Rheumatoide Arthritis und das intestinale Mikrobiom – Ein potentieller Faktor in der Pathogenese der RA

Zusammenfassung

Die rheumatoide Arthritis (RA) ist eine chronische, entzündliche, systemische Autoimmunerkrankung, die chronisch progredient verläuft und zu schweren strukturellen Schäden und Funktionseinschränkungen führen kann. Ihre Pathogenese ist komplex und nicht abschließend verstanden. Neben genetischen, scheinen vor allem Umweltfaktoren eine wichtige Rolle zu spielen. Der Darm bildet die „innere Grenze“ zur Umwelt und kommt mit vielen Umweltfaktoren in Kontakt. Daher rückt der Darm in den letzten Jahren und mit ihm das Mikrobiom zunehmend (wieder) in den Fokus der Wissenschaft. Immer mehr evidente Befunde zeigen, dass die Mikrobiom-Darm-Gelenk-Achse eine wichtige Rolle bei der RA darstellt. Mikrobielle Dysbiose sowie eine intakte Darmbarriere („leaky gut“) und daraus resultierende bakterielle Translokation stellen potentielle Faktoren in der RA-Pathogenese dar. Hier fassen wir die derzeit bekannte Rolle der intestinalen Mikrobiota für Entstehung und Verlauf der RA zusammen. Wir betrachten dabei die neuesten Erkenntnisse auf dem Gebiet der Mikrobiomforschung und beschreiben den Zusammenhang zwischen intestinaler Dysbiose, intakte Barrierefunktion, bakterielle Translokation, adaptive Immunantwort sowie einen möglichen diätetischen Therapieansatz.

Abstract

Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic autoimmune disease that is chronically progressive and can lead to severe structural damage and functional impairment. Its pathogenesis is complex and not conclusively understood. Besides genetic factors, environmental factors seem to play an important role. The intestine forms the “inner boundary” with the environment and comes into contact with many environmental factors. Therefore, in recent years, the intestine, and with it the microbiome, have increasingly become a focus of research. More and more evidence shows that the microbiome-gut-joint axis plays an important role in RA. Microbial dysbiosis as well as an intact gut barrier (“leaky gut”) and resulting bacterial translocation are potential factors in RA pathogenesis. Here, we summarize the currently known role of the intestinal microbiota in the development and progression of RA. We review recent findings in the field of microbiome research and describe the relationship between intestinal dysbiosis, intact barrier function, bacterial translocation, adaptive immune response, and a potential dietary therapeutic approach.

Schlüsselwörter

Rheumatoide Arthritis - intestinale Mikrobiota - Dysbiose - Zonulin - Ballaststoffe

Key words

rheumatoid arthritis - intestinal microbiota - dysbiosis - zonulin - fibre

Publikationsverlauf

Artikel online veröffentlicht:
27. September 2023

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