Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA.
Hospital for Special Surgery, New York, New York, USA.
J Orthop Res. 2021 Feb;39(2):251-257. doi: 10.1002/jor.24927. Epub 2020 Dec 7.
The past 15 years have witnessed a renaissance in the study of the microbes that colonize the human body. The vast majority of the human microbiome resides within the gut. Alterations to the gut microbiome have been associated with the pathogenesis and progression of wide-ranging diseases throughout the body-including atherosclerosis, depression, and obesity. Our understanding of the effects of the gut microbiome on the musculoskeletal system remains in its infancy, but preclinical work has demonstrated an effect of the gut microbiome on the success of orthopedic surgical procedures, osteoporosis, osteoarthritis, and muscle mass. In this perspective I review preclinical findings demonstrating that an impaired presurgical gut microbiome can increase the likelihood of developing periprosthetic joint infection and how alterations in the gut microbiome can reduce bone strength by impairing bone tissue material properties. In addition to discussing these examples, I review the hypothesis that many chronic non-communicable diseases have become more prevalent in modern industrialized societies as a result of changes in the composition of the gut microbiome resulting from changes in environment/lifestyle (diet, sanitation, antibiotic use). The most burdensome musculoskeletal disorders are chronic and non-communicable and may therefore be related to generational shifts in the composition of the gut microbiome, a possibility I illustrate by reviewing changes in the prevalence of osteoarthritis over the last century. Microbiome-based therapeutics are potentially innocuous, inexpensive, and have the potential to be effective with only occasional use, making them attractive for addressing the needs of chronic and/or slowly progressing musculoskeletal disorders.
在过去的 15 年中，人们对定植于人体的微生物的研究迎来了复兴。人体微生物组的绝大多数存在于肠道内。肠道微生物组的改变与包括动脉粥样硬化、抑郁症和肥胖症在内的广泛疾病的发病机制和进展有关。我们对肠道微生物组对肌肉骨骼系统的影响的理解仍处于起步阶段，但临床前研究已经证明了肠道微生物组对骨科手术成功率、骨质疏松症、骨关节炎和肌肉质量的影响。在这篇观点文章中，我回顾了临床前研究结果，表明术前肠道微生物组受损可能增加发生假体周围关节感染的可能性，以及肠道微生物组的改变如何通过损害骨组织材料特性来降低骨强度。除了讨论这些例子外，我还提出了一个假设，即由于环境/生活方式（饮食、卫生、抗生素使用）的改变导致肠道微生物组组成的改变，许多慢性非传染性疾病在现代工业化社会中更为普遍。最具负担的肌肉骨骼疾病是慢性和非传染性的，因此可能与肠道微生物组组成的代际变化有关，我通过回顾上个世纪骨关节炎患病率的变化来说明这一点。基于微生物组的治疗方法具有潜在的无害性、廉价性，并且只需偶尔使用即可有效，因此对于解决慢性和/或进展缓慢的肌肉骨骼疾病的需求具有吸引力。
