Ostrov Barbara E, Amsterdam Daniel
a Pediatrics and Medicine, Pediatric Rheumatology, Department of Pediatrics, Rheumatology, Department of Medicine , Penn State College of Medicine , Hershey , PA , USA.
b Microbiology and Immunology, Pathology and Medicine , Jacobs School of Medicine and Biomedical Sciences, Chief of Service, Laboratory Medicine, Erie County Medical Center , Buffalo , NY , USA.
Immunol Invest. 2017 Nov;46(8):769-792. doi: 10.1080/08820139.2017.1373828.
Modulation of the immune system by microbes, especially from the gastrointestinal tract, is increasingly considered a key factor in the onset, course and outcome of rheumatic diseases. The interplay of the microbiome, along with genetic predisposition and environmental exposure, is thought to be an important trigger for rheumatic diseases. Improved identification of the relationship of disease-specific genetic alterations and rheumatic diseases has potential diagnostic and therapeutic applications. Treatment of rheumatic disorders is influenced by microbial actions but this interplay can be challenging due to variable and unpredictable responses to therapies. Expanded knowledge of the microbiome now allows clinicians to more precisely select ideal medication regimens and to predict response to and toxicity from drugs. Rheumatic diseases and associated therapies were among the earliest microbiome interactions investigated, yet it is notable that current research is focused on clinical and immunological associations but, in comparison, a limited number of studies regarding the microbiome's impact on treatment for rheumatic diseases have been published. In the coming years, further knowledge of immunomodulating interactions between the microbiome and the immune system will aid our understanding of autoimmunity and will be increasingly important in selection of therapeutic agents for patients with autoimmune and rheumatic diseases. In this review, recent literature regarding the bidirectional immunomodulatory effects of the microbiome with rheumatic diseases and current understanding and gaps regarding the drug-microbiome interface in the management of these disorders is presented.
微生物对免疫系统的调节作用，尤其是来自胃肠道的微生物，越来越被认为是风湿性疾病发病、病程和预后的关键因素。微生物群与遗传易感性和环境暴露之间的相互作用，被认为是风湿性疾病的重要触发因素。对疾病特异性基因改变与风湿性疾病关系的进一步认识具有潜在的诊断和治疗应用价值。风湿性疾病的治疗受微生物作用的影响，但由于对治疗的反应多变且不可预测，这种相互作用可能具有挑战性。现在，对微生物群的深入了解使临床医生能够更精确地选择理想的药物治疗方案，并预测药物的反应和毒性。风湿性疾病及相关治疗是最早研究的微生物群相互作用之一，但值得注意的是，目前的研究集中在临床和免疫学关联上，相比之下，关于微生物群对风湿性疾病治疗影响的研究发表数量有限。在未来几年，对微生物群与免疫系统之间免疫调节相互作用的进一步了解将有助于我们理解自身免疫，并在为自身免疫性和风湿性疾病患者选择治疗药物时变得越来越重要。在这篇综述中，介绍了关于微生物群与风湿性疾病双向免疫调节作用的最新文献，以及目前对这些疾病管理中药物 - 微生物群界面的理解和差距。
