Asim Fatima, Clarke Lowenna, Donnelly Elizabeth, Jamal Fouzia Rahana, Piccicacchi Lucrezia Maria, Qadir Mahanoor, Raja Nain Tara, Samadi Cyrus, Then Chee Kin, Kiltie Anne E
School of Medicine, Medical Sciences and Nutrition, University of Aberdeen Medical School, Aberdeen, UK.
Department of General Medicine, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
BMJ Oncol. 2023 Nov 10;2(1):e000107. doi: 10.1136/bmjonc-2023-000107. eCollection 2023.
Cancer remains one of the leading causes of death worldwide, despite advances in treatments such as surgery, chemotherapy, radiotherapy and immunotherapy. The role of the gut microbiota in human health and disease, particularly in relation to cancer incidence and treatment response, has gained increasing attention. Emerging evidence suggests that dietary fibre, including prebiotics, can modulate the gut microbiota and influence antitumour effects. In this review, we provide an overview of how dietary fibre impacts the gut-tumour axis through immune and non-immune mechanisms. Preclinical evidence shows that β-glucan or inulin effectively suppress extraintestinal tumour growth via immunomodulation. Other fibres such as resistant starch, modified citrus pectin and rye bran may confer antitumour effects through metabolic regulation, production of metabolites or downregulation of the insulin/insulin-like growth factor 1 axis. Additionally, we highlight the potential for dietary fibre to modify the response to immunotherapy, chemotherapy and radiotherapy, as shown by inulin increasing the abundance of beneficial gut bacteria, such as , , and , which have been associated with enhanced immunotherapy outcomes, particularly in melanoma-bearing mice. Furthermore, certain types of dietary fibre, such as psyllium, partially hydrolysed guar gum, hydrolysed rice bran and inulin plus fructooligosaccharide, have been shown to mitigate gastrointestinal toxicities in patients with cancer undergoing pelvic radiotherapy. Despite the proven benefits, it is noteworthy that most adults do not consume enough dietary fibre, underscoring the importance of promoting dietary fibre supplementation in patients with cancer to optimise their treatment responses.
尽管手术、化疗、放疗和免疫疗法等治疗手段取得了进展，但癌症仍然是全球主要的死亡原因之一。肠道微生物群在人类健康和疾病中的作用，尤其是与癌症发病率和治疗反应的关系，已越来越受到关注。新出现的证据表明，膳食纤维，包括益生元，可以调节肠道微生物群并影响抗肿瘤效果。在这篇综述中，我们概述了膳食纤维如何通过免疫和非免疫机制影响肠道-肿瘤轴。临床前证据表明，β-葡聚糖或菊粉可通过免疫调节有效抑制肠外肿瘤生长。其他纤维，如抗性淀粉、改性柑橘果胶和黑麦麸，可能通过代谢调节、代谢产物的产生或胰岛素/胰岛素样生长因子1轴的下调发挥抗肿瘤作用。此外，我们强调了膳食纤维改变对免疫疗法、化疗和放疗反应的潜力，如菊粉可增加有益肠道细菌的丰度，如 、 、 和 ，这些细菌与免疫疗法效果增强有关，尤其是在荷黑素瘤小鼠中。此外，某些类型的膳食纤维，如车前子壳、部分水解瓜尔胶、水解米糠以及菊粉加低聚果糖，已被证明可减轻接受盆腔放疗的癌症患者的胃肠道毒性。尽管已证实膳食纤维有益，但值得注意的是，大多数成年人膳食纤维摄入量不足，这凸显了在癌症患者中促进补充膳食纤维以优化其治疗反应的重要性。
