肠道菌群与2型糖尿病

研究表明,2型糖尿病患者肠道菌群结构及功能与健康人不同,肠道菌群可能通过干预宿主营养及能量的吸收利用,促进脂肪的合成及存储,引发慢性低度炎性反应等机制影响2型糖尿病的发展.多项针对肠道菌群的治疗措施在2型糖尿病的动物模型和人群研究中开展,表明饮食、运动及药物均可通过干预肠道菌群的结构及功能影响糖尿病的发生和发展.干预肠道菌群可能成为今后糖尿病防治领域的重要手段之一.     

肠道菌群与肥胖和糖尿病的关系

人的胃肠道内寄居着种类繁多的单细胞微生物,称为肠道菌群.基因、出生方式、婴幼儿喂养模式、抗生素应用、卫生居住条件以及长期的饮食习惯有助于塑造肠道菌群的组成.越来越多的动物和人体研究表明肠道菌群与肥胖和2型糖尿病密切相关.肠道菌群可通过宿主能量代谢、免疫系统及炎性反应等影响代谢综合征及2型糖尿病的发生、发展.干预肠道菌群有可能成为防治肥胖及糖尿病的新靶点.     

肠道菌群与肥胖和2型糖尿病的相关性

近年来研究发现肠道菌群、肥胖、胰岛素抵抗及2型糖尿病之间有着紧密的联系.有证据表明,在宿主的营养、免疫和代谢中有不可替代的作用的肠道菌群不仅可以通过调节宿主脂肪吸收存储相关的基因,影响后者的能量平衡,更重要的是其结构失调导致宿主循环系统中内毒素增加,诱发慢性、低水平炎症,导致肥胖和胰岛素抵抗及糖尿病.肠道菌群影响人体健康已得到初步证明,研究结果表明肠道菌群很可能与肥胖及2型糖尿病的发生发展有密切联系[1],但是究竟是如何联系的呢？我们对此进行如下综述.     

肠道菌群与1型糖尿病的关系

1型糖尿病发病机制与遗传因素、环境因素及自身免疫因素均有关,是在遗传因素基础上,由环境因素启动,以T淋巴细胞介导的胰岛β细胞进行性损伤为主要特征的自身免疫性疾病.肠道菌群作为环境因素与1型糖尿病发生有直接关系,可通过改变肠壁通透性和宿主免疫系统影响发病.肠道菌群、宿主免疫及1型糖尿病三者之间存在相互联系,研究肠道菌群可为1型糖尿病的预防和治疗提供线索.     

肠道菌群失调诱发2型糖尿病的研究进展

糖尿病属于临床常见的慢性代谢性疾病之一,该疾病的发生、发展和遗传、饮食、环境等多种因素存在较强的相关性,以高血糖为典型临床症状,目前,临床常将糖尿病分为I型糖尿病、2型糖尿病、妊娠期糖尿病及其他特殊类型糖尿病,但以2型糖尿病最为常见,有数据显示,全球大约有90%的糖尿病患者为2型糖尿病。近年来,有研究显示,肠道菌群和2型糖尿病的发生、发展存在一定的相关性,肠道菌群失调可诱发2型糖尿病。该文将对肠道菌群、肠道菌群与2型糖尿病关系进行分析和综述,针对肠道菌群失调诱发2型糖尿病进行探讨,以此为临床防治2型糖尿病提供相关的参考依据。     

肠道菌群与2型糖尿病及并发症

2型糖尿病(type 2 diabetes mellitus,T2DM)是一种由多因素导致的代谢性疾病,关于其发病机制的研究逐渐深入,其中肠道菌群与糖尿病的关系成为近年来研究的焦点.肠道菌群与人体健康息息相关,越来越多的研究发现肠道菌群的失调可能通过多种机制参与T2DM的发生与发展,而T2DM病患者体内代谢环境的改变又可能会影响肠道菌群的组成和功能.在这篇综述中,我们总结最近的相关研究探讨肠道菌群失调在T2DM发生和发展中的作用、有关的治疗策略以及未来的研究前景.     

肠道菌群如何帮助控制糖尿病

研究表明,肠道微生物群、肠道细菌.葡萄糖代谢和2型糖尿病之间存在着许多明确而重要的相关性。免疫系统利用肠道菌群来控制葡萄糖代谢。保持肠道的健康可以降低2型糖尿病的发生风险及帮助更好地管理糖尿病。     

重视肠道菌群在肥胖与2型糖尿病发病中的作用

过去的几十年,随着环境和生活水平的改变,肥胖的发病率已经大幅增加,已成为威胁人类健康的重要疾病.肥胖能产生一系列健康问题,如高血压病、2型糖尿病、心血管疾病、非酒精性脂肪性肝病、阻塞性睡眠呼吸暂停综合征和癌症等.虽然遗传因素可以决定一个人的肥胖倾向,但近年来的研究结果表明,健康人群和肥胖或2型糖尿病患者之间肠道菌群的结构存在显著不同[1],肠道菌群可能在肥胖及其相关性疾病的发生中发挥重要作用.     

2型糖尿病合并腹泻的临床特征及相关因素分析

[目的]研究2型糖尿病(DM)合并腹泻患者肠道菌群及胃肠动力变化,探讨2型DM腹泻的发病机制.[方法]通过大便特检、消化道钡餐及纤维结肠镜检查研究60例2型DM合并腹泻患者的肠道菌群、胃肠动力及肠黏膜变化,并与40例无腹泻的2型DM患者对照.[结果]与对照组比较,2型DM腹泻患者血糖水平更高(P＜0.01),无明显肠道菌群失调,但有脂肪吸收不良(P＜0.01),且胃肠动力明显紊乱.[结论]2型DM腹泻患者存在胃肠动力紊乱,可能与高血糖、糖尿病植物神经病变有关.     

肠道菌群和老年2型糖尿病的研究进展

正肠道菌群在人体的消化、代谢、营养及免疫调节方面发挥着重要的作用,人口老龄化的快速发展使得老年2型糖尿病(T2DM)病人与日俱增,越来越多的研究表明肠道菌群和肥胖、T2DM等代谢性疾病存在一定的相关性,在老年T2DM的发生发展中肠道菌群也扮演着重要的角色。1老年2型糖尿病在我国糖尿病(DM)病人中,60岁以上者患病率在20%以上,比20~30岁人群高出10倍,年龄每增加     

Considering gut microbiota in treatment of type 2 diabetes mellitus

ABSTRACT

Advances in the understanding of the pathogenesis of type 2 diabetes mellitus (T2D) have revealed a role for gut microbiota dysbiosis in driving this disease. This suggests the possibility that approaches to restore a healthy host–microbiota relationship might be a means of ameliorating T2D. Indeed, recent studies indicate that many currently used treatments for T2D are reported to impact gut microbiota composition. Such changes in gut microbiota may mediate and/or reflect the efficacy of these interventions. This article outlines the rationale for considering the microbiota as a central determent of development of T2D and, moreover, reviews evidence that impacting microbiota might be germane to amelioration of T2D, both in terms of understanding mechanisms that mediate efficacy of exiting T2D therapies and in developing novel treatments for this disorder.     

Understanding the role of the gut ecosystem in diabetes mellitus

Diabetes mellitus is a type of metabolic disorder whereby patients are unable to regulate glycemia. It is currently a worldwide public health issue, and is a burden to society because of its disabling and common complications. Diabetes is multifactorial, and also induces the onset of other diseases. In the present report, we review the labyrinth encompassing the gut microbiota and gut microbiota‐derived metabolites in type 1 diabetes and type 2 diabetes pathogenesis. There have been exceptional improvements in deoxyribonucleic acid sequencing and mass spectrometry technologies throughout these past years, and these have allowed the comprehensive collection of information on our unique gut ecosystem. We would like to advocate incorporating metagenome and metabolome information for a comprehensive perspective of the complex interrelationships between the gut environment, host metabolism and diabetes pathogenesis. We hope that with this improved understanding we would be able to provide exciting novel therapeutic approaches to engineer an ideal gut ecosystem for optimal health.     

肠道菌群代谢产物与胰岛素抵抗相关衰老疾病的研究进展

2型糖尿病(T2DM)和阿尔茨海默病(AD)都是与年龄相关的衰老性疾病,二者存在多种共同危险因素.肠道微生物通过多种代谢产物参与胰岛素生理机能的调控过程,在胰岛素抵抗(IR)发生发展中发挥重要的作用.该文从IR的角度,对肠道菌群代谢产物与T2DM及AD发病机制的内在联系作一综述.     

Gut Microbiota and Type 1 Diabetes

The gut immune system has a key role in the development of autoimmune diabetes, and factors that control the gut immune system are also regulators of beta-cell autoimmunity. Gut microbiota modulate the function of the gut immune system by their effect on the innate immune system, such as the intestinal epithelial cells and dendritic cells, and on the adaptive immune system, in particular intestinal T cells. Due to the immunological link between gut and pancreas, e.g. the shared lymphocyte homing receptors, the immunological changes in the gut are reflected in the pancreas. According to animal studies, changes in gut microbiota alter the development of autoimmune diabetes. This has been demonstrated by antibiotics that induce changes in the gut microbiota. Furthermore, gut-colonizing microbes may modify the incidence of autoimmune diabetes in animal models. Deficient toll-like receptor (TLR) signaling, mediating microbial stimulus in immune cells, prevents autoimmune diabetes, which appears to be dependent on alterations in the intestinal microbiota. Although few studies have been conducted in humans, recent studies suggest that the abundance of Bacteroides and lack of butyrate-producing bacteria in fecal microbiota are associated with beta-cell autoimmunity and type 1 diabetes. It is possible that altered gut microbiota are associated with immunological aberrancies in type 1 diabetes. The changes in gut microbiota could lead to alterations in the gut immune system, such as increased gut permeability, small intestinal inflammation, and impaired tolerance to food antigens, all of which are observed in type 1 diabetes. Poor fitness of gut microbiota could explain why children who develop type 1 diabetes are prone to enterovirus infections, and do not develop tolerance to cow milk antigens. These candidate risk factors of type 1 diabetes may imply an increased risk of type 1 diabetes due to the presence of gut microbiota that do not support health. Despite the complex interaction of microbiota, host, environment, and disease mechanisms, gut microbiota are promising novel targets in the prevention of type 1 diabetes.     

From obesity through immunity to type 2 diabetes mellitus

Diabetes mellitus is a metabolic disorder that leads to the development of a number of complications. The etiology of each metabolic complication is undoubtedly multifactorial. Patients with diabetes have increased susceptibility to and severity of infections. The course of infections is also more complicated in the patient group. One of the possible causes of this increased prevalence of infections is defect in immunity. Different disturbances in humoral innate immunity have been described in patients with diabetes. Concerning cellular innate immunity, most studies show decreased functions of polymorphonuclear cells and monocyte/macrophages of these patients compared to cells of healthy subjects. Several studies have shown alterations in peripheral blood mononuclear cells from patients with type 2 diabetes, an effect that contributes to the high incidence of infections in these patients. The gut microbiota plays different roles such as the following: protects against pathogens, helps in the maturation of the immune system, regulates the intestinal hormone secretion, synthesizes vitamin K and several vitamins B, and produces short-chain fatty acids (SCFAs). It also plays a role in immunomodulation and might contribute to the alterations in glucose metabolism. In the present review, I focused on the role of obesity, the immune system, and the gut microbiota in the pathogenesis of type 2 diabetes mellitus, and as a second point, how type 2 diabetes impairs the immune system.     

Gut Microbiota in Metabolic-associated Fatty Liver Disease and in Other Chronic Metabolic Diseases

The gut microbiome plays a key role in the health-disease balance in the human body. Although its composition is unique for each person and tends to remain stable throughout lifetime, it has been shown that certain bacterial patterns may be determining factors in the onset of certain chronic metabolic diseases, such as type 2 diabetes mellitus (T2DM), obesity, metabolic-associated fatty liver disease (MAFLD), and metabolic syndrome. The gut-liver axis embodies the close relationship between the gut and the liver; disturbance of the normal gut microbiota, also known as dysbiosis, may lead to a cascade of mechanisms that modify the epithelial properties and facilitate bacterial translocation. Regulation of gut microbiota is fundamental to maintaining gut integrity, as well as the bile acids composition. In the present review, we summarize the current knowledge regarding the microbiota, bile acids composition and their association with MAFLD, obesity, T2DM and metabolic syndrome.     

Intestinal microbiota and type 2 diabetes: From mechanism insights to therapeutic perspective

The incidence of type 2 diabetes (T2DM) is rapidly increasing worldwide. However, the pathogenesis of T2DM has not yet been well explained. Recent evidence suggests that the intestinal microbiota composition is associated with obesity and T2DM. In this review, we provide an overview about the mechanisms underlying the role of intestinal microbiota in the pathogenesis of T2DM. There is clear evidence that the intestinal microbiota influences the host through its effect on body weight, bile acid metabolism, proinflammatory activity and insulin resistance, and modulation of gut hormones. Modulating gut microbiota with the use of probiotics, prebiotics, antibiotics, and fecal microbiota transplantation may have benefits for improvement in glucose metabolism and insulin resistance in the host. Further studies are required to increase our understanding of the complex interplay between intestinal microbiota and the host with T2DM. Further studies may be able to boost the development of new effective therapeutic approaches for T2DM.     

Role of gut microbiota,bile acids and their cross‐talk in the effects of bariatric surgery on obesity and type 2 diabetes

Type 2 diabetes mellitus is becoming increasingly prevalent worldwide, and has become one of the greatest threats to global health. Bariatric surgery was initially designed to achieve weight loss, and subsequently was noted to induce improvements or remission of type 2 diabetes. Currently, these bariatric operations, such as Roux‐en‐Y gastric bypass and sleeve gastrectomy, are the most effective procedures for the treatment of obesity and type 2 diabetes mellitus worldwide. However, the specific mechanism mediating the beneficial effects of metabolic surgery has remained largely unknown. Those mechanical explanations, such as restriction and malabsorption, are challenged by accumulating evidence from human and animal models of these procedures, which points to the weight‐independent factors, such as hormones, bile acids, gut microbiota, nervous system and other potential underlying mechanisms. A growing body of evidence suggests that gut microbiota are associated with the development of several metabolic disorders, and bile acids and FXR signaling are important for the metabolic benefits of bariatric surgery. Given the close relationship between bacteria and bile acids, it is reasonable to propose that microbiota–bile acid interactions play a role in the mechanisms underlying the effects of metabolic surgery.     

The gut microbiota and metabolic disease: current understanding and future perspectives

The human gut microbiota has been studied for more than a century. However, of nonculture‐based techniques exploiting next‐generation sequencing for analysing the microbiota, development has renewed research within the field during the past decade. The observation that the gut microbiota, as an environmental factor, contributes to adiposity has further increased interest in the field. The human microbiota is affected by the diet, and macronutrients serve as substrates for many microbially produced metabolites, such as short‐chain fatty acids and bile acids, that may modulate host metabolism. Obesity predisposes towards type 2 diabetes and cardiovascular disease. Recently, it has been established that levels of butyrate‐producing bacteria are reduced in patients with type 2 diabetes, whereas levels of Lactobacillus sp. are increased. Recent data suggest that the reduced levels of butyrate‐producing bacteria might be causally linked to type 2 diabetes. Bariatric surgery, which promotes long‐term weight loss and diabetes remission, alters the gut microbiota in both mice and humans. Furthermore, by transferring the microbiota from postbariatric surgery patients to mice, it has been demonstrated that an altered microbiota may contribute to the improved metabolic phenotype following this intervention. Thus, greater understanding of alterations of the gut microbiota, in combination with dietary patterns, may provide insights into how the gut microbiota contributes to disease progression and whether it can be exploited as a novel diagnostic, prognostic and therapeutic target.     

Guts, Germs, and Meals: The Origin of Type 1 Diabetes

Type 1 diabetes mellitus (T1DM) is due, in part, to non-genetically determined factors including environmental factors. The nature of these environmental effects remains unclear but they are important to identify since they may be amenable to therapy. Recently, the gut microbiota, the trillions of microorganisms inhabiting the gut, as well as diet, have been implicated in T1DM pathogenesis. Since dietary changes can reshape this complex gut community, its co-evolution could have been altered by changes to our diet, agriculture, personal hygiene, and antibiotic usage, which coincide with the increased incidence of T1DM. Recent studies demonstrate an association between altered gut microbiota and T1DM in both T1DM patients and animal models of the disease. Further studies should provide new insight into those critical host-microbial interactions, potentially suggesting new diagnostic or therapeutic strategies for disease prevention.