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O paradigma das alterações do microbioma intestinal na doença inflamatória intestinal: o rumo certo para novas abordagens terapêuticas?
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Resumo(s)
A Doença Inflamatória Intestinal apresenta-se como uma patologia crónica que se divide em duas formas patológicas distintas: a Doença de Crohn, que afeta particularmente o intestino delgado e o cólon, mas que pode atingir qualquer zona do trato gastrointestinal, e a Colite Ulcerosa, que se restringe ao cólon e ao reto. Embora não esteja descrita uma etiologia concreta, cada vez mais a comunidade científica aponta para que a doença resulte de uma interação complexa entre vários fatores, onde se incluem fatores genéticos, fatores ambientais, desregulação imunitária e a disbiose intestinal.
A disbiose intestinal é caracterizada pela diminuição da variedade, qualitativa e quantitativa, da comunidade microbiana que habita o intestino. À data, sabemos que o intestino possui diversas funções no que à imunidade diz respeito, estas derivam em parte da importância particular que os metabolitos derivados da fermentação de alguns alimentos possuem, destacando-se a importância dos ácidos gordos de cadeia curta. A comunidade intestinal é composta, na sua maioria, por bactérias, sendo que a influência de determinados fatores, como a dieta, a utilização de fármacos, o uso de prebióticos e de probióticos se encontra bastante fundamentada. Uma disrupção nesta comunidade é capaz de afetar a homeostasia intestinal e preconizar a inflamação.
A alimentação tem sido também um grande alvo de estudo, derivado ao seu imenso potencial benéfico, mas também patológico, sendo de relevar o papel que os diversos aditivos alimentares apresentam para além de regimes alimentares específicos, como a dieta ocidental, assumidamente pró-inflamatória.
Entendido o poder do microbioma e percebendo-se a possível ligação entre este e a alimentação, diversas oportunidades terapêuticas acabam por surgir desde a possibilidade de se recorrer a dietas de exclusão até ao uso de transplantes fecais de microbiota.
Inflammatory Bowel Disease presents itself as a chronic pathology that is divided into two distinct pathological forms: Crohn's disease, which particularly affects the small intestine and colon, although it can affect any area of the gastrointestinal tract, and Ulcerative Colitis, which is restricted to the colon and rectum. Although a concrete etiology is not described, the scientific community increasingly points out that the disease results from a complex interaction between several factors, including genetic factors, environmental factors, immune dysregulation and intestinal dysbiosis. Intestinal dysbiosis is characterized by a decrease in the variety, qualitative and quantitative, of the microbial community that inhabits the intestine. Nowadays, we know that the intestine has several functions concerning immunity, these derive in part from the particular importance that metabolites obtained from the fermentation of some foods have, highlighting the importance of short-chain fatty acids. The intestinal community is mostly composed of bacteria, and the influence of certain factors, such as diet, the use of drugs, the use of prebiotics and probiotics is well-founded. A disruption in this community is capable of affecting intestinal homeostasis and advocating inflammation. Food has also been a major target of study, as a result of its immense beneficial but also pathological potential, and the role that different food additives have in addition to specific diets, such as the Western diet, which is admittedly pro-inflammatory, should be highlighted. Understanding the power of the microbiome and realizing the possible connection between it and food, several therapeutic opportunities end up being unraveled from the possibility of resorting to exclusion diets to the use of microbiota fecal transplants.
Inflammatory Bowel Disease presents itself as a chronic pathology that is divided into two distinct pathological forms: Crohn's disease, which particularly affects the small intestine and colon, although it can affect any area of the gastrointestinal tract, and Ulcerative Colitis, which is restricted to the colon and rectum. Although a concrete etiology is not described, the scientific community increasingly points out that the disease results from a complex interaction between several factors, including genetic factors, environmental factors, immune dysregulation and intestinal dysbiosis. Intestinal dysbiosis is characterized by a decrease in the variety, qualitative and quantitative, of the microbial community that inhabits the intestine. Nowadays, we know that the intestine has several functions concerning immunity, these derive in part from the particular importance that metabolites obtained from the fermentation of some foods have, highlighting the importance of short-chain fatty acids. The intestinal community is mostly composed of bacteria, and the influence of certain factors, such as diet, the use of drugs, the use of prebiotics and probiotics is well-founded. A disruption in this community is capable of affecting intestinal homeostasis and advocating inflammation. Food has also been a major target of study, as a result of its immense beneficial but also pathological potential, and the role that different food additives have in addition to specific diets, such as the Western diet, which is admittedly pro-inflammatory, should be highlighted. Understanding the power of the microbiome and realizing the possible connection between it and food, several therapeutic opportunities end up being unraveled from the possibility of resorting to exclusion diets to the use of microbiota fecal transplants.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2020, Universidade de Lisboa, Faculdade de Farmácia.
Palavras-chave
Doença inflamatória intestinal Doença de crohn Colite ulcerosa Microbioma Disbiose Mestrado integrado - 2020