TableĀ 2

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 rationaleReference
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.