Seekatz Anna Maria, Safdar Nasia, Khanna Sahil
Department of Biological Sciences, Clemson University, Clemson, SC, USA.
University of Wisconsin, Madison, WI, USA.
Therap Adv Gastroenterol. 2022 Nov 18;15:17562848221134396. doi: 10.1177/17562848221134396. eCollection 2022.
UNLABELLED: The species composition of the human gut microbiota is related to overall health, and a healthy gut microbiome is crucial in maintaining colonization resistance against pathogens. Disruption of gut microbiome composition and functionality reduces colonization resistance and has been associated with several gastrointestinal and non-gastrointestinal diseases. One prime example is infection (CDI) and subsequent recurrent infections that occur after the development of systemic antibiotic-related dysbiosis. Standard-of-care antibiotics used for both acute and recurrent infections do not address dysbiosis and often worsen the condition. Moreover, monoclonal antibodies, recommended in conjunction with standard-of-care antibiotics for the prevention of recurrent CDI in patients at high risk of recurrence, reduce recurrences but do not address the underlying dysbiosis. Fecal microbiota transplantation (FMT) is an evolving therapeutic strategy in which microbes are harvested from healthy donor stool and transplanted into the gut of a recipient to restore the gut microbiome. Although effective in the prevention of recurrent CDI, some existing challenges include screening and the standardization of stool acquisition and processing. Recent safety alerts by the US Food and Drug Administration raised concern about the possibility of transmission of multidrug-resistant organisms or severe acute respiratory syndrome coronavirus 2 FMT. Increased knowledge that microbes are beneficial in restoring the gut microbiome has led to the clinical development of several newer biotherapeutic formulations that are more regulated than FMT, which may allow for improved restoration of the gut microbiome and prevention of CDI recurrence. This review focuses on mechanisms by which gut microbiome restoration could influence colonization resistance against the pathogen PLAIN LANGUAGE SUMMARY: A rich and diverse gut microbiome is key to immune system regulation and colonization resistance against pathogens.A disruption in the gut microbiome composition can make the gut more vulnerable to diseases such as infection (CDI), caused by the bacterium .CDI management presents a therapeutic dilemma, as it is usually treated with antibiotics that can treat the infection but also can damage the microbiome.Treatment of CDI using antibiotics can further reduce microbial diversity and deplete beneficial bacteria from the gut leading to a condition called dysbiosis.Antibiotic treatment can be followed by therapies that restore the gut microbiota, boost colonization resistance, and prevent the development of antimicrobial resistance.It is important to evaluate treatment options to determine their safety and effectiveness. The researchers provided an overview of the mechanisms that the gut microbiome uses to prevent colonization of the gut by pathogens.They subsequently reviewed the efficacy and shortcomings of the following treatments for CDI: - Antibiotics- Monoclonal antibodies- Fecal microbiota transplantation (FMT) Commensal intestinal bacteria prevent colonization of the gut by pathogens using mechanisms such as: - Competition for key nutrients- Production of inhibitory bile acids- Short-chain fatty acid production- Lowering the luminal pH- Production of bacteriocinsAntibiotic therapy is recommended as a standard treatment for CDI. However, patients are vulnerable to recurrent CDI after discontinuation of the therapy.Monoclonal antibodies that inactivate toxins may be recommended along with antibiotics to prevent recurrent CDI. However, this approach does not restore the microbiome.FMT is one method of microbial restoration, where stool is harvested from a healthy donor and transplanted into a patient's colon.Although FMT has shown some efficacy in the treatment of recurrent CDI, the procedure is not standardized.Safety concerns have been raised about the possibility of transmission of multidrug-resistant pathogens FMT. Treatment methods that can efficiently restore the diversity of the gut microbiome are crucial in preventing recurrence of CDI.
未标注:人类肠道微生物群的物种组成与整体健康相关,健康的肠道微生物群对于维持对病原体的定植抗性至关重要。肠道微生物群组成和功能的破坏会降低定植抗性,并与多种胃肠道和非胃肠道疾病有关。一个主要例子是艰难梭菌感染(CDI)以及在全身性抗生素相关的生态失调发生后出现的后续反复感染。用于急性和反复感染的标准护理抗生素无法解决生态失调问题,而且往往会使病情恶化。此外,对于复发风险高的患者,与标准护理抗生素联合推荐用于预防反复CDI的单克隆抗体可减少复发,但无法解决潜在的生态失调问题。粪便微生物群移植(FMT)是一种不断发展的治疗策略,即从健康供体粪便中采集微生物并移植到受体肠道中以恢复肠道微生物群。尽管FMT在预防反复CDI方面有效,但一些现存挑战包括筛查以及粪便采集和处理的标准化。美国食品药品监督管理局最近发布的安全警报引发了人们对多重耐药生物体或严重急性呼吸综合征冠状病毒2通过FMT传播可能性的担忧。人们越来越认识到微生物有助于恢复肠道微生物群,这导致了几种更新的生物治疗制剂的临床开发,这些制剂比FMT受到更严格的监管,这可能有助于更好地恢复肠道微生物群并预防CDI复发。本综述重点关注肠道微生物群恢复可能影响对病原体定植抗性的机制。
通俗易懂的总结:丰富多样的肠道微生物群是免疫系统调节和对病原体定植抗性的关键。肠道微生物群组成的破坏会使肠道更容易受到由艰难梭菌引起的疾病如艰难梭菌感染(CDI)的影响。CDI的治疗面临一个治疗困境,因为通常用抗生素治疗,抗生素可以治疗感染但也会损害微生物群。使用抗生素治疗CDI会进一步降低微生物多样性并耗尽肠道中的有益细菌,导致一种称为生态失调的状况。抗生素治疗后可以采用恢复肠道微生物群、增强定植抗性和预防抗菌药物耐药性发展的疗法。评估治疗方案以确定其安全性和有效性很重要。研究人员概述了肠道微生物群用于防止病原体在肠道定植的机制。随后,他们回顾了以下CDI治疗方法的疗效和缺点: - 抗生素 - 单克隆抗体 - 粪便微生物群移植(FMT) 共生肠道细菌通过以下机制防止病原体在肠道定植: - 争夺关键营养素 - 产生抑制性胆汁酸 - 产生短链脂肪酸 - 降低管腔pH值 - 产生细菌素 抗生素疗法被推荐为CDI的标准治疗方法。然而,患者在停止治疗后容易出现反复CDI。使艰难梭菌毒素失活的单克隆抗体可能与抗生素一起推荐用于预防反复CDI。然而,这种方法并不能恢复微生物群。FMT是一种微生物恢复方法,即从健康供体采集粪便并移植到患者结肠中。尽管FMT在治疗反复CDI方面已显示出一定疗效,但该程序尚未标准化。人们对通过FMT传播多重耐药病原体的可能性提出了安全担忧。能够有效恢复肠道微生物群多样性的治疗方法对于预防CDI复发至关重要。
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