Dietert Rodney R, Dietert Janice M
Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
Performance Plus Consulting, Lansing, NY 14882, USA.
Healthcare (Basel). 2015 Mar 3;3(1):100-29. doi: 10.3390/healthcare3010100.
Increasing prevalences, morbidity, premature mortality and medical needs associated with non-communicable diseases and conditions (NCDs) have reached epidemic proportions and placed a major drain on healthcare systems and global economies. Added to this are the challenges presented by overuse of antibiotics and increased antibiotic resistance. Solutions are needed that can address the challenges of NCDs and increasing antibiotic resistance, maximize preventative measures, and balance healthcare needs with available services and economic realities. Microbiome management including microbiota seeding, feeding, and rebiosis appears likely to be a core component of a path toward sustainable healthcare. Recent findings indicate that: (1) humans are mostly microbial (in terms of numbers of cells and genes); (2) immune dysfunction and misregulated inflammation are pivotal in the majority of NCDs; (3) microbiome status affects early immune education and risk of NCDs, and (4) microbiome status affects the risk of certain infections. Management of the microbiome to reduce later-life health risk and/or to treat emerging NCDs, to spare antibiotic use and to reduce the risk of recurrent infections may provide a more effective healthcare strategy across the life course particularly when a personalized medicine approach is considered. This review will examine the potential for microbiome management to contribute to sustainable healthcare.
非传染性疾病和病症（NCDs）的患病率、发病率、过早死亡率及医疗需求不断上升，已达到流行程度，给医疗系统和全球经济带来了巨大负担。此外，抗生素的过度使用和抗生素耐药性增加也带来了挑战。需要找到能够应对非传染性疾病和抗生素耐药性增加的挑战、最大限度地采取预防措施，并在医疗需求与可用服务和经济现实之间取得平衡的解决方案。微生物组管理，包括微生物群落接种、喂养和重建，似乎可能是实现可持续医疗保健道路的核心组成部分。最近的研究结果表明：（1）就细胞和基因数量而言，人类大多是微生物；（2）免疫功能障碍和炎症调节异常在大多数非传染性疾病中起关键作用；（3）微生物组状态影响早期免疫教育和非传染性疾病风险，以及（4）微生物组状态影响某些感染的风险。管理微生物组以降低晚年健康风险和/或治疗新出现的非传染性疾病、减少抗生素使用并降低反复感染的风险可能提供一种更有效的全生命周期医疗保健策略，特别是在考虑个性化医疗方法时。本综述将探讨微生物组管理对可持续医疗保健的潜在贡献。
