Das humane Mikrobiom

Zusammenfassung

Die Erforschung des humanen Mikrobioms wird unser Verständnis von entzündlichen, metabolischen und onkologischen Erkrankungen bedeutend erweitern. Die Komplexität dieses Forschungsfeldes lässt sich jedoch nur interdisziplinär und translational sowie unter Einbeziehung der Bioinformatik bewältigen. Reine In-silico-Analysen und statistische Assoziationen werden sich nicht unmittelbar in belastbare klinische Konzepte überführen lassen, wie es bereits aus der humanen Genomforschung bekannt ist. Potenzielle Ansatzpunkte für zukünftige Behandlungsstrategien sind nachgewiesene Einflüsse von Ernährung und Medikation auf die Diversität des Mikrobioms sowie therapeutische Effekte mikrobieller Stoffwechselprozesse und –produkte. Bei der Transplantation intestinaler Flora sollten die gleichen Maßstäbe gelten wie bei der Zulassung von Arzneimitteln und Medizinprodukten – und zwar nicht nur im Zusammenhang mit refraktären Clostridium-difficile-Infektionen. Bevor hier Empfehlungen für die Praxis gegeben werden können, müssen neben solchen objektiven Effektivitätsparametern, vor allem auch Aspekte der Spendereignung, Materialaufbereitung, Patientensicherheit – einschließlich der Rolle von fäkalen Pathogenen und Toxinen – umfassend wissenschaftlich untersucht und in kontrollierten Studien getestet werden.

Abstract

Research into the human microbiome will substantially enhance our understanding of inflammatory, metabolic and malignant diseases. The complexity of this research area can only be addressed by an interdisciplinary translational approach including bioinformatics. Data derived from pure in silico analyses and statistical associations will not automatically translate into sound clinical concepts, as we have learned previously in genetics. Potential targets for future treatment strategies include the proven impact of nutrition and medication on microbial diversity and therapeutic effects of microbial metabolic processes and metabolites. Fecal microbial transplantation (FMT) beyond its indication in refractory Clostridium difficile infection (CDI) should be held against the same standards and regulated by the same procedures that are applied to all investigational compounds and treatments prior to their approval. Donor fidelity, sample processing and recipient safety (including the role of fecal pathogens and toxins) need thorough scientific investigation and evaluation in clinical trials with objective outcome parameters prior to any recommendations for clinical practice.

Schlüsselwörter

Mikrobiom - Entzündung - Infektion - Stoffwechsel - Adipositas - Onkogenese

Keywords

Microbiome - Inflammation - Infection - Metabolism - Obesity - Oncogenesis

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