Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Division of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Nat Rev Gastroenterol Hepatol. 2022 Jan;19(1):7-25. doi: 10.1038/s41575-021-00499-1. Epub 2021 Aug 27.
Variability in disease presentation, progression and treatment response has been a central challenge in medicine. Although variability in host factors and genetics are important, it has become evident that the gut microbiome, with its vast genetic and metabolic diversity, must be considered in moving towards individualized treatment. In this Review, we discuss six broad disease groups: infectious disease, cancer, metabolic disease, cardiovascular disease, autoimmune or inflammatory disease, and allergic and atopic diseases. We highlight current knowledge on the gut microbiome in disease pathogenesis and prognosis, efficacy, and treatment-related adverse events and its promise for stratifying existing treatments and as a source of novel therapies. The Review is not meant to be comprehensive for each disease state but rather highlights the potential implications of the microbiome as a tool to individualize treatment strategies in clinical practice. Although early, the outlook is optimistic but challenges need to be overcome before clinical implementation, including improved understanding of underlying mechanisms, longitudinal studies with multiple data layers reflecting gut microbiome and host response, standardized approaches to testing and reporting, and validation in larger cohorts. Given progress in the microbiome field with concurrent basic and clinical studies, the microbiome will likely become an integral part of clinical care within the next decade.
疾病表现、进展和治疗反应的可变性一直是医学的核心挑战。尽管宿主因素和遗传因素的可变性很重要，但显然必须考虑肠道微生物组，因为其具有巨大的遗传和代谢多样性，以朝着个体化治疗的方向发展。在这篇综述中，我们讨论了六大疾病组：传染病、癌症、代谢疾病、心血管疾病、自身免疫或炎症性疾病以及过敏和特应性疾病。我们强调了肠道微生物组在疾病发病机制和预后、疗效以及与治疗相关的不良事件中的现有知识，及其在现有治疗方法分层和作为新型治疗方法来源方面的潜力。这篇综述并不是针对每种疾病状态的全面综述，而是强调了微生物组作为一种在临床实践中个体化治疗策略的工具的潜在意义。尽管这还处于早期阶段，但前景乐观，但在临床实施之前仍需要克服挑战，包括更好地了解潜在机制、进行反映肠道微生物组和宿主反应的多数据层的纵向研究、标准化的测试和报告方法，以及在更大的队列中进行验证。鉴于微生物组领域在基础和临床研究方面的进展，在未来十年内，微生物组很可能成为临床护理的一个组成部分。
