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The microbiome of inflammatory bowel disease
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O microbioma intestinal humano é essencial para o estado geral de saúde do hospedeiro e tem um papel importante no sistema imunitário, metabolismo e defende o intestino de agentes patogénicos exógenos. Genética, hábitos alimentares, medicação e outros fatores ambientais podem comprometer o balanço da microbiota intestinal. A perda de equilíbrio, devido à redução da diversidade microbiana, é denominada disbiose. Esta terminologia, disbiose, está relacionada com o desenvolvimento de inúmeras doenças tal como distúrbios a nível do intestino. De facto, existe uma associação entre esta alteração da microbiota e a doença inflamatória intestinal.
A doença inflamatória intestinal engloba duas vertentes, a doença de Crohn e a colite ulcerativa. Esta patologia é imunomediada, caracterizada por uma inflamação crónica do trato gastrointestinal que exige aos doentes o uso prolongado de medicação que compromete a qualidade de vida. Citoquinas, interleucinas e o fator de necrose tumoral são mediadores inflamatórios identificados em virtude da resposta imunitária nesta doença.
A prevalência a nível mundial desta enfermidade é notável nos países ocidentais, no entanto nos novos países industrializados a incidência tem vindo a aumentar nos últimos anos.
As abordagens terapêuticas para a doença inflamatória intestinal devem não só minimizar os sintomas e induzir a remissão, como também devem restabelecer a comunidade microbiana intestinal. Probióticos e prebióticos têm demonstrado resultados favoráveis no restabelecimento do equilíbrio do microbioma. Contudo, nos tratamentos atuais usados, nomeadamente como os aminosalicilatos, corticosteroides, imunomoduladores e agentes biológicos, alguns doentes não respondem ou ao longo do tempo a terapêutica vai perdendo resposta e efetividade. Desta maneira, a resposta ao tratamento não é consistente devido à heterogeneidade entre os doentes. Estes aspetos salientam a necessidade de desenvolver novos tratamentos com melhorias a nível da resposta e a nível do perfil de segurança- devido aos efeitos secundários que a medicação atual provoca. Inovações futuras devem debruçar-se nas necessidades individuais dos doentes, sendo mais explorado o microbioma e o seu papel na patogénese da doença juntamente com o genoma humano.
The human gut microbiome is essential for the overall health status of the host and plays a crucial role in the immune system, metabolism and safeguard the bowel from exogenous pathogens. Genetics, diet, medication, and other environmental factors can compromise the balance of the gut microbiota. The loss of equilibrium due to the reduced microbial diversity is called dysbiosis. This terminology, dysbiosis, is related to the development of several diseases, such as intestinal disorders. In fact, there is an association between this alteration of the gut microbiota and the inflammatory bowel disease. Inflammatory bowel disease comprises two conditions, Crohn’s disease and Ulcerative colitis. This pathology is an immune-mediated disease characterized by a chronic inflammation of the gastrointestinal tract, which demands long-term use of medication that compromises the quality of life. Cytokines, interleukins, and tumor necrosis factor are some of the inflammatory mediators identified due to the immune response in this disease. Worldwide the prevalence of this illness is distinguished in the Western world. However, the incidence has been increasing in newly industrialized countries in the past few years. Therapeutic approaches for inflammatory bowel disease need to not only minimize symptoms and induce remission, but also restore the gut microbial community. Probiotics and prebiotics have demonstrated positive results in reestablishing the equilibrium of the gut microbiome. Though the current treatments used, such as aminosalicylates, corticosteroids, immunomodulators, and biologic agents, some patients do not respond or in time start to these approaches lose response and effectiveness to therapy. Thus, the response to treatments is not consistent because of heterogeneity among patients. These aspects underline the need to develop novel treatments with improved response and an enhanced safety profile- the actual medication leads to the onset of several side effects. Future innovations can dwell on the individual needs, exploring more the microbiome and its play in the pathogenesis of the disease along with genomics.
The human gut microbiome is essential for the overall health status of the host and plays a crucial role in the immune system, metabolism and safeguard the bowel from exogenous pathogens. Genetics, diet, medication, and other environmental factors can compromise the balance of the gut microbiota. The loss of equilibrium due to the reduced microbial diversity is called dysbiosis. This terminology, dysbiosis, is related to the development of several diseases, such as intestinal disorders. In fact, there is an association between this alteration of the gut microbiota and the inflammatory bowel disease. Inflammatory bowel disease comprises two conditions, Crohn’s disease and Ulcerative colitis. This pathology is an immune-mediated disease characterized by a chronic inflammation of the gastrointestinal tract, which demands long-term use of medication that compromises the quality of life. Cytokines, interleukins, and tumor necrosis factor are some of the inflammatory mediators identified due to the immune response in this disease. Worldwide the prevalence of this illness is distinguished in the Western world. However, the incidence has been increasing in newly industrialized countries in the past few years. Therapeutic approaches for inflammatory bowel disease need to not only minimize symptoms and induce remission, but also restore the gut microbial community. Probiotics and prebiotics have demonstrated positive results in reestablishing the equilibrium of the gut microbiome. Though the current treatments used, such as aminosalicylates, corticosteroids, immunomodulators, and biologic agents, some patients do not respond or in time start to these approaches lose response and effectiveness to therapy. Thus, the response to treatments is not consistent because of heterogeneity among patients. These aspects underline the need to develop novel treatments with improved response and an enhanced safety profile- the actual medication leads to the onset of several side effects. Future innovations can dwell on the individual needs, exploring more the microbiome and its play in the pathogenesis of the disease along with genomics.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2022, Universidade de Lisboa, Faculdade de Farmácia.
Palavras-chave
Microbiota Dysbiosis Inflammatory bowel disease Inflammation Heterogeneity Mestrado integrado - 2022