Targeted microbiota manipulation using probiotics, prebiotics, synbiotics, and fecal microbiota transplantation holds potential for IBD treatment.
Although current treatment options for inflammatory bowel diseases (IBD) induce clinical remission by reducing inflammation, the authors of a paper published in Intestinal Research indicate that targeted microbiota manipulation using probiotics, prebiotics, synbiotics, and fecal microbiota transplantation (FMT) holds potential in the treatment of IBD.
The authors noted that the incidence of IBD is rising in many developing countries and that patients with IBD are at an increased risk for developing colorectal cancer, otherwise known as colitis-associated cancer.
“Colitis stimulates carcinogenesis by inducing the expansion of genotoxic bacteria,” they wrote. “Patients with IBD show a significant clinical heterogeneity, which makes the right treatment for each patient difficult.”
The human gastrointestinal tract hosts a complex ecosystem of microorganisms, collectively known as the gut microbiota, comprising bacteria, archaea, fungi, protozoa, and viruses, they wrote. This microbiota, estimated at around 40 trillion microorganisms, significantly outnumbers human cells and possesses a vast genetic repertoire. The symbiotic relationship between the gut microbiota and humans plays a crucial role in maintaining intestinal homeostasis.
Various factors influence the composition of the gut microbiota, including delivery mode, diet, age, antibiotics, and environmental factors. Most bacteria in the human intestine belong to four main phyla: Firmicutes, Bacteroidetes, Actinobacteria, and Proteobacteria, with their proportions varying along the gastrointestinal tract.
Dysbiosis & IBD
Disruptions in the balance of gut microbiota, termed dysbiosis, are associated with gastrointestinal diseases such as IBD and irritable bowel syndrome (IBS). Dysbiosis, characterized by alterations in microbial diversity and specific taxa abundance, is implicated in the pathophysiology of IBD.
According to the review, studies have consistently shown decreased microbial diversity in fecal samples of patients with IBD, with reductions in Firmicutes and Bacteroidetes and increases in Proteobacteria and Actinobacteria. Specific genera, such as Bacteroides, Eubacterium, Faecalibacterium, and Ruminococcus, are found to be reduced in Crohn’s disease, whereas patients with ulcerative colitis show declines in Bacteroides and Clostridium XIVab. Additionally, dysbiosis extends beyond bacteria to include alterations in archaeal and viral diversity.
The study authors noted that interkingdom interactions within the gut microbiota, particularly between bacteria and fungi (mycobiome), have been implicated in Crohn’s disease. Emerging evidence suggests that dysbiosis contributes to IBD pathogenesis, possibly through aberrant immune responses to gut microbiota in genetically susceptible individuals.
Understanding the intricate relationship between the gut microbiota and IBD offers potential insights into disease diagnosis, treatment, and prevention, they stressed.
Targeted Microbiota Manipulation
“Though still in its infancy, targeted microbiota manipulation using probiotics, prebiotics, synbiotics, and FMT is one of the potential armamentariums in IBD,” they wrote. “Another microbiota-based intervention, FMT, has gathered much attention as a new therapeutic option for IBD, but its efficacy remains questionable. Standardization of various parameters will surely help increase its effectiveness and success rate in IBD.”
Further research is needed to elucidate the precise mechanisms underlying dysbiosis and its role in IBD progression.
