Gastroenterology. 2023 Jan 23. pii: S0016-5085(23)00049-5. [Epub ahead of print]
The central role of gut microbiota in the regulation of health and disease has been convincingly demonstrated. Polymicrobial inter-kingdom interactions between bacteria (the bacteriome) and fungal (the mycobiome) communities of the gut have become a prominent focus for development of potential therapeutic approaches. In addition to polymicrobial interactions, the complex gut ecosystem also mediates interactions between host and the microbiota. These interactions are complex and bidirectional, microbiota composition can be influenced by host immune response, disease-specific therapeutics, antimicrobial drugs, and overall ecosystems. However, the gut microbiota also influences host immune response to a drug or therapy by potentially transforming the drug's structure and altering bioavailability, activity or toxicity, this is especially true in cases where the gut microbiota has produced a biofilm. The negative ramifications of biofilm formation include alteration of gut permeability, enhanced antimicrobial resistance, and alteration of host immune response effectiveness. Natural modulation of the gut microbiota, using pro- and pre-biotic approaches may also be used to affect the host microbiome, a type of "natural" modulation of the host microbiota composition. In this review we discuss potential bidirectional interactions between microbes and host, describe the changes in gut microbiota induced by probiotic and prebiotic approaches, and their potential clinical consequences and summarize how to develop a systematic approach to designing probiotics capable of altering the host microbiota in disease states, using Crohn's Disease (CD) as a model chronic disease. Understanding how the effective changes in the microbiome may enhance treatment efficacy may unlock the possibility of modulating the gut microbiome to improve treatment using a natural approach.
Keywords: Crohn’s disease; biotherapeutics; microbiome; nutritional supplements; targeting the microbiome