Mars Ruben A T, Frith Mary, Kashyap Purna C
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Department of Medicine, University of Chicago, Chicago, Illinois.
Gastroenterology. 2021 Jan;160(2):538-555. doi: 10.1053/j.gastro.2020.10.058. Epub 2020 Nov 28.
There have been numerous human studies reporting associations between the intestinal microbiome and functional gastrointestinal disorders (FGIDs), and independently animal studies have explored microbiome-driven mechanisms underlying FGIDs. However, there is often a disconnect between human and animal studies, which hampers translation of microbiome findings to the clinic. Changes in the microbiota composition of patients with FGIDs are generally subtle, whereas changes in microbial function, reflected in the fecal metabolome, appear to be more precise indicators of disease subtype-specific mechanisms. Although we have made significant progress in characterizing the microbiome, to effectively translate microbiome science in a timely manner, we need concurrent and iterative longitudinal studies in humans and animals to determine the precise microbial functions that can be targeted to address specific pathophysiological processes in FGIDs. A systems approach integrating multiple data layers rather than evaluating individual data layers of symptoms, physiological changes, or -omics data in isolation will allow for validation of mechanistic insights from animal studies while also allowing new discovery. Patient stratification for clinical trials based on functional microbiome alterations and/or pathophysiological measurements may allow for more accurate determination of efficacy of individual microbiome-targeted interventions designed to correct an underlying abnormality. In this review, we outline current approaches and knowledge, and identify gaps, to provide a potential roadmap for accelerating translation of microbiome science toward microbiome-targeted personalized treatments for FGIDs.
已有大量人体研究报告了肠道微生物群与功能性胃肠疾病(FGIDs)之间的关联,并且独立的动物研究也探索了FGIDs背后由微生物群驱动的机制。然而,人体研究和动物研究之间往往存在脱节,这阻碍了将微生物群研究结果转化到临床应用。FGIDs患者的微生物群组成变化通常较为细微,而粪便代谢组所反映的微生物功能变化似乎是疾病亚型特异性机制更精确的指标。尽管我们在描述微生物群方面取得了重大进展,但为了及时有效地将微生物群科学转化应用,我们需要在人类和动物中同时进行并反复开展纵向研究,以确定可针对FGIDs中特定病理生理过程的精确微生物功能。采用整合多个数据层的系统方法,而不是孤立地评估症状、生理变化或组学数据的单个数据层,将能够验证动物研究中的机制性见解,同时也能实现新的发现。基于功能性微生物群改变和/或病理生理测量对临床试验进行患者分层,可能有助于更准确地确定旨在纠正潜在异常的个体微生物群靶向干预措施的疗效。在本综述中,我们概述了当前的方法和知识,并找出差距,以提供一条潜在的路线图,加速将微生物群科学转化为针对FGIDs的微生物群靶向个性化治疗方法。
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