Microbial-Based Therapies in the Treatment of Inflammatory Bowel Disease – An Overview of Human Studies

Abstract

Inflammatory bowel disease (IBD) is a group of multifactorial and inflammatory infirmities comprised of two main entities: Ulcerative colitis (UC) and Crohn’s disease (CD). Classic strategies to treat IBD are focused on decreasing inflammation besides inducing and extending disease remission. However, these approaches have several limitations such as low responsiveness, excessive immunosuppression, and refractoriness. Despite the multifactorial causality of IBD, immune disturbances and intestinal dysbiosis have been suggested as the central players in disease pathogenesis. Hence, therapies aiming at modulating intestinal microbial composition may represent a promising strategy in IBD control. Fecal microbiota transplantation (FMT) and probiotics have been explored as promising candidates to reestablish microbial balance in several immune-mediated diseases such as IBD. These microbial-based therapies have demonstrated the ability to reduce both the dysbiotic environment and production of inflammatory mediators, thus inducing remission, especially in UC. Despite these promising results, there is still no consensus on the relevance of such treatments in IBD as a potential clinical strategy. Thus, this review aims to critically review and describe the use of FMT and probiotics to treat patients with IBD.

Manipulating resident microbiota to enhance regulatory immune function to treat inflammatory bowel diseases

“…Based on the current knowledge in the pathogenesis of IBD, manipulating the microbiota is considered as one of the rational treatment strategies for IBD [6,28,110,111]. However, existing microbiota-targeting therapies including antibiotics, prebiotics, probiotics, and fecal microbial transplantation (FMT) demonstrate inconsistent results and the overall outcomes are not satisfactory in clinical practice [6,28,112].…”

“…Currently available probiotics potentially modulate dysbiosis in IBD, but their effects are transient and limited in most IBD subsets [6,111,112]. The possible reasons are: (1) single bacterial strains or combinations of traditional probiotics are not designed to replace the microbial species that are depleted in IBD patients and are unlikely to be effective given the broad heterogeneity in the microbial profile of individual IBD patients [9].…”

“…(4) The proper delivery methods of live bacteria should be considered [122]. The most common species of current probiotics are Lactobacillus and Bifidobacterium, which have limited effects on IBD [112,123]. Several clinical trials demonstrated that combination probiotics VSL#3 (containing 8 live bacterial species), E. coli Nissle, B. bifidum ?…”

Sacral nerve stimulation improves colonic inflammation mediated by autonomic‐inflammatory cytokine mechanism in rats

“…It has been a worldwide healthcare problem with a continually increasing incidence . Current available therapies include thiopurine analogs, antibodies against tumor necrosis factor α, chronic immunosuppressant, microbial‐based therapies, and surgery . However, most of them have side effects or drawbacks and none is able to cure the disease.…”

“…However, most of them have side effects or drawbacks and none is able to cure the disease. Microbial‐based therapies are relatively new, and promising results are available in the literature; however, no consensus has been reached regarding its clinical strategy in the treatment of IBD . There is an urgent need to develop new effective and safe therapies.…”