Intestinal Microbiome in Scleroderma

Recent Progress

Elizabeth R. Volkmann

Disclosures

Curr Opin Rheumatol. 2017;29(6):553-560. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Our evolving understanding of how gut microbiota affects immune function and homeostasis has led many investigators to explore the potentially pathologic role of gut microbiota in autoimmune diseases. This review will discuss the rapidly advancing field of microbiome research in systemic sclerosis (SSc), an incurable autoimmune disease with significant gastrointestinal morbidity and mortality.

Recent findings: Recent reports have identified common perturbations in gut microbiota across different SSc cohorts. Compared with healthy controls, patients with SSc have decreased abundance of beneficial commensal genera (e.g. Faecalibacterium, Clostridium and Bacteroides) and increased abundance of pathbiont genera (e.g. Fusobacterium, Prevotella and Erwinia). Certain genera may protect against (e.g. Bacteroides, Clostridium, and Lactobacillus), or conversely exacerbate (e.g. Fusobacterium and Prevotella) gastrointestinal symptoms in SSc. These genera represent potential targets to avert or treat gastrointestinal dysfunction in SSc.

Summary: Emerging evidence suggests that alterations in gut microbiota exist in the SSc disease state; however, future basic and clinical studies are needed to ascertain the mechanism by which these alterations perpetuate inflammation and fibrosis in SSc. Therapeutic trials are also needed to investigate whether dietary interventions or fecal transplantation can restore the gut microbial balance and improve health outcomes in SSc.

Video abstract: http://links.lww.com/COR/A38.

Introduction

Accumulating evidence suggests that gastrointestinal tract (GIT) microbiota has a profound effect on human health and disease. The burgeoning body of science investigating the microbiome has illuminated important relationships between alterations in GIT microbiota and specific rheumatic diseases, including systemic sclerosis (SSc). The present article reviews the evolving association between GIT microbiota and autoimmunity with a focus on the SSc disease state. Specifically, this review highlights recent reports revealing unique features of the GIT microbiome in patients with SSc and posits how these features may relate to clinical dimensions of this disease. The present review also describes the need for ongoing research in this area to better understand the mechanistic and clinical implications of SSc-related GIT microbiota alterations and how these data may inform the future discovery and assessment of novel therapeutic interventions, including fecal transplantation.

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