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首页> 外文期刊>Journal of clinical gastroenterology >Mucosal Permeability and Immune Activation as Potential Therapeutic Targets of Probiotics in Irritable Bowel Syndrome
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Mucosal Permeability and Immune Activation as Potential Therapeutic Targets of Probiotics in Irritable Bowel Syndrome

机译：肠黏膜通透性和免疫激活作为益生菌在肠易激综合征中的潜在治疗靶标

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摘要

There is increasingly convincing evidence supporting the participation of the gut microenvironment in the pathophysiology of irritable bowel syndrome (IBS). Studies particularly suggest an interplay between luminal factors (eg, foods and bacteria residing in the intestine), the epithelial barrier, and the mucosal immune system. Decreased expression and structural rearrangement of tight junction proteins in the small bowel and colon leading to increased intestinal permeability have been observed, particularly in post-infectious IBS and in IBS with diarrhea. These abnormalities are thought to contribute to the outflow of antigens through the leaky epithelium, causing overstimulation of the mucosal immune system. Accordingly, subsets of patients with IBS show higher numbers and an increased activation of mucosal immunocytes, particularly mast cells. Immune factors, released by these cells, including proteases, histamine, and prostanoids, participate in the perpetuation of the permeability dysfunction and contribute to the activation of abnormal neural responses involved in abdominal pain perception and changes in bowel habits. All these mechanisms represent new targets for therapeutic approaches in IBS. Probiotics are an attractive therapeutic option in IBS given their recognized safety and by virtue of positive biological effects they can exert on the host. Of importance for the IBS pathophysiology is that pre-clinical studies have shown that selective probiotic strains exhibit potentially useful properties including anti-inflammatory effects, improvement of mucosal barrier homeostasis, beneficial effects on intestinal microbiota, and a reduction of visceral hypersensitivity. The effect of probiotics on IBS is positive in most randomized, controlled studies, although the gain over the placebo is small. Identifying tailored probiotic approaches for subgroups of IBS patients represents a challenge for the future.
机译：越来越有说服力的证据支持肠道微环境参与肠易激综合征（IBS）的病理生理。研究尤其表明，管腔因素（例如，食物和肠道细菌），上皮屏障和粘膜免疫系统之间存在相互作用。已经观察到小肠和结肠中紧密连接蛋白的表达降低和结构重排，导致肠道通透性增加，特别是在感染后IBS和腹泻的IBS中。这些异常被认为是导致抗原通过渗漏的上皮细胞流出，引起粘膜免疫系统的过度刺激。因此，患有IBS的患者亚群显示出更高的数目，并且粘膜免疫细胞，特别是肥大细胞的活化增加。这些细胞释放的免疫因子，包括蛋白酶，组胺和类前列腺素，参与了通透性功能障碍的长期存在，并有助于激活异常的神经反应，而异常的神经反应与腹痛感和排便习惯的改变有关。所有这些机制代表了IBS治疗方法的新目标。鉴于益生菌公认的安全性，并且它们可以对宿主产生积极的生物学作用，因此益生菌是IBS中有吸引力的治疗选择。对于IBS病理生理学而言，重要的是临床前研究表明，选择性益生菌菌株具有潜在的有用特性，包括抗炎作用，粘膜屏障稳态的改善，对肠道菌群的有益作用以及内脏超敏性的降低。在大多数随机对照研究中，益生菌对IBS的作用是积极的，尽管与安慰剂相比获益很小。为IBS患者亚群确定量身定制的益生菌方法代表了未来的挑战。

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