Sartor R Balfour
Division of Gastroenterology and Hepatology, Center for Gastrointestinal Biology and Disease, Department of Medicine, Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, USA.
Nestle Nutr Inst Workshop Ser. 2014;79:29-39. doi: 10.1159/000360674. Epub 2014 Sep 5.
Abundant clinical and experimental evidence supports a role for resident microbiota in Crohn's disease and pouchitis, and probably in ulcerative colitis (UC). These disorders occur in areas of highest bacterial concentrations. Pouchitis and Crohn's colitis respond to antibiotics, while pouchitis and UC can be treated with probiotics. Serologic markers recognizing intestinal bacteria and yeast are present in the majority of Crohn's disease patients and may predict disease aggressiveness. Abnormal profiles of fecal and mucosally associated enteric bacteria (dysbiosis) occur in Crohn's disease, UC, pouchitis and experimental enterocolitis, with a proliferation of aggressive species that promote experimental colitis and a corresponding decrease in protective bacterial subsets. Many of these protective bacteria produce short-chain fatty acids, including butyrate, that promote epithelial barrier function, inhibit effector immune responses and induce regulatory T cell subsets. Furthermore, certain Clostridia species stimulate regulatory T cells that can inhibit intestinal inflammation. Animal models of chronic, immune-mediated enterocolitis convincingly demonstrate that enteric resident bacteria stimulate effector immune cells in susceptible hosts and that a subset of enteric bacteria has particularly aggressive activities, with host and bacterial specificity. Recent studies suggest parallel and perhaps complementary roles for enteric viruses, which have only very recently been identified.
大量临床和实验证据支持常驻微生物群在克罗恩病和袋炎中起作用，可能在溃疡性结肠炎（UC）中也起作用。这些疾病发生在细菌浓度最高的区域。袋炎和克罗恩结肠炎对抗生素有反应，而袋炎和UC可用益生菌治疗。大多数克罗恩病患者存在识别肠道细菌和酵母的血清学标志物，这些标志物可能预测疾病的侵袭性。在克罗恩病、UC、袋炎和实验性小肠结肠炎中出现粪便和黏膜相关肠道细菌的异常谱（生态失调），具有促进实验性结肠炎的侵袭性菌种增殖以及相应的保护性细菌亚群减少。许多这些保护性细菌产生短链脂肪酸，包括丁酸，其可促进上皮屏障功能、抑制效应免疫反应并诱导调节性T细胞亚群。此外，某些梭菌属菌种刺激可抑制肠道炎症的调节性T细胞。慢性免疫介导性小肠结肠炎的动物模型令人信服地证明，肠道常驻细菌在易感宿主中刺激效应免疫细胞，并且一部分肠道细菌具有特别强的侵袭性活动，具有宿主和细菌特异性。最近的研究表明肠道病毒具有平行且可能互补的作用，而肠道病毒直到最近才被发现。
