肠道菌群移植在结直肠肿瘤防治中的作用及其研究进展

The Role of Intestinal Microbiota Transplantation in the Prevention and Treatment of Colorectal Tumors and Related Research Advances

摘要: 肠道菌群在结肠直肠癌(CRC)发生、发展以及防治中的理论研究是一个新兴的研究领域。肠道菌群与机体肠道上皮细胞紧密合作，并通过介导免疫调节、胆固醇代谢以及分泌基因毒素等多种手段调控CRC的恶性生物学行为。目前，通过包括益生菌、益生元、抗生素和肠道菌群移植(FMT)等在内的多种方式来调控肠道菌群的失调，被认为是CRC防治的一种新思路。通过纠正菌群构成、调节先天免疫系统、增强肠道屏障功能、防止病原体定植和对肿瘤细胞发挥选择性细胞毒性等机制，显示出良好的治疗效果，同时，也伴随着风险和争议，比如伦理问题以及可能会带来临床不良反应。从临床前研究到临床应用的转化过程中，我们应仔细评估风险和效益比，以及患者的选择。此外，鉴于宿主对肠道菌群移植的个体化反应，开发个性化的菌群移植疗法可能是临床治疗成功的关键。

Abstract: Theoretical research regarding the role of gut microbes in the development, progression and treatment of colorectal cancer (CRC) is an emerging area of research. Intestinal flora cooperates closely with intestinal epithelial cells, and regulates the malignant biological behavior of CRC by mediating immune regulation, cholesterol metabolism and gene toxin secretion. Modulation of intestinal flora through various modalities including probiotics, prebiotics, antibiotics and intestinal flora transplantation (FMT) to reverse existing dysbiosis is considered a new avenue for the prevention and treatment of CRC. These modalities have shown promising results through mechanisms such as correcting flora composition, modulating the innate immune system, enhancing intestinal barrier function, preventing pathogen colonization and exerting selective cytotoxicity on tumor cells, and are accompanied by risks and controversies, such as ethical issues and the possibility of clinical adverse effects. The risk-benefit ratio and patient selection should be carefully evaluated during the translation from preclinical studies to clinical applications. Given the individualized response of the host to intestinal flora transplantation, the development of personalized flora transplantation therapies may be key to the success of clinical treatment.