Modulating Composition and Metabolic Activity of the Gut Microbiota in IBD Patients.

Mario Matijašić,Hana Čipčić Paljetak,Donatella Verbanac,Dina Ljubas Kelečić,Mihaela Perić,Darija Vranešić Bender,Željko Krznarić,Tomislav Meštrović,Marina Panek

doi:10.3390/ijms17040578

Abstract

The healthy intestine represents a remarkable interface where sterile host tissues come in contact with gut microbiota, in a balanced state of homeostasis. The imbalance of gut homeostasis is associated with the onset of many severe pathological conditions, such as inflammatory bowel disease (IBD), a chronic gastrointestinal disorder increasing in incidence and severely influencing affected individuals. Despite the recent development of next generation sequencing and bioinformatics, the current scientific knowledge of specific triggers and diagnostic markers to improve interventional approaches in IBD is still scarce. In this review we present and discuss currently available and emerging therapeutic options in modulating composition and metabolic activity of gut microbiota in patients affected by IBD. Therapeutic approaches at the microbiota level, such as dietary interventions alone or with probiotics, prebiotics and synbiotics, administration of antibiotics, performing fecal microbiota transplantation (FMT) and the use of nematodes, all represent a promising opportunities towards establishing and maintaining of well-being as well as improving underlying IBD symptoms.

Highlights

Inflammatory bowel disease (IBD) is a chronic relapsing inflammatory condition which is comprised of two clinically and morphologically different entities: Ulcerative colitis (UC) and Crohn’s disease (CD)
Patients using ciprofloxacin for 10 weeks in the treatment of perianal fistulising CD showed bigger percentage of fistula remission [120], which is a finding supported by a recent meta-analysis [121], while patients with active CD on rifaximin therapy had a better clinical outcome compared to patients who received only placebo [122]
A state of unbalanced gut microbiota and defects in innate and adaptive immune responses have been repeatedly recognized as key stakeholders in the development of gut inflammatory processes leading to inflammatory bowel disease (IBD)

Summary

Introduction

Inflammatory bowel disease (IBD) is a chronic relapsing inflammatory condition which is comprised of two clinically and morphologically different entities: Ulcerative colitis (UC) and Crohn’s disease (CD). The human gut microbiota is a diverse microbial community, estimated to contain over 1000 different bacterial species, as well as commensal fungi and viruses [2]. The observed changes in gut microbiota and associated metabolites in IBD patients are not completely consistent among different scientific reports, with the observed discrepancies usually explained by different study design parameters, such as diverse samples (feces/biopsy), sampling location (inflamed/non-inflamed site), disease state (active/non-active), methods of sample analysis, as well as differences in subjects of these studies (age, diet, use of medications) [17]. Holistic approaches that take into account different factors able to modify the composition of gut microbiota and manipulate with it, today, represent a powerful tool, which might be very useful for basic and clinical researchers in finding new therapeutic options for patients affected by these devastating diseases

Nutritional Patterns and Dietary Interventions

Use of Antibiotics

Fecal Microbiota Transplantation

Investigational Approaches

Findings

Conclusions and Future Perspectives