Microbiota-Driven Strategies for Managing IBD-Associated Risks: From Infections to Mental Health.

Area of Science:

• Immunometabolism
• Microbiomics
• Gastroenterology

Background:

• Inflammatory bowel diseases (IBD) are increasingly viewed as systemic immunometabolic conditions, not just gastrointestinal disorders.
• Gut microbiota, including the virome, plays a crucial role, with reduced short-chain fatty acids (SCFAs) linked to pathogenic processes.
• Microbiota dysbiosis contributes to compromised epithelial barriers, immune dysregulation, and increased risks of infections, anemia, neuropsychiatric issues, and extraintestinal manifestations.

Purpose of the Study:

• To review the role of gut microbiota alterations in IBD pathogenesis.
• To critically evaluate emerging microbiota-targeted therapies for IBD.
• To discuss barriers to clinical translation and propose a future framework for personalized IBD care.

Main Methods:

• Literature review and critical evaluation of existing research on IBD and gut microbiota.
• Analysis of emerging microbiota-targeted strategies: fecal microbiota transplantation (FMT), live biotherapeutic products (LBPs), and precision postbiotics.
• Discussion of clinical translation challenges and future directions for IBD management.

Main Results:

• Microbiota dysbiosis, characterized by reduced SCFAs, impairs epithelial barrier function and immune regulation in IBD.
• Microbiota alterations increase susceptibility to recurrent infections (e.g., Clostridioides difficile), anemia, neuropsychiatric comorbidities, and extraintestinal manifestations.
• FMT, LBPs, and postbiotics show promise as adjuncts to conventional immunosuppressive therapies for IBD.

Conclusions:

• Gut microbiota plays a central role in the systemic immunometabolic aspects of IBD.
• Microbiota-targeted therapies represent a potential paradigm shift in IBD management.
• Personalized, functionally integrated care focused on microbiota homeostasis is essential for long-term IBD remission.