Novel clinical intervention pathway based on the pathogenesis mechanism of Enterotoxigenic Bacteroides fragilis

Enterotoxigenic Bacteroides fragilis (ETBF) is a pivotal pathogenic microbe associated with intestinal dysbiosis. Its major virulence factor, Bacteroides fragilis toxin (BFT), is a zinc-dependent metalloproteinase that disrupts intestinal barrier function by degrading adhesion molecules in epithelial cells, thereby triggering inflammatory signaling cascades and inducing aberrant proliferation of intestinal epithelial cells. Beyond this direct toxin-mediated pathogenicity, ETBF-induced pathogenesis also involves intercellular signal transduction mediated by outer membrane vesicles and complex epigenetic regulatory perturbations. Collectively, these pathological processes promote the development of inflammatory bowel disease (IBD) and colorectal cancer (CRC). This review elaborates on the structure-activity relationships of BFT and its multifaceted roles in inducing tissue damage, remodeling the inflammatory microenvironment, and driving carcinogenic progression. We also analyze the technical limitations of current clinical diagnostic approaches for ETBF, and prospect the development of targeted detection methodologies, including integrated multi-omics analyses and molecular diagnostic systems. Furthermore, this review systematically expounds on a variety of promising targeted therapeutic strategies against ETBF, clarifies their potential clinical application value and latest research progress, and thus provides a comprehensive theoretical framework for the clinical diagnosis, treatment and prognostic management of ETBF-associated diseases.