Airola Carlo, Severino Andrea, Porcari Serena, Fusco William, Mullish Benjamin H, Gasbarrini Antonio, Cammarota Giovanni, Ponziani Francesca Romana, Ianiro Gianluca
Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Antibiotics (Basel). 2023 May 8;12(5):868. doi: 10.3390/antibiotics12050868.
The human gut is inhabited by a multitude of bacteria, yeasts, and viruses. A dynamic balance among these microorganisms is associated with the well-being of the human being, and a large body of evidence supports a role of dysbiosis in the pathogenesis of several diseases. Given the importance of the gut microbiota in the preservation of human health, probiotics, prebiotics, synbiotics, and postbiotics have been classically used as strategies to modulate the gut microbiota and achieve beneficial effects for the host. Nonetheless, several molecules not typically included in these categories have demonstrated a role in restoring the equilibrium among the components of the gut microbiota. Among these, rifaximin, as well as other antimicrobial drugs, such as triclosan, or natural compounds (including evodiamine and polyphenols) have common pleiotropic characteristics. On one hand, they suppress the growth of dangerous bacteria while promoting beneficial bacteria in the gut microbiota. On the other hand, they contribute to the regulation of the immune response in the case of dysbiosis by directly influencing the immune system and epithelial cells or by inducing the gut bacteria to produce immune-modulatory compounds, such as short-chain fatty acids. Fecal microbiota transplantation (FMT) has also been investigated as a procedure to restore the equilibrium of the gut microbiota and has shown benefits in many diseases, including inflammatory bowel disease, chronic liver disorders, and extraintestinal autoimmune conditions. One of the most significant limits of the current techniques used to modulate the gut microbiota is the lack of tools that can precisely modulate specific members of complex microbial communities. Novel approaches, including the use of engineered probiotic bacteria or bacteriophage-based therapy, have recently appeared as promising strategies to provide targeted and tailored therapeutic modulation of the gut microbiota, but their role in clinical practice has yet to be clarified. The aim of this review is to discuss the most recently introduced innovations in the field of therapeutic microbiome modulation.
人类肠道中栖息着大量细菌、酵母和病毒。这些微生物之间的动态平衡与人类的健康状况相关，大量证据支持生态失调在多种疾病发病机制中的作用。鉴于肠道微生物群在维护人类健康方面的重要性，益生菌、益生元、合生元和后生元传统上一直被用作调节肠道微生物群并为宿主带来有益效果的策略。尽管如此，一些通常不包括在这些类别中的分子已被证明在恢复肠道微生物群各组成部分之间的平衡方面发挥作用。其中，利福昔明以及其他抗菌药物（如三氯生）或天然化合物（包括吴茱萸碱和多酚）具有共同的多效性特征。一方面，它们抑制有害细菌的生长，同时促进肠道微生物群中有益细菌的生长。另一方面，在生态失调的情况下，它们通过直接影响免疫系统和上皮细胞或通过诱导肠道细菌产生免疫调节化合物（如短链脂肪酸）来促进免疫反应的调节。粪便微生物群移植（FMT）也已作为一种恢复肠道微生物群平衡的方法进行了研究，并在许多疾病中显示出益处，包括炎症性肠病、慢性肝脏疾病和肠外自身免疫性疾病。目前用于调节肠道微生物群的技术最显著的局限性之一是缺乏能够精确调节复杂微生物群落特定成员的工具。包括使用工程益生菌或基于噬菌体的疗法在内的新方法最近已成为有前景的策略，可对肠道微生物群进行有针对性和量身定制的治疗性调节，但其在临床实践中的作用尚待阐明。本综述的目的是讨论治疗性微生物群调节领域最近引入的创新。
