The Microbiome: a Revolution in Treatment for Rheumatic Diseases?
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Purpose of Review
The microbiome is the term that describes the microbial ecosystem that cohabits an organism such as humans. The microbiome has been implicated in a long list of immune-mediated diseases which include rheumatoid arthritis, ankylosing spondylitis, and even gout. The mechanisms to account for this effect are multiple. The clinical implications from observations on the microbiome and disease are broad.
A growing number of microbiota constituents such as Prevotella copri, Porphyromonas gingivalis, and Collinsella have been correlated or causally related to rheumatic disease. The microbiome has a marked effect on the immune system. Our understanding of immune pathways modulated by the microbiota such as the induction of T helper 17 (Th17) cells and secretory immunoglobulin A (IgA) responses to segmented filamentous bacteria continues to expand. In addition to the gut microbiome, bacterial communities of other sites such as the mouth, lung, and skin have also been associated with the pathogenesis of rheumatic diseases.
Strategies to alter the microbiome or to alter the immune activation from the microbiome might play a role in the future therapy for rheumatic diseases.
KeywordsMicrobiome Ankylosing spondylitis Rheumatoid arthritis Psoriatic arthritis Mucosal immunity
JTR is supported by the Stan and Madelle Rosenfeld Family Trust and the William and Mary Bauman Foundation. This work was also supported by a Jane Bruckel Award from the Spondylitis Association of America to MJA and by Research to Prevent Blindness, New York City.
Compliance with Ethical Standards
Conflict of Interest
JTR reports research collaboration for OpenBiome, consultancy for Abbvie, consultancy for Santen, speaking for Mallinckrodt, consultancy for Gilead, speaking for Janssen, consultancy for Genentech, consultancy for Allergan, grants from Alcon Research Institute, consultancy for Portage, consultancy for Topivert, consultancy for Mitotech, and consultancy for Xoma, outside the submitted work. MJA declares that he has no conflicts of interest.
Human and Animal Rights and Informed Consent
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and were in compliance with all applicable ethical standards (including the Helsinki Declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).
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