Anand S, Mandal S, Patil P, Tomar S K
TFSL, Dairy Microbiology Division, ICAR- National Dairy Research Institute, Karnal, Haryana, India.
Eur J Clin Microbiol Infect Dis. 2016 Nov;35(11):1721-1739. doi: 10.1007/s10096-016-2726-5. Epub 2016 Jul 29.
Secretory diarrhea is a historically known serious health implication around the world which primarily originates through pathogenic microorganisms rather than immunological or genetical disorders. This review highlights infective mechanisms of non-inflammatory secretory diarrhea causing pathogens, known therapeutics and their efficacy against them. These non-inflammatory diarrheal pathogens breach cell barriers, induce inflammation, disrupt fluid secretion across the epithelium by alteration in ion transport by faulting cystic fibrosis transmembrane conductance regulator (CFTR), calcium activated chloride channels and ion exchanger functions. Currently, a variety of prevention strategies have been used to treat these symptoms like use of antibacterial drugs, vaccines, fluid and nutritional therapy, probiotics and prebiotics as adjuncts. In progression of the need for a therapy having quick physiological effects, withdrawing the symptoms with a wide and safe therapeutic index, newer antisecretory agents like potent inhibitors, agonists and herbal remedies are some of the interventions which have come into light through greater understanding of the mechanisms and molecular targets involved in intestinal fluid secretion. Although these therapies have their own pros and cons inside the host, the quest for new antisecretory agents has been a successful elucidation to reduce burden of diarrheal disease.
分泌性腹泻是一种在全球范围内由来已久的严重健康问题,主要由病原微生物引起,而非免疫或遗传紊乱。本综述重点介绍了导致非炎性分泌性腹泻的病原体的感染机制、已知的治疗方法及其疗效。这些非炎性腹泻病原体破坏细胞屏障,引发炎症,通过破坏囊性纤维化跨膜传导调节因子(CFTR)、钙激活氯离子通道和离子交换器功能来改变离子转运,从而扰乱上皮细胞的液体分泌。目前,已采用多种预防策略来治疗这些症状,如使用抗菌药物、疫苗、液体和营养疗法、益生菌和益生元作为辅助手段。随着对具有快速生理效应、以广泛且安全的治疗指数消除症状的疗法的需求不断增加,通过对肠道液体分泌所涉及的机制和分子靶点的更深入了解,一些新的抗分泌剂如强效抑制剂、激动剂和草药疗法等已崭露头角。尽管这些疗法在宿主体内各有优缺点,但对新型抗分泌剂的探索已成功地减轻了腹泻病的负担。