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2017 ; 60
(6
): 943-951
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The gut microbiome as a target for prevention and treatment of hyperglycaemia in
type 2 diabetes: from current human evidence to future possibilities
#MMPMID28434033
Brunkwall L
; Orho-Melander M
Diabetologia
2017[Jun]; 60
(6
): 943-951
PMID28434033
show ga
The totality of microbial genomes in the gut exceeds the size of the human
genome, having around 500-fold more genes that importantly complement our coding
potential. Microbial genes are essential for key metabolic processes, such as the
breakdown of indigestible dietary fibres to short-chain fatty acids, biosynthesis
of amino acids and vitamins, and production of neurotransmitters and hormones.
During the last decade, evidence has accumulated to support a role for gut
microbiota (analysed from faecal samples) in glycaemic control and type 2
diabetes. Mechanistic studies in mice support a causal role for gut microbiota in
metabolic diseases, although human data favouring causality is insufficient. As
it may be challenging to sort the human evidence from the large number of animal
studies in the field, there is a need to provide a review of human studies. Thus,
the aim of this review is to cover the current and future possibilities and
challenges of using the gut microbiota, with its capacity to be modified, in the
development of preventive and treatment strategies for hyperglycaemia and type 2
diabetes in humans. We discuss what is known about the composition and
functionality of human gut microbiota in type 2 diabetes and summarise recent
evidence of current treatment strategies that involve, or are based on,
modification of gut microbiota (diet, probiotics, metformin and bariatric
surgery). We go on to review some potential future gut-based glucose-lowering
approaches involving microbiota, including the development of personalised
nutrition and probiotic approaches, identification of therapeutic components of
probiotics, targeted delivery of propionate in the proximal colon, targeted
delivery of metformin in the lower gut, faecal microbiota transplantation, and
the incorporation of genetically modified bacteria that express therapeutic
factors into microbiota. Finally, future avenues and challenges for understanding
the interplay between human nutrition, genetics and microbial genetics, and the
need for integration of human multi-omic data (such as genetics, transcriptomics,
epigenetics, proteomics and metabolomics) with microbiome data (such as
strain-level variation, transcriptomics, proteomics and metabolomics) to make
personalised treatments a successful future reality are discussed.
|Diabetes Mellitus, Type 2/drug therapy/genetics/*metabolism/*microbiology
[MESH]