Probiotics in inflammatory bowel disease: Pathophysiological background and clinical applications  

作　　者：Cristiano Pagnini Gianfranco Delle Fave Giorgos Bamias 

机构地区：[1]Faculty of Medicine and Psychology, S.Andrea Hospital, Sapienza University, Rome 00189, Italy [2]Academic Department of Gastroenterology, Laikon Hospital, Ethnikon and Kapodistriakon University, Athens 11527, Greece

出　　处：《World Journal of Immunology》2013年第3期31-43,共13页世界免疫学杂志

摘　　要：Ulcerative colitis and Crohn's disease, collectively termed the inflammatory bowel diseases(IBD), are chronic inflammatory disorders of the gastrointestinal tract. A "dysbiotic" relationship between the commensal gut flora and the intestinal mucosa-associated immune system has been at the core of the pathogenesis of these conditions. Probiotics are "good bacteria" with the ability to benefit the health of the host and their therapeutic application has been studied in IBD. The theoretical basis for such utilization relies upon the ability of probiotic microorganisms to interfere with the dysregulated homeostasis that takes place in IBD and restore the immune-bacterial interaction at the intestinal mucosa. Proposed mechanisms of action include the reconstitution of altered flora composition, enhancement of the integrity of the epithelial barrier, promotion of tolerogenic action by dendritic cells, strengthening of the defensive mechanisms of the innate immunity, and the suppression of pro-inflammatory adaptive immune responses. Despite this abundance of supporting experimental evidence, clinical application of probiotics in IBD has been disappointing. Possible explanations for such discrepancy include the great diversity of microorganisms that fall under the definition of probiotics, the lack of standardization of dosages and administration schemes, the heterogeneity between clinical trials, and the inclusion in the treatment arms of patients with a large variety of clinical phenotypes. Addressing these important issues will be critical for the optimal usage of probiotic-based therapies for patients with IBD.Ulcerative colitis and Crohn’s disease, collectively termed the inflammatory bowel diseases （IBD）, are chronic inflammatory disorders of the gastrointestinal tract. A “dysbiotic” relationship between the commensal gut flora and the intestinal mucosa-associated immune system has been at the core of the pathogenesis of these conditions. Probiotics are “good bacteria” with the ability to benefit the health of the host and their therapeutic application has been studied in IBD. The theoretical basis for such utilization relies upon the ability of probiotic microorgan-isms to interfere with the dysregulated homeostasis that takes place in IBD and restore the immune-bacterial in-teraction at the intestinal mucosa. Proposed mechanisms of action include the reconstitution of altered flora com-position, enhancement of the integrity of the epithelial barrier, promotion of tolerogenic action by dendritic cells, strengthening of the defensive mechanisms of the innate immunity, and the suppression of pro-inflammatory adaptive immune responses. Despite this abundance of supporting experimental evidence, clinical application of probiotics in IBD has been disappointing. Possible explanations for such discrepancy include the great diversity of microorganisms that fall under the definition of probiot-ics, the lack of standardization of dosages and adminis-tration schemes, the heterogeneity between clinical trials, and the inclusion in the treatment arms of patients with a large variety of clinical phenotypes. Addressing these important issues will be critical for the optimal usage of probiotic-based therapies for patients with IBD.

关 键 词：PROBIOTICS Commensal flora Mucosa-associated immune system Inflammatory bowel disease Clinical trials POUCHITIS Ulcerative colitis Crohn’s disease 

分 类 号：R1[医药卫生—公共卫生与预防医学]