Till Holger, Castellani Christoph, Moissl-Eichinger Christine, Gorkiewicz Gregor, Singer Georg
Department of Paediatric and Adolescent Surgery, Medical University of Graz Graz, Austria.
Department of Internal Medicine, Medical University of Graz Graz, Austria.
Front Microbiol. 2015 Oct 16;6:1154. doi: 10.3389/fmicb.2015.01154. eCollection 2015.
Next generation sequencing techniques are currently revealing novel insight into the microbiome of the human gut. This new area of research seems especially relevant for neonatal diseases, because the development of the intestinal microbiome already starts in the perinatal period and preterm infants with a still immature gut associated immune system may be harmed by a dysproportional microbial colonization. For most gastrointestinal diseases requiring pediatric surgery there is very limited information about the role of the intestinal microbiome. This review aims to summarize the current knowledge and outline future perspectives for important pathologies like necrotizing enterocolitis (NEC) of the newborn, short bowel syndrome (SBS), and Hirschsprung's disease associated enterocolitis (HAEC). Only studies applying next generation sequencing techniques to analyze the diversity of the intestinal microbiome were included. In NEC patients intestinal dysbiosis could already be detected prior to any clinical evidence of the disease resulting in a reduction of the bacterial diversity. In SBS patients the diversity seems to be reduced compared to controls. In children with Hirschsprung's disease the intestinal microbiome differs between those with and without episodes of enterocolitis. One common finding for all three diseases seems to be an overabundance of Proteobacteria. However, most human studies are based on fecal samples and experimental data question whether fecal samples actually represent the microbiome at the site of the diseased bowel and whether the luminal (transient) microbiome compares to the mucosal (resident) microbiome. In conclusion current studies already allow a preliminary understanding of the potential role of the intestinal microbiome in pediatric surgical diseases. Future investigations could clarify the interface between the intestinal epithelium, its immunological competence and mucosal microbiome. Advances in this field may have an impact on the understanding and non-operative treatment of such diseases in infancy.
新一代测序技术目前正在揭示关于人类肠道微生物群的新见解。这一研究新领域似乎与新生儿疾病特别相关，因为肠道微生物群的发育在围产期就已开始，而肠道相关免疫系统仍不成熟的早产儿可能会因微生物定植失调而受到伤害。对于大多数需要小儿外科手术的胃肠道疾病，关于肠道微生物群作用的信息非常有限。本综述旨在总结当前知识，并概述新生儿坏死性小肠结肠炎（NEC）、短肠综合征（SBS）和先天性巨结肠相关小肠结肠炎（HAEC）等重要病理的未来研究前景。仅纳入了应用新一代测序技术分析肠道微生物群多样性的研究。在NEC患者中，在疾病的任何临床证据出现之前就已检测到肠道菌群失调，导致细菌多样性降低。在SBS患者中，与对照组相比，微生物群多样性似乎降低。在先天性巨结肠患儿中，有小肠结肠炎发作和无发作的患儿肠道微生物群不同。这三种疾病的一个共同发现似乎是变形菌门过度生长。然而，大多数人体研究基于粪便样本，实验数据质疑粪便样本是否真的代表患病肠道部位的微生物群，以及肠腔（短暂性）微生物群与黏膜（常驻性）微生物群是否可比。总之，目前的研究已经使人们对肠道微生物群在小儿外科疾病中的潜在作用有了初步了解。未来的研究可以阐明肠道上皮、其免疫能力和黏膜微生物群之间的界面。该领域的进展可能会对这类婴儿期疾病的理解和非手术治疗产生影响。
