至治愈IBD。从粪便移植、益生菌、益生元、微生物产物到针对微生物的饮食等一系列广泛的治疗工具，可能会取代当前的IBD治疗方法。
