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. 2015 Mar;13(1):105-20.
doi: 10.1007/s11938-014-0042-7.

Therapeutic Manipulation of the Microbiome in IBD: Current Results and Future Approaches

Jonathan J Hansen  1 , R Balfour Sartor
Affiliations

Therapeutic Manipulation of the Microbiome in IBD: Current Results and Future Approaches

Jonathan J Hansen et al. Curr Treat Options Gastroenterol. 2015 Mar.

Abstract

Despite recent major strides in our understanding of the genetic and microbial influences that contribute to the development of the inflammatory bowel diseases (IBDs), their etiology continues to be enigmatic. Results from experiments in animal models of IBDs overwhelmingly support a causal role of the microbiota in these diseases, though whether such a cause-effect relationship exists in human IBDs is still uncertain. Therefore, virtually all currently approved and most often prescribed treatments for IBDs are directed toward the over-active immune response in these diseases rather than the intestinal bacteria. Nevertheless, there is an important need for non-immunosuppressive therapies that may present a more favorable risk-benefit profile such as those that selectively target the disruptions in gut microbiota that accompany IBDs. This need has led to clinical trials of various microbial-directed therapies including fecal microbial transplant, antibiotics, probiotics, and prebiotics. Unfortunately, these published studies, many of which are small, have generally failed to demonstrate a consistent benefit of these agents in IBDs, thus leading to slow acceptance of microbe-focused treatments for these conditions. In this article, we review and summarize the microbial basis for IBDs and the results of the most recent trials of fecal microbial transplant, antibiotics, probiotics, and prebiotics in IBDs. We also comment on possible safety concerns with these agents, speculate on why they have failed to show efficacy in certain clinical settings, and propose strategies to improve their usefulness.

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Conflict of interest statement

Conflict of Interest

Jonathan J. Hansen declares that he has no conflict of interest.

R. Balfour Sartor has received consulting fees/honorarium and paid travel accommodations from Dannon/Yakult and grants from Salix and GSK.

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References

    1. Kappelman MD, Rifas-Shiman SL, Porter CQ, Ollendorf DA, Sandler RS, Galanko JA, et al. Direct health care costs of Crohn’s disease and ulcerative colitis in us children and adults. Gastroenterology. 2008;135(6):1907–13. - PMC - PubMed
    1. Jostins L, Ripke S, Weersma RK, Duerr RH, McGovern DP, Hui KY, et al. Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease. Nature. 2012;491(7422):119–24. The most comprehensive genome-wide association study in IBD to date. Identified 163 IBD susceptibility loci. - PMC - PubMed
    1. Hansen J, Gulati A, Sartor RB. The role of mucosal immunity and host genetics in defining intestinal commensal bacteria. Curr Opin Gastroenterol. 2010;26(6):564–71. - PMC - PubMed
    1. Seekatz AM, Aas J, Gessert CE, Rubin TA, Saman DM, Bakken JS, et al. Recovery of the gut microbiome following fecal microbiota transplantation. MBio. 2014;5(3):e00893–14. - PMC - PubMed
    1. Gevers D, Kugathasan S, Denson LA, Vazquez-Baeza Y, Van Treuren W, Ren B, et al. The treatment-naive microbiome in new-onset Crohn’s disease. Cell Host Microbe. 2014;15(3):382–92. - PMC - PubMed