Ist für den Intensivpatienten gut, was gut ist für seine Darmflora?

Zusammenfassung

Über Zehntausende von Jahren hat sich evolutionsgeschichtlich eine Symbiose zwischen kolonisierenden Bakterien speziell auch der Darmflora und dem Wirt entwickelt, welche in guten Tagen für beide Parteien von Nutzen ist. Aktivitäten der modernen Medizin, z. B. die Anwendung von Antibiotika, aber auch die Verschlechterung des Wirtszustands mit entsprechender Verschlechterung des intestinalen Milieus können dazu führen, dass die intestinalen Bakterien ihre Virulenzgene hochregulieren und damit den Wirt schädigen. Die Interaktionen zwischen pathogenen Keimen und dem Wirt finden dabei vorwiegend an der Schnittstelle zwischen Bakterium und Darmepithelzelle statt. Dies wird deshalb gefährlich, weil Bakterien untereinander kommunizieren, sich organisieren und damit einen koordinierten Angriff auf den Wirt, z. B. durch Korrumpierung der wirtseigenen Darmepithelzellen durchführen können. Zukünftige Strategien zur Vermeidung der sog. „gut derived sepsis” sollten deshalb darauf abzielen, den Bakterien Bedingungen zu bieten, welche Virulenz und damit Schädigung des Wirtes unnötig machen und das symbiotische Verhältnis zum beidseitigen Nutzen wiederherstellen.

Abstract

For the last then thousands of years a symbiotic relationship between colonizing flora in the host has emerged to benefit both parties. However, modern advances in medicine allowing treatment of critically ill and compromised patients including use of potent antimicrobials forced the intestinal flora to adapt and develop strategies to survive against threats originating from a hostile environment and attempts of its extermination. Research work has shown that for this purpose microbials are able to communicate, to organize in functional communities and to regulate their virulence in order to protect their self-interests. It could be demonstrated that this germs mainly generate adverse effects against the host by interacting with his epithelial cells i. e. in the intestines. By doing so the bacteria can induce paracellular permeability defects promoting translocation of toxins with systemic downstream effects. Moreover some germs are able to corrupt and exploit host cellular function in order to satisfy their needs leading to harm to the host more as a collateral damage. In the post antibiotic aera future treatment concepts to prevent devastating effects of „gut derived sepsis” should therefore become directed towards optimization of microbial frame conditions in order to minimize their need to upregulate virulence and thus jeopardize the host.

Schlüsselwörter

Darmflora - Translokation - bakterielle Virulenzregulation - Bakterien-Wirt-Interaktion - intestinales Milieu

Keywords

bacteria host interactions - gut derived sepsis - virulence regulation - microbial behavior

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