Микробиом, дисбиоз толстой кишки и воспалительные заболевания кишечника: когда функция важнее таксономии

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Измененный микробиом кишечника (дисбиоз) вовлечен в патогенез большинства неинфекционных заболеваний органов  пищеварения  – воспалительные  заболевания кишечника (ВЗК), синдром  раздраженного кишечника, колоректальный рак, целиакия, печеночная  энцефалопатия, неалкогольная  жировая болезнь печени, алкогольные поражения  печени, желчнокаменная болезнь и другие. В статье рассматриваются молекулярно-биологические аспекты взаимодействия дисбиотической микробиоты с иммунной  системой  человека  в контексте  развития ВЗК. Авторами даются оригинальные  трактовки понятий таксономического (микробиологического) и метаболического  (функционального) дисбиоза. Особое внимание уделяется гипотезе о том, что дисбиотические состояния микробиоценоза  кишечника обусловлены не столько изменениями  структуры микробиома, сколько нарушениями его метаболизма, а метаболом является  бóльшим предиктором  дисбиоза, нежели таксономический состав микробиома. Отмечается важность учета дисбиотических изменений   микробиоты   кишечника   у  пациентов  с язвенным  колитом и болезнью  Крона, поскольку  они  могут существенно  влиять  на течение и прогноз ВЗК. Подробно обсуждаются факторы,   затрудняющие   оценку  микробиоты в клинической практике, и описываются современные  тесты на дисбиоз, включая GA-map Dysbiosis Test  (GA-тест) и  отечественный  тест «Колонофлор-16».   На  основании   результатов клинических исследований, в том числе собственных, демонстрируется, что снижение генетической бутират-продуцирующей способности микробиома, наряду с увеличением численности патобионтов и снижением микробного разнообразия, – важная и неотъемлемая характеристика  дисбиоза  у пациентов  с ВЗК, а уровень гена бутирил-КоA:ацетат-КоA-трансферазы (BcoAT) может рассматриваться как потенциальный биомаркер  для оценки функциональных возможностей микробиоты кишечника в клинической  практике. В  заключение  критически обсуждаются  подходы  к коррекции   дисбиоза кишечника с использованием пробиотиков, пребиотиков, метабиотиков  и трансплантации фекальной  микробиоты  в дополнение  к стандартной терапии ВЗК.

Об авторах

С. И. Ситкин

ФГУП «Государственный научно-исследовательский институт особо чистых биопрепаратов» ФМБА России; ФГБОУ ВО «Северо-Западный государственный медицинский университет имени И.И. Мечникова» Минздрава России

Автор, ответственный за переписку.
Email: drsitkin@gmail.com

Ситкин Станислав Игоревич – кандидат медицинских наук, ведущий научный сотрудник лаборатории микробиологии ФГУП «Гос.НИИ ОЧБ» ФМБА России, доцент кафедры пропедевтики внутренних болезней, гастроэнтерологии и диетологии ФГБОУ ВО СЗГМУ им. И.И. Мечникова МЗ России.

197110, Санкт-Петербург, ул. Пудожская, 7; 195067, Санкт-Петербург, Пискаревский пр., 47.

Тел.: +7 (812) 498 48 56. 

Россия

Т. Я. Вахитов

ФГУП «Государственный научно-исследовательский институт особо чистых биопрепаратов» ФМБА России

Email: fake@neicon.ru

Вахитов Тимур Яшэрович – доктор биологических наук, начальник лаборатории микробиологии.

197110, Санкт-Петербург, ул. Пудожская, 7.

Россия

Е. В. Демьянова

ФГУП «Государственный научно-исследовательский институт особо чистых биопрепаратов» ФМБА России

Email: fake@neicon.ru

Демьянова Елена Валерьевна – кандидат фармацевтических наук, заместитель начальника лаборатории микробиологии.

197110, Санкт-Петербург, ул. Пудожская, 7.

Россия

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