Laboratory of Nutrition and Metabolic Surgery (LIM-35), Department of Gastroenterology, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil.
Curr Opin Clin Nutr Metab Care. 2023 Sep 1;26(5):482-489. doi: 10.1097/MCO.0000000000000957. Epub 2023 Jun 22.
Cachexia is a complex, multifactorial syndrome primarily characterized by weight loss, muscle wasting, anorexia, and systemic inflammation. It is prevalent in cancer patients and is associated with a poor prognosis, including lower resistance to intervention toxicity, quality of life, and survival, compared to patients without the syndrome. The gut microbiota and its metabolites have been shown to influence host metabolism and immune response. Our article reviews the current evidence suggesting a role of gut microbiota in the development and progression of cachexia, while discussing the potential mechanisms involved. We also describe promising interventions targeting gut microbiota aiming to improve outcomes related to cachexia.
Dysbiosis, an imbalance in gut microbiota, has been associated with cancer cachexia through pathways involving muscle wasting, inflammation, and gut barrier dysfunction. Interventions targeting gut microbiota, such as probiotics, prebiotics, synbiotics, and fecal microbiota transplantation, have shown promising results in managing this syndrome in animal models. However, evidence in humans is currently limited.
Mechanisms linking gut microbiota and cancer cachexia need to be further explored, and additional human research is necessary to evaluate the appropriate dosages, safety, and long-term outcomes of prebiotic and probiotic use in microbiota management for cancer cachexia.
恶病质是一种复杂的、多因素的综合征，主要表现为体重减轻、肌肉消耗、厌食和全身炎症。它在癌症患者中很常见，与预后不良有关，包括对干预毒性、生活质量和存活率的抵抗力低于没有该综合征的患者。肠道微生物群及其代谢物已被证明会影响宿主的代谢和免疫反应。我们的文章综述了目前关于肠道微生物群在恶病质发生和发展中的作用的证据，同时讨论了涉及的潜在机制。我们还描述了针对肠道微生物群的有前途的干预措施，旨在改善与恶病质相关的结果。
肠道微生物群失衡（即肠道微生物群失调）通过涉及肌肉消耗、炎症和肠道屏障功能障碍的途径与癌症恶病质有关。针对肠道微生物群的干预措施，如益生菌、益生元、合生元和粪便微生物群移植，在动物模型中对管理这种综合征显示出了有希望的结果。然而，目前人类的证据有限。
需要进一步探索肠道微生物群与癌症恶病质之间的联系机制，还需要进行更多的人体研究，以评估益生菌和益生元在癌症恶病质的微生物群管理中的适当剂量、安全性和长期结果。
