The microbiota in inflammatory bowel disease: current and therapeutic insights

Abstract

Inflammatory bowel disease is a heterogeneous group of chronic disorders that result from the interaction of the intestinal immune system with the gut microbiome. Until recently, most investigative efforts and therapeutic breakthroughs were centered on understanding and manipulating the altered mucosal immune response that characterizes these diseases. However, more recent studies have highlighted the important role of environmental factors, and in particular the microbiota, in disease onset and disease exacerbation. Advances in genomic sequencing technology and bioinformatics have facilitated an explosion of investigative inquiries into the composition and function of the intestinal microbiome in health and disease and have advanced our understanding of the interplay between the gut microbiota and the host immune system. The gut microbiome is dynamic and changes with age and in response to diet, antibiotics and other environmental factors, and these alterations in the microbiome contribute to disease onset and exacerbation. Strategies to manipulate the microbiome through diet, probiotics, antibiotics or fecal microbiota transplantation may potentially be used therapeutically to influence modulate disease activity. This review will characterize the factors involved in the development of the intestinal microbiome and will describe the typical alterations in the microbiota that are characteristic of inflammatory bowel disease. Additionally, this manuscript will summarize the early but promising literature on the role of the gut microbiota in the pathogenesis of inflammatory bowel disease with implications for utilizing this data for diagnostic or therapeutic application in the clinical management of patients with these diseases.

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“…The loss of bacteria belonging to the Firmicutes phylum and abundance of some Gammaproteobacteria, collectively impair the mucosal immune response to normal bacterial flora and disrupt regulatory functions of Tlymphocytes playing a key role in inducing chronic intestinal inflammation to develop IBD [1,[91][92][93]. The loss of diversity in fecal communities has been consistently shown in IBD cases and on an average, 25% fewer microbial genes could be detected in the fecal community of IBD patients [94][95][96]. The most prominent change in the microbial diversity associated with IBD is the decreased abundance of Firmicutes phylum that includes loss of Faecalibacterium prausnitzii, a bacterium that maintains inflammatory homeostasis of the gut with its potential antiinflammatory effect [91].…”

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“…Although IBD etiology remains unresolved, a general consensus supports the important role of gut dysbiosis in promoting and determining chronic intestinal inflammation . Hundreds of research papers have described the composition of IBD intestinal microbiota and its poor bacterial diversity in respect to healthy controls; however, it has not yet been clarified whether the gut microbial perturbations are a cause or an effect of disease .…”

“…43 Microbiota and IBD susceptibility Although IBD etiology remains unresolved, a general consensus supports the important role of gut dysbiosis in promoting and determining chronic intestinal inflammation. [44][45][46]…”