medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-10-92-100medsovet-5726Research ArticleАЛЛЕРГОЛОГИЯ И ИММУНОЛОГИЯALLERGOLOGY AND IMMUNOLOGYМикробиота кишечника как ключевой фактор формирования иммунитета и толерантности. Возможности пробиотиковIntestinal microbiota as a key factor in the formation of immunity and tolerance. Probiotics capabilitieshttps://orcid.org/0000-0003-2743-1460КорниенкоЕ. А.KornienkoE. A.

Корниенко Елена Александровна, д.м.н., профессор кафедры детских болезней имени профессора И.М. Воронцова факультета послевузовского и дополнительного профессионального образования

192100, Санкт-Петербург, ул. Литовская, д. 2

Elena A. Kornienko, Dr. of Sci. (Med.), Professor of the Department of Children’s Diseases named after Professor I.M. Vorontsov of the Faculty of Postgraduate and Additional Professional Education

2, Litovskaya St., St Petersburg, 194100

elenkornienk@yandex.ruСанкт-Петербургский государственный педиатрический медицинский университетРоссияSt Petersburg State Pediatric UniversityRussian Federation20202907202001092100Copyright © Корниенко Е.А., 20202020Корниенко Е.А.Kornienko E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5726

Введение. Микробиом кишечника является неотъемлемой частью здоровья его хозяина и выполняет несколько важнейших функций: метаболическую, координирующую, защитную, эпигенетическую, которые тесно взаимосвязаны. В условиях дисбиоза нарушение этих функций способствует формированию патологии.Иммунная система кишечника находится в постоянном взаимодействии с микробиотой. Она представлена всеми иммунными клетками: Т- и В-лимфоцитами, Т-регуляторными (Tr), дендритными клетками, макрофагами. Микропрезентация антигенов происходит через М-клетки, расположенные между эпителиоцитами. На мембране эпителия представлены Toll-подобные рецепторы, распознающие паттерны микробных клеток. Дендритные клетки осуществляют презентацию этих антигенов Т-клеткам и направляют дальнейший адаптивный иммунный ответ.Иммунная система созревает в результате заселения кишечника микробиотой, что подтверждено экспериментально на животных-гнотобионтах. В физиологических условиях она обеспечивает толерантность к собственной микробиоте посредством Tr-клеток. При дисбиозе толерогенное действие уменьшается, в результате развивается воспаление.

Состояние кишечного барьера. Кишечный барьер поддерживается микробиотой, которая стимулирует синтез муцина и клаудина. При дисбиозе усиливается проницаемость, а иммунная система подвергается атаке микробов и их метаболитов, что способствует воспалению.Дисбиоз предрасполагает к развитию воспалительных заболеваний кишечника, колоректального рака, метаболического синдрома и ожирения, пищевой аллергии. Микробиота при этих заболеваниях теряет свое разнообразие и богатство и оказывает преимущественно провоспалительное действие.

Влияние пробиотиков на иммунную систему. Пробиотики за счет адгезии в слизистый слой усиливают барьерные функции, взаимодействуют с иммунной системой, влияют на дендритные клетки, способствуя образованию Tr и препятствуя активации ядерного фактора воспаления NF-kB. Метаболиты комменсалов, в частности бутират, усиливают привлечение в толстую кишку Tr-клеток, оказывая толерогенное действие.

Показания к назначению пробиотиков. Enterococcus faecium и Bifidobacterium longum доказали действие, аналогичное нормальной кишечной микробиоте, и свою эффективность в лечении дисбиоза у детей и взрослых.

Introduction. The intestinal microbiome is an integral part of the health of its owner and performs several important functions: metabolic, coordinating, protective, epigenetic, which are closely interactive. In conditions of dysbiosis, disturbances of these functions contributes to different disorders.The intestinal immune system closely interacts with the microbiota. It is represented by all cells: T- and B-lymphocytes, T-regulatory, dendritic cells, macrophages. Micropresentation of antigens occurs through M-cells located between enterocytes. Toll-like receptors that recognize bacterial patterns are presented on the epithelial membrane. Dendritic cells present these antigens to T-cells and direct a further adaptive immune response.The immune system matures as a result of colonization of the intestine with microbiota, which is confirmed experimentally in gnotobiotic animals. Under physiological conditions, the immune system provides tolerance to its own microbiota through Tr-cells. Tolerogenic effects decrease in dysbiotic conditions, as a result, inflammation develops.

The state of the intestinal barrier. The intestinal barrier is maintained by microbiota, which stimulates the synthesis of mucin and claudine. In dysbiosis, permeability increases, and the immune system is attacked by microbes and their metabolites, which contributes to inflammation.Dysbiosis predisposes to the development of inflammatory bowel diseases, colorectal cancer, metabolic syndrome and obesity, food allergies. In these diseases, the microbiota loses its diversity and richness and has a predominantly pro-inflammatory effect.

The effect of probiotics on the immune system. Probiotics, due to adhesion to the mucous layer, enhance barrier functions, interact with the immune system, affect dendritic cells, promoting the formation of Tr and inhibiting the activation of NF-kB. Commensal metabolites (butyrate) increase the involvement of Tr cells in the colon, exerting a tolerogenic effect.

Indications for the appointment of probiotics. Enterococcus faecium and Bifidobacterium longum have proven their activities similar to normal microbiota, and effectiveness in treatment of dysbiosis in children and adults.

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The authors declare that there are no conflicts of interest present.