Das Mikrobiom bei Adipositas und kardiometabolische Erkrankungen: Die Mischung macht es!

Zusammenfassung

Das Darmmikrobiom ist ein komplexes Ökosystem, das aus einer Vielzahl von hauptsächlich Bakterien, aber auch Archaeen und Viren besteht. In den letzten Jahren konnte ein starker Zusammenhang zwischen Mikrobiom-Veränderungen und der Entstehung von Erkrankungen, zu denen auch Adipositas und verschiedene Stoffwechselkrankheiten gehören, gefunden werden. Darmbakterien sind an der Synthese essentieller Vitaminen, Extraktionen von Nährstoffen sowie den Abbau von Ballaststoffen beteiligt. Zusätzlich spielt das Mikrobiom eine wichtige Rolle in der Reifung des Immunsystems des Wirts, seiner Darmbarriere, der neuronalen intestinalen Aktivität, und der Produktion und Freisetzung von gastrointestinalen Hormonen. Veränderungen der Zusammensetzung des mikrobiellen Ökosystems im Darm sind mit dem Auftreten von Adipositas, Typ 2 Diabetes, arterieller Hypertonie, nicht alkoholischer Lebererkankung (NAFLD) sowie kardiovaskulären Krankheiten assoziiert.

Vor allem tierexperimentelle Untersuchungen weisen auf einen starken Kausalzusammenhang zwischen dem Mikrobiom und diesen Erkrankungen hin. Hierfür können zusätzlich zu wirtspezifischen oder Umweltfaktoren sowohl Zusammensetzung wie auch die Funktion der Darmbakterien eine chronische systemische Inflammation mitverursachen und unterhalten.

Ein möglichst diverses Mikrobiom kann die metabolische Gesundheit des Wirts positiv beeinflussen und stellt somit einen potentiellen therapeutischen Ansatz bei kardiometabolischen Erkrankungen dar. Beispielsweise werden Stuhltransplantationen zur Therapie unterschiedlicher Erkrankungen wie Clostridium difficile-Infektionen eingesetzt und verbessern auch bei Personen mit Metabolischem Syndrom die Insulinsensitivität. Bevor eine Modulation des Mikrobioms in der Zukunft zur Prävention und Therapie von Adipositas und begleitenden Erkrankungen eingesetzt werden kann, müssen noch weitere klinische Studien die Effektivität und Sicherheit einer gezielten Manipulation der Darmbakterien belegen.

Abstract

The gut microbiota is a complex ecosystem, which mainly consists of bacteria, but also archaea and viruses. During recent years it has been shown that changes in the microbiota are associated with several diseases including obesity and metabolic diseases.

Gut bacteria contribute to the synthesis of essential vitamins, extraction of nutrients and fermentation of indigestible fibres to short chain fatty acids, modulation of bile acids and bile acid signalling. In addition, microbiota play an important role in the maturation of the host´s immune system, the gut barrier function, neuronal intestinal activity and the production of gut hormones. Changes in the microbiota composition are related to the development of obesity, type 2 diabetes, non-alcoholic fatty liver disease (NAFLD), hypertension and cardiovascular diseases. Particularly animal studies have suggested a strong causal relationship between microbiota and the pathophysiology of these diseases. In addition to host specific factors, both the composition and function of the microbiota may contribute to initiating and maintaining chronic systemic inflammation. However, the precise mechanisms linking variations in the gut microbiome with the development of obesity and metabolic diseases in humans are not entirely understood.

A diversified spectrum of gut bacteria may beneficially affect metabolic health of the host and therefore represents a promising target for future therapeutic approaches in the treatment of cardiometabolic diseases.

Emerging applications such as fecal transplants are showing promising results in the resolution of infectious bowel disease and improvement of insulin sensitivity in patients with metabolic syndrome. However, to take advantage of microbiota modulation in the prevention and treatment of obesity and its related diseases, further clinical trials have to prove efficacy and safety of interventions aiming at altering the gut microbiota.

Schlüsselwörter

Intestinales Mikrobiom - Adipositas - Insulinresistenz - Typ 2 Diabetes - NAFLD - Hypertonie - kardiovaskuläre Erkrankungen - Übersicht

Key words

Intestinal microbiome - obesity - insulin resistance - type 2 Diabetes - NASH - hypertension - cardiovascular diseases - review

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