What role do microbiota-targeted interventions play in personalised medicine for conditions like inflammatory bowel disease?

From the Guidelines

Microbiota-targeted interventions, such as probiotics, prebiotics, and fecal microbiota transplantation (FMT), play a crucial role in personalized medicine for inflammatory bowel disease (IBD), but their use should be approached with caution and under medical supervision, as evidenced by recent guidelines 1. When considering personalized medicine approaches for IBD, it's essential to understand that these interventions aim to address the dysbiosis contributing to intestinal inflammation.

• Probiotics, like VSL#3, containing eight bacterial strains at doses of 450-900 billion CFU daily, can be beneficial.
• Prebiotics, such as inulin at 5-10g daily, may also be considered.
• FMT has shown promise, with 28-52% remission rates in ulcerative colitis, but its use is recommended against outside of clinical trials for IBD treatment, as per the latest AGA clinical practice guideline 1.
• Diet modifications, including the Specific Carbohydrate Diet or Mediterranean diet, can be effective but require consistent adherence and medical supervision. These interventions work by restoring microbial diversity, strengthening the intestinal barrier, modulating immune responses, and improving metabolite production that supports gut health.
• The effectiveness of these interventions varies significantly between individuals, highlighting the need for microbiome testing before intervention 1.
• Patients should implement these approaches as part of a comprehensive treatment plan that may still include conventional medications like mesalamine or biologics, under the guidance of a healthcare provider, to ensure the best outcomes in terms of morbidity, mortality, and quality of life.

From the Research

Role of Microbiota-Targeted Interventions in Personalised Medicine

• Microbiota-targeted interventions, such as probiotics, prebiotics, synbiotics, and fecal microbiota transplantation (FMT), have been recognized as promising therapeutic strategies for inflammatory bowel disease (IBD) 2, 3, 4, 5.
• These interventions aim to modulate the gut microbiota to improve inflammation, remission rate, and microscopic aspects of IBD 2, 3.
• FMT, in particular, has shown significant efficacy in improving clinical response and remission rates in ulcerative colitis (UC) patients, and multistrain probiotics have shown efficacy in reducing clinical relapse rates in UC patients 3.
• The efficacy of microbiota-targeted interventions varies among different IBD subtypes and disease stages, highlighting the need for personalized treatment strategies 3, 5.

Mechanisms of Action and Potential Therapeutic Targets

• The gut microbiota contributes to the maintenance of health and, when disrupted, may drive gastrointestinal and extragastrointestinal disease 4.
• Certain bacteria can induce protective immune responses and enhance intestinal barrier function, which could be potential therapeutic targets 4.
• Further studies are required to better understand the mechanisms of action of microbiota-targeted interventions and to develop personalized therapies 2, 5.

Current Understanding and Future Directions

• The current understanding of microbiota- and dietary-therapies for treating IBD suggests that restoration of gut dysbiosis is a safer and more sustainable approach than traditional medications 5.
• Future studies should include individual gut microbiota differences to develop personalized therapy for IBD 5.
• FMT has also shown promise in treating recurrent Clostridioides difficile infection, with moderate-certainty evidence suggesting a large increase in resolution of infection compared to alternative treatments 6.