粪便菌群移植治疗现状及其应用前景

粪便菌群移植(fecal microbiota transplantation,FMT)可以重建正常肠道微生态结构,治疗肠道菌群紊乱性疾病。国内外均有FMT的相关报道,但FMT的具体机制及标准化过程并不明确。本研究针对现有的FMT开展案例,对FMT操作方法、研究治疗现状及应用前景作一综述。     

粪菌移植技术中肠道噬菌体对疾病影响的研究进展

粪菌移植(fecal microbiota transplantation, FMT)是一种创新的方法,通过将健康供体的粪便微生物群移植到疾病患者体内,达到重建肠道微生态平衡的目的,为治疗疾病提供帮助。粪菌移植技术在复发性艰难拟梭菌感染(recurrent Clostridioides difficile infection, rCDI)的治疗中效果很好,并且其治疗潜力不仅局限于胃肠道疾病,而且在其他与微生物相关的疾病中被不断挖掘。探索FMT成功治疗疾病的影响因素,除了肠道细菌的恢复,还涉及肠道噬菌体的调节。肠道噬菌体是肠道微生物群的重要组成部分,在细菌的复杂动力学中发挥着重要作用,其转移可能与FMT的疗效有关。本综述回顾了肠道噬菌体的生物学特性和主要的生物信息学分析策略,总结了FMT中肠道噬菌体作用的临床研究,探讨了FMT中肠道噬菌体群落的变化和可能的作用机制,讨论了肠道噬菌体与FMT疗效的关系及其存在的安全性问题,既能提高对FMT中肠道噬菌体作用的理解,也能推动FMT的临床应用。     

以肠道菌群为靶向的粪菌移植法及其在畜牧业的应用潜能

肠道微生物与宿主机体健康息息相关。粪便微生物移植(又称为粪菌移植,fecal microbiota transplantation,FMT)通过将健康供体粪便中的完整肠道菌群移入肠道微生态失衡的患者胃肠道内,经肠道菌群重构、恢复至正常状态。用FMT治疗某些肠道疾病如复发性艰难梭菌感染、溃疡性结肠炎、肠易激综合症、克罗恩病效果显著,且可能对因肠道菌群紊乱引起的肠道外疾病的治疗有潜在价值。本文主要对FMT技术的发展进程、在疾病上的研究以及在畜牧业上的应用潜能进行综述,并分析其应用的制约因素。     

粪菌移植途径的临床应用现状

人体肠道内寄居着数量庞大、种类繁多的微生物,形成肠道微生态稳态,而肠道微生态失衡与多种肠内、肠外疾病相关。随着人们对肠道菌群在宿主健康及疾病中作用的深入认识,粪菌移植(faecal microbiota transplantation, FMT)被给予厚望,其作为重建肠道菌群的有效手段,已成功应用于艰难梭菌感染(Clostridioides difficile infection, CDI)等疾病的治疗和探索性研究,并被认为是近年的突破性医学进展。随着近几年FMT研究的深入,人们发现FMT对各系统疾病皆有潜在的治疗作用。在1990年之前,菌群移植都是经灌肠实施,近几年随着粪菌移植研究的深入,粪菌移植途径也呈多样化发展。本文对粪菌移植途径、临床应用和存在的问题等作一综述。     

艾滋病患者肠道微生态与抗逆转录病毒治疗及耐药相关性研究新进展

艾滋病(AIDS)是一种由人类免疫缺陷病毒(HIV)引起的免疫缺陷性疾病,因其高传染性和不可治愈而备受关注。本文综述了HIV患者肠道菌群的变化与其发病机制、抗逆转录病毒耐药及肠道免疫激活的相关性。抗逆转录病毒治疗(ART)是降低肠道黏膜免疫和导致持续炎症的独立风险因素。肠道菌群参与或干扰抗病毒药物的代谢,造成肠道黏膜的通透性增加,微生物移位,激活不同的T细胞亚群的免疫活性,产生炎性因子导致CD4+细胞数量持续低下。某些特定的益生菌及粪菌移植(FMT)可调节HIV患者的肠道微生态的平衡,延缓AIDS的发病进程。     

粪菌移植的临床应用研究进展

人类的肠道菌群种类及数量众多,目前被认为是人体的一个特殊器官。肠道菌群在维持肠道的正常生理功能和机体免疫功能方面发挥了重要作用,肠道微生态失衡与炎症性肠病、代谢综合征、肝病、心血管疾病、精神疾病、关节炎等多种肠内外疾病密切相关,纠正肠道微生态失衡将有助于上述疾病的治疗。粪菌移植（fecal microbiota transplantation,FMT）是指将健康人粪便中的功能菌群移植到患者胃肠道内,重建具有正常功能的肠道菌群,以达到治疗肠道和肠道外疾病的目的。目前报道FMT已应用于艰难梭菌感染、炎症性肠病、肠易激综合征、代谢综合征等多种疾病的治疗中。本文就FMT的临床应用现状作一综述。     

溃疡性结肠炎肠道菌群及其代谢产物的研究进展

溃疡性结肠炎(UC)是一种病因尚未阐明的慢性非特异性肠道炎症疾病,多认为由易感人群免疫反应紊乱所致,疾病负担重,严重影响生活质量。近年随着人们生活方式的改变与诊断水平的提升,UC发病率和患病率逐年增加。研究显示肠道菌群及其代谢产物在UC的发生发展过程中起着关键作用,包括调节免疫、参与信号转导、保护肠黏膜屏障和营养代谢等,肠道菌群代谢产物的紊乱及微生态的失衡在炎症的形成及发展、免疫应激及稳态等方面产生重要影响。该文对近年来肠道菌群及其代谢产物与UC关系的相关研究作一综述,并探讨基于肠道菌群以及其代谢产物的UC防治策略。     

肠道微生态在血液肿瘤发生发展中的作用研究进展

肠道微生态在血液肿瘤的发生、发展及预后中起到了至关重要的作用。近年来, 动物和临床研究取得了很大的进展。肠道微生物不仅能诱导基因突变和异常免疫反应导致淋巴瘤发生, 还可以通过慢性炎症促进慢性淋巴细胞白血病(chronic lymphoblastic leukemia, CLL)的发展, 扰乱细胞增殖和凋亡的平衡, 引发异常的固有和适应性免疫反应。肠道中普雷沃菌通过白细胞介素17(IL-17)促进多发性骨髓瘤(multiple myeloma, MM)的发展, 且特定肠道微生物可以水解尿素生成L-谷氨酰胺(Gln)促进MM的进展。血液肿瘤的治疗可以造成肠道微生态失调。因此, 维持肠道微生态的稳定对治疗效果和疾病预后具有重要意义。粪菌移植(fecal microbiota transplantation, FMT)可以纠正肠道微生态失衡, 具有广阔的临床应用前景。

     

基于肠道菌群与代谢水平的相关性论高血压病理机制CSCD

随着医学文献和数据研究的不断挖掘,不良生活方式在高血压发病的多种病因中日益突出,使得高血压发生的病理机制愈加复杂化,病因愈加多样化,群体愈加大众化。以往公认的高血压病理机制是遗传因素与环境因素共同作用,此机制已无法满足当下复杂的病理环境,而对高血压的治疗主要强调外周血管重塑和中枢血压的调控,却忽略了机体内部微生态系统中肠道菌群的平衡。本文将以代谢水平对肠道菌群平衡的影响为立足点,从肠道微生态领域探讨高血压发生的可能病理机制,从而为未来心脑血管疾病的防治提供一种新的分析视角。作为新的契入点,肠道菌群将是未来高血压新的靶向机制。     

粪菌移植治疗肠易激综合征研究进展

粪菌移植(faecal microbiota transplantation,FMT)是将从健康供体获得的粪便悬液转移至患者消化道,从而恢复肠道正常微生物组成和功能的一种治疗方法。近年来,FMT治疗肠易激综合征(irritable bowel syndrome,IBS)的疗效和经济效益越来越受到研究者的重视。这种方法已经成为艰难梭菌感染(Clostridium difficile infection,CDI)的成熟替代疗法。此外,FMT还在炎症性肠病(inflammatory bowel disease,IBD)和胃肠疾病以外的疾病,如心血管疾病、自身免疫性疾病和代谢综合征等多种疾病的治疗中取得了显著进展。关于FMT仍有许多未解的问题,需要在这一领域进行更多研究。本文就IBS的发病机制、FMT的疗效和安全性进行综述。     

Beneficial Effects of Celastrol on Immune Balance by Modulating Gut Microbiota in Experimental Ulcerative Colitis Mice

Ulcerative colitis (UC) is a chronic inflammatory bowel disease caused by many factors including colonic inflammation and microbiota dysbiosis. Previous studies have indicated that celastrol (CSR) has strong anti-inflammatory and immune-inhibitory effects. Here, we investigated the effects of CSR on colonic inflammation and mucosal immunity in an experimental colitis model, and addressed the mechanism by which CSR exerts the protective effects. We characterized the therapeutic effects and the potential mechanism of CSR on treating UC using histological staining, intestinal permeability assay, cytokine assay, flow cytometry, fecal microbiota transplantation (FMT), 16S rRNA sequencing, untargeted metabolomics, and cell differentiation. CSR administration significantly ameliorated the dextran sodium sulfate (DSS)-induced colitis in mice, which was evidenced by the recovered body weight and colon length as well as the decreased disease activity index (DAI) score and intestinal permeability. Meanwhile, CSR down-regulated the production of pro-inflammatory cytokines and up-regulated the amount of anti-inflammatory mediators at both mRNA and protein levels, and improved the balances of Treg/Th1 and Treg/Th17 to maintain the colonic immune homeostasis. Notably, all the therapeutic effects were exerted in a gut microbiota-dependent manner. Furthermore, CSR treatment increased the gut microbiota diversity and changed the compositions of the gut microbiota and metabolites, which is probably associated with the gut microbiota-mediated protective effects. In conclusion, this study provides the strong evidence that CSR may be a promising therapeutic drug for UC.     

基于NF-κB信号通路的益生菌治疗溃疡性结肠炎的研究进展

溃疡性结肠炎（UC）是一种肠道非特异性炎症性疾病,迁延不愈,严重影响患者的生活质量。目前认为,肠道菌群的改变是诱发和维持结肠炎症的主要原因。临床上应用益生菌制剂作为UC患者的辅助治疗,可平衡患者肠道菌群,减轻炎症反应。UC患者免疫调节功能紊乱,TLR4及其信号传导通路是UC发病的重要环节。易感人群肠道中的菌群突破肠上皮屏障,免疫系统被各种微生物抗原激活,炎症细胞活化从而导致结肠黏膜组织产生炎症反应,该过程可由TLR4-NF-κB信号传导通路介导。本研究就益生菌基于TLR4-NF-κB信号通路对溃疡性结肠炎的治疗进行综述。     

Treatment and mechanism of fecal microbiota transplantation in mice with experimentally induced ulcerative colitis

Restoring intestinal microbiota dysbiosis with fecal microbiota transplantation is considered as a promising treatment for ulcerative colitis. However, the mechanisms underlying its relieving effects remain unclear. Ulcerative colitis pathogenesis is associated with the involvement of immune cells and inflammatory cytokines. Here, we aimed to investigate the effect of fecal microbiota transplantation on T cell cytokines in a dextran sulfate sodium-induced ulcerative colitis mouse model. Five-aminosalicylic acid (5-ASA) was used as the positive control. Male C57BL/6 mice were randomly assigned to control, model (UC), UC + FMT, and UC + 5-ASA groups. Each group consisted of five mice. The establishment of the mouse model was verified by fecal occult-blood screening and hematoxylin–eosin staining. Results showed that fecal microbiota transplantation reduced colonic inflammation, significantly decreased T helper (Th)1 and Th17 cells, interferon-gamma, interleukin-2 and interleukin-17, as well as significantly increased Th2 and regulatory T (Treg) cells, interleukin-4, interleukin-10, and transforming growth factor-beta, and improved routine blood count. Furthermore, 16S rRNA gene-sequencing analysis showed a significant increase in the relative abundance of genus Akkermansia and a significant decrease in the relative abundance of genus Helicobacter in the ulcerative colitis group. Fecal microbiota transplantation restored the profile of the intestinal microbiota to that of the control group. These findings demonstrated the capability of fecal microbiota transplantation in controlling experimentally induced ulcerative colitis by improving Th1/Th2 and Th17/Treg imbalance through the regulation of intestinal microbiota.     

肠道微生物群落与炎症性肠病关系研究进展

目的炎症性肠病（IBD）包括克罗恩病（CD）和溃疡性结肠炎（UC）,以持续性肠道非特异性炎症为特征,通常反复发作、迁延不愈,临床上仍无特效性的治疗手段。IBD确切的发病机制尚不清楚,涉及免疫、环境及遗传等因素,这些因素共同诱导肠道炎症、黏膜损伤和修复。肠道微生物群落及其代谢产物、宿主基因易感性及肠道黏膜免疫三方面共同参与了IBD的发病机制。本文从消化道微生态角度出发,对目前IBD相关的肠道微生物群落研究现状、宿主-微生物间免疫应答及益生菌治疗等内容进行探讨。     

肠道菌群在慢性疲劳综合征中的作用研究进展

慢性疲劳综合征(chronic fatigue syndrome,CFS)是一种病因不明的慢性疾病,与免疫、神经炎症、感染和精神等因素有关。其临床特征主要是长期(6个月以上)的极度疲劳感伴肌肉和关节疼痛、头痛、淋巴结肿痛、喉咙痛、光敏感、直立后不适以及流感样症状等,可累及多系统。CFS诊断必须排除其他疾病,因为对CFS的病因所知甚少,并且这种疾病缺乏明确的生物标记物,所以给诊断带来一定困难。目前许多基础研究和临床研究揭示了肠道菌群失调在CFS中的具体表现,以及肠道微生态干预在缓解疲劳、睡眠和注意力障碍等症状的决定性作用。本综述复习了关于肠道菌群失调和CFS关系的研究,总结肠道菌群在CFS发病过程中的作用,明确二者之间的关系,以此来加深临床工作者对CFS的认识,便于尽早诊断,合理治疗。     

Microbial treatment in chronic constipation

Chronic functional constipation is a kind of common intestinal disease that occurs in children, adults and elderly people. This disease not only causes great influence to physiological function, but also results in varying degrees of psychological barriers. At present, constipation treatments continue to rely on traditional methods such as purgative therapy and surgery. However, these approaches can disrupt intestinal function. Recent research between intestinal diseases and gut microbiota has gradually revealed a connection between constipation and intestinal flora disturbance, providing a theoretical basis for microbial treatment in chronic constipation. Microbial treatment mainly includes probiotic preparations such as probiotics, prebiotics, synbiotics and fecal microbiota transplantation (FMT). Due to its safety, convenience and curative effect, probiotic preparations have been widely accepted, especially gradually developed FMT with higher curative effects. Microbial treatment improves clinical symptoms, promotes the recovery of intestinal flora, and has no complications during the treatment process. Compared with traditional treatments, microbial treatment in chronic constipation has advantages, and is worthy of further promotion from clinical research to clinical application.     

肠道微生态与生命早期健康

肠道微生态是指肠道正常菌群与其宿主之间相互作用、相互影响的统一整体[1]。生命早期一般指自母体妊娠阶段开始算起至出生后2岁内（近1 000天）,这段时间的生命生长发育对于整个生命周期至关重要。随着对肠道微生态研究的不断深入,发现生命早期健康肠道微生态的建立对婴儿各系统生长发育至关重要,因各种因素导致的肠道微生态改变或结构异常与生命早期婴儿发生免疫系统、消化系统、内分泌系统等相关疾病息息相关。本研究将综述生命早期肠道微生物来源、健康肠道微生态建立的相关因素及其生理作用,以及因不健全或紊乱的肠道微生态而引起的相关疾病。