Division of Movement Disorders and Neuromodulation, Weill Institute of Neurology, University of California, San Francisco, CA, USA.
Division of Occupational and Environmental Medicine, University of California, San Francisco, CA, USA.
Neurotherapeutics. 2020 Oct;17(4):1406-1417. doi: 10.1007/s13311-020-00942-2. Epub 2020 Oct 9.
The gastrointestinal microbiome is altered in Parkinson's disease and likely plays a key role in its pathophysiology, affecting symptoms and response to therapy and perhaps modifying progression or even disease initiation. Gut dysbiosis therefore has a significant potential as a therapeutic target in Parkinson's disease, a condition elusive to disease-modifying therapy thus far. The gastrointestinal environment hosts a complex ecology, and efforts to modulate the relative abundance or function of established microorganisms are still in their infancy. Still, these techniques are being rapidly developed and have important implications for our understanding of Parkinson's disease. Currently, modulation of the microbiome can be achieved through non-pharmacologic means such as diet, pharmacologically through probiotic, prebiotic, or antibiotic use and procedurally through fecal transplant. Novel techniques being explored include the use of small molecules or genetically engineered organisms, with vast potential. Here, we review how some of these approaches have been used to date, important areas of ongoing research, and how microbiome modulation may play a role in the clinical management of Parkinson's disease in the future.
肠道微生物组在帕金森病中发生改变，并且可能在其病理生理学中发挥关键作用，影响症状和对治疗的反应，甚至可能改变疾病的进展或起始。因此，肠道菌群失调作为帕金森病的治疗靶点具有重要意义，而迄今为止，这种疾病一直难以进行疾病修饰治疗。胃肠道环境中存在着复杂的生态系统，目前仍处于初级阶段，努力调节既定微生物的相对丰度或功能。尽管如此，这些技术正在迅速发展，并对我们理解帕金森病具有重要意义。目前，可以通过非药物手段（如饮食）、通过使用益生菌、益生元和抗生素进行药物调节，以及通过粪便移植进行程序性调节来调节微生物组。目前正在探索的新技术包括使用小分子或基因工程生物体，具有巨大的潜力。在这里，我们回顾了迄今为止这些方法中的一些已经被使用的情况、正在进行的重要研究领域，以及微生物组调节在未来可能在帕金森病的临床管理中发挥的作用。
