Future microbial and dietary interventions that could have a role in managing IBD and other intestinal inflammatory conditions once clinical remission and mucosal healing is established
| Intervention and rationale | Reference |
|---|---|
| Induce regulatory (protective) immune responses by probiotics, components of commensals such as Clostridium groups IV and XIVA, bacterial products such as polysaccharide A or dietary retinoic acid. Regulatory T cells maintain mucosal homoeostasis and can prevent relapse of inflammation. | 56, 118 |
| Improving mucosal barrier function with probiotics or their products, including p40 from Lactobacillus rhamnosus GG, and short-chain fatty acids produced by Bifidobacterium and Clostridium species, including Faecalibacterium prausnitzii. Short-chain fatty acids such as butyrate that are products of bacterial metabolism of non-absorbed carbohydrates (fibre and prebiotics) are the primary metabolic fuel of colonic epithelial cells. Inflammation develops in the absence of short-chain fatty acids because of epithelial starvation/damage. | 55 |
| Decreasing luminal concentrations of antigens and TLR ligands that drive aggressive immune responses. Commensal luminal microbial antigens stimulate the TH1/TH17 responses that mediate chronic inflammation in Crohn's disease. | 49, 119 |
IBD, inflammatory bowel disease.