Nurturing the Gut, Moms with IBD and Their Babies.
Nurturing the Gut, Moms with IBD and Their Babies.
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滋养肠道，患有炎症性肠病的妈妈和她们的宝宝。
DOI：
10.1093/ecco-jcc/jjad139
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Bishu,Shrinivas
中科院分区：
文献类型：
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作者：
Bishu,Shrinivas
炎症性肠病[IBD]，包括克罗恩病[CD]和溃疡性结肠炎[UC]，是宿主对肠道微生物群失调的反应失调的结果。当易感宿主遇到环境风险因素，使天平向炎症倾斜时，就会出现这种情况。1一个独特的重要问题，交叉基因-环境相互作用，是母亲传播IBD给他们的后代。临床上，这是IBD母亲经常提出的非常高价值的问题。我们知道患有IBD的母亲的后代相对于没有IBD的母亲的后代有更高的发展IBD的风险。然而，这种风险的大小和IBD向婴儿“世代传播”的机制尚不清楚。流行病学研究报告了IBD母亲后代的IBD发病率差异很大，从2%到近40%！2-4虽然这种差异可能是由于随着时间的推移跟踪个人水平的流行病学数据所固有的挑战，但很明显，我们对IBD母婴传播的理解存在许多差距。在本期杂志中，Sabino等人提出了一种IBD可能世代传播的潜在途径。这些数据来自“通过微生物组探索疾病在泌尿系传播的机制”[MECONIUM]研究，该研究跟踪了一组IBD母亲及其后代的早期生活。MECONIUM研究探讨了IBD母亲后代的肠道微生物群如何演变，并导致这些后代患IBD的风险。MECONIUM研究前瞻性跟踪了200多名患者，并根据关键变量进行了调整，如母亲年龄和种族，分娩方式，喂养类型，医疗并发症和早期抗生素使用。纵向和受控设计有可能为IBD世代传播的基础途径提供有价值的见解。5在此，作者发现，沿着分娩方式和喂养类型，母体IBD状态是后代β多样性的主要贡献者，甚至在分娩后长达2年。在分类学水平上，双歧杆菌属在结肠炎小鼠模型和可能在UC患者中具有保护作用，但在IBD母亲的后代中含量较低。6-8越来越多的数据表明，母乳通过细胞因子、代谢物和免疫球蛋白具有显著的免疫调节特性。9，10反过来，小鼠模型将断奶与肠道内稳态和以后生活中炎症性疾病的风险联系起来。与这些可能性相一致，IBD母亲的母乳中趋化因子的水平显着降低
Inflammatory bowel diseases [IBD], encompassing Crohn’s disease [CD] and ulcerative colitis [UC], are the consequence of dysregulated host responses to dysbiotic gut microbiota. This scenario arises when a susceptible host meets environmental risk factors that tip the scales towards inflammation. 1 A uniquely important question that intersects gene-environment interactions, is maternal transmission of IBD to their offspring. Clinically, this is very high-value question that is frequently posed by mothers with IBD. We know that offspring of mothers with IBD have a higher risk of developing IBD relative to offspring of mothers without IBD. Yet the magnitude of this risk and the mechanisms that underlie the ‘generational transmission’of IBD to infants are very unclear. Epidemiological studies have reported widely varying rates of IBD in offspring of mothers with IBD, ranging from 2% to near 40%! 2–4 Whereas this variance may be due to the challenges inherent in tracking individual-level epidemiological data over time, it is clear our understanding of mother to infant transmission of IBD has many gaps.In this edition of the Journal, Sabino et al. present a potential pathway whereby IBD may be generationally transferred. These data are drawn from the ‘Exploring MEChanisms Of disease traNsmission In Utero through the Microbiome’[MECONIUM] study, which follows a cohort of mothers with IBD and their offspring through early life. 5 The MECONIUM study examines how the gut microbiota of offspring of mothers with IBD evolves and contributes to the risk that these offspring will develop IBD. The MECONIUM study prospectively follows> 200 patients, and is adjusted for key variables like maternal age and race, mode of delivery, feeding type, medical complications, and early antibiotic use. The longitudinal and controlled design has the potential to provide valuable insights into the pathways that underlie the generational transmission of IBD. 5 Herein, the authors discovered that along with mode of delivery and feeding type, maternal IBD status is a major contributor to the β-diversity of offspring even up to 2 years after delivery. At the taxonomic level, the genus Bifidobacterium, which is protective in murine models of colitis and possibly in patients with UC, was less abundant in offspring of mothers with IBD. 6–8 Accumulating data indicate that maternal breast milk has substantial immune-modulatory properties via cytokines, metabolites, and immunoglobulins. 9, 10 In turn, murine models have linked weaning with intestinal homeostasis and to the risk of inflammatory conditions later in life. 11 Consistent with these possibilities, the breast milk of mothers with IBD has significantly lower levels of the chemokine