medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-10-84-95medsovet-6915Research ArticleСАХАРНЫЙ ДИАБЕТDIABETES MELLITUSВлияние кишечной микробиоты на развитие инсулинорезистентностиInfluence of gut microbiota on the development of insulin resistancehttps://orcid.org/0000-0001-6385-540XДемидоваТ. Ю.DemidovaT. Yu.

Демидова Татьяна Юльевна, доктор медицинских наук, профессор, заведующая кафедрой эндокринологии лечебного факультета

Scopus ID: 7003771623; SPIN-код 9600-9796

117997, Москва, ул. Островитянова, д. 1

Tatiana Yu. Demidova, Dr. Sci. (Med.), Professor, Head of the Department of Endocrinology, Faculty of Medicine

Scopus ID: 7003771623

1, Ostrovityanov St., Moscow, 117997

t.y.demidova@gmail.comhttps://orcid.org/0000-0002-3656-0312ЛобановаК. Г.LobanovaK. G.

Лобанова Кристина Геннадьевна, ассистент кафедры эндокринологии лечебного факультета

SPIN-код 6044-1684

117997, Москва, ул. Островитянова, д. 1

Kristina G. Lobanova, Assistant of the Department of Endocrinology of the Medical Faculty

1, Ostrovityanov St., Moscow, 117997

miss.sapog@mail.ruhttps://orcid.org/0000-0002-8344-6424ШевцоваН. С.ShevtsovaN. S.

Шевцова Надежда Сергеевна, студентка 6-го курса лечебного факультета

117997, Москва, ул. Островитянова, д. 1

Nadezhda S. Shevtsova, Student of the Medical Faculty

1, Ostrovityanov St., Moscow, 117997

nshevcova01@gmail.comhttps://orcid.org/0000-0002-3684-9992КоротковаТ. Н.KorotkovaT. N.

Короткова Татьяна Николаевна, заведующий лабораторией клинической биохимии, иммунологии и аллергологии

SPIN-код 6502-3727 

115446, Москва, Каширское шоссе, д. 21

Tatiana N. Korotkova, Head of the Laboratory of Clinical Biochemistry, Immunology and Allergology

21, Kashirskoye Shosse, Moscow, 115446

 

https://orcid.org/0000-0002-6826-5924КочинаА. С.KochinaA. S.

Кочина Анна Сергеевна, аспирант кафедры эндокринологии лечебного факультета

117997, Москва, ул. Островитянова, д. 1

Anna S. Kochina, Postgraduate Student of the Department of Endocrinology of the Medical Faculty

1, Ostrovityanov St., Moscow, 117997

anna_kochina_@mail.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationФедеральный исследовательский центр питания, биотехнологии и безопасности пищиРоссияFederal Research Center of Nutrition, Biotechnology and Food SafetyRussian Federation2022180620220108495Copyright © Демидова Т.Ю., Лобанова К.Г., Шевцова Н.С., Короткова Т.Н., Кочина А.С., 20222022Демидова Т.Ю., Лобанова К.Г., Шевцова Н.С., Короткова Т.Н., Кочина А.С.Demidova T.Y., Lobanova K.G., Shevtsova N.S., Korotkova T.N., Kochina A.S.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/6915

Инсулинорезистентность (ИР) – важная проблема человечества, ведущая к развитию многих метаболических нарушений. Патогенетический механизм развития ИР в настоящее время полностью не изучен. Тем не менее существует ряд гипотез, объясняющих развитие данного состояния. К ним относятся такие гипотезы, как гипотеза бережливого генотипа, бережливого фенотипа, гормональная, стрессовая, хороших и плохих калорий, хронического метаболического воспаления, микробиотическая и комплексная модель, предложенная профессором Райнером Штраубом. В данной статье подробно рассмотрена микробиотическая теория, которая объясняет механизм развития нечувствительности периферических тканей к инсулину при дисбиозе за счет увеличения трансмиссии провоспалительных молекул из кишечника в кровоток и активации системного воспаления, нарушения механизма «кишечник – мозг – периферия» и нарушения рецепторных взаимодействий активных метаболитов кишечной микробиоты (КМ) на уровне клеток метаболических органов. Ценность данной теории состоит в том, что ее факторы воздействуют на все звенья патогенеза развития ИР, отраженные в интегрированной комплексной модели профессора Штрауба. В обзоре подробно рассмотрено взаимовлияние КМ и метаболических процессов организма человека на развитие ИР, приведены данные клинических исследований влияния КМ (ее состава, активных метаболитов, отдельных штаммов бактерий) на развитие ИР и роли хронического метаболического воспаления в данном процессе. Кроме этого, уделено внимание двунаправленным влияниям КМ и метформина, приведены данные клинических исследований об изменении КМ здоровых людей и людей с ИР под воздействием метформина. Рассмотрено, как КМ влияет на фармакокинетику данного препарата. Также показана возможность коррекции ИР путем использования пищевых волокон.

Insulin resistance (IR) is an important problem of humanity, which leads to development of many metabolic disorders. Сurrently the pathogenic mechanism of the development of IR is not completely investigated. Nevertheless, there are some hypotheses explaining the development of this condition. These include such hypotheses as the hypothesis of thrifty genotype, thrifty phenotype, hormonal, stress, good and bad calories, chronic metabolic inflammation, microbiotic and integrated model suggested by Professor Rainer Straub. In this article, the microbiotic theory will be considered in detail, explaining the mechanism of the development of peripheral tissue insensitivity to insulin in dysbiosis due to amplification of transmission by proinflammatory molecules from the intestine to the bloodstream and activation of systemic inflammation, disruption of the “gut-brain-periphery” mechanism and impaired receptor interactions of active intestinal metabolites of the gut microbiota (GM) at the level of cells of metabolic organs. The value of this theory is that its factors affect all links in the pathogenesis of the development of IR, reflected in the integrated model of Professor Straub. In this review the influence of GM and metabolic processes of human body on the development of IR will be considered in detail, data from clinical studies about the influence of GM (its composition, active metabolites, individual bacterial strains) on the development of IR and the role of chronic metabolic inflammation in this process will also be presented. In addition, attention will be paid to bidirectional effects of GM and metformin, as well as to data from clinical studies on changes in GM in healthy people and people with IR under the influence of metformin and how GM affects the pharmacokinetics of this drug. The possibility of IR correction through the use of dietary fiber will also be considered.

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