Ophthalmology Department, University Clinical Hospital of Vigo (SERGAS), 36213 Vigo, Spain.
Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain.
Int J Mol Sci. 2022 Jun 24;23(13):7020. doi: 10.3390/ijms23137020.
In the last decades, personalized medicine has been increasing its presence in different fields of medicine, including ophthalmology. A new factor that can help us direct medicine towards the challenge of personalized treatments is the microbiome. The gut microbiome plays an important role in controlling immune response, and dysbiosis has been associated with immune-mediated diseases such as non-infectious uveitis (NIU). In this review, we gather the published evidence, both in the pre-clinical and clinical studies, that support the possible role of intestinal dysbiosis in the pathogenesis of NIU, as well as the modulation of the gut microbiota as a new possible therapeutic target. We describe the different mechanisms that have been proposed to involve dysbiosis in the causality of NIU, as well as the potential pharmacological tools that could be used to modify the microbiome (dietary supplementation, antibiotics, fecal microbiota transplantation, immunomodulators, or biologic drugs) and, consequently, in the control of the NIU. Furthermore, there is increasing scientific evidence suggesting that the treatment with anti-TNF not only restores the composition of the gut microbiota but also that the study of the composition of the gut microbiome will help predict the response of each patient to anti-TNF treatment.
在过去的几十年中，个性化医学在医学的不同领域中越来越受到关注，包括眼科。一个可以帮助我们将医学治疗方向转向个性化治疗挑战的新因素是微生物组。肠道微生物组在控制免疫反应中起着重要作用，而微生物失调与免疫介导的疾病如非感染性葡萄膜炎（NIU）有关。在这篇综述中，我们收集了支持肠道微生物失调在 NIU 发病机制中的可能作用以及调节肠道微生物组作为新的潜在治疗靶点的已发表证据，包括临床前和临床研究。我们描述了已提出的涉及 NIU 因果关系的微生物失调的不同机制，以及可用于改变微生物组的潜在药理工具（饮食补充剂、抗生素、粪便微生物移植、免疫调节剂或生物药物），从而控制 NIU。此外，越来越多的科学证据表明，使用抗 TNF 治疗不仅可以恢复肠道微生物组的组成，而且研究肠道微生物组的组成将有助于预测每位患者对抗 TNF 治疗的反应。
