Кишкова проникність та її роль у патогенезі метаболічно-асоційованих захворювань. Огляд літератури
DOI:
https://doi.org/10.30978/UTJ2023-1-44Ключові слова:
кишкова проникність, ліпополісахарид, кишковий бар’єрАнотація
Висвітлено значення проникності кишкового бар’єра в патогенезі «метаболічних захворювань» (цукровий діабет, ожиріння тощо). Показано, що нормальна кишкова мікробіота відіграє важливу роль у підтримці цілісності кишкового епітеліального бар’єра, а порушення її гомеостазу значно впливає не лише на проникність кишечника, а й на системні запальні процеси, імунну функцію, резистентність до інсуліну та ліпідний обмін. Визначено, що «західна» дієта забезпечує мікробіоту інструментами, необхідними для протидії імунній системі господаря. Ці зміни можуть руйнувати кишковий бар’єр і спричинити розвиток метаболічної ендотоксинемії. Підвищена проникність кишечника для ендотоксину відіграє ключову роль у розвитку метаболічних змін унаслідок посиленої транслокації продуктів життєдіяльності бактерій та призводить до розвитку як місцевого, так і системного запалення низької градації. Кишкова мікробіота, впливаючи на метаболічні процеси у жировій тканині та печінці через зміну кишкової проникності, може спричинити системну резистентність до інсуліну і порушити регуляцію рівня глюкози. Зміни у взаємозв’язках між імунними клітинами кишечника та мікробіомом призводять до аберантних запальних перекосів і пов’язані з порушенням кишкового бар’єра, прогресуванням метаболічних захворювань та інсулінорезистентністю. Імунні клітини кишечника регулють біодоступність гормонів шлунково‑кишкового тракту, які контролюють рівень глюкози в крові та впливають на проникність кишкового бар’єра. Аномалії у щільних з’єднаннях міжклітинних зв’язків у кишечнику пов’язані з метаболічними та запальними захворюваннями. Порушення бар’єрної функції кишечника підтверджено як на тваринних моделях метаболічно‑асоційованих захворювань, так і у дослідженнях за участю людей. Зазначено, що бар’єрна дисфункція є важливою причиною метаболічного синдрому. Наведено дані щодо впливу коригування способу життя (зміни в раціоні харчування, фізичні вправи) і терапевтичних стратегій (метформін, пребіотики та пробіотики, баріатрична хірургія) на проникність кишечника.
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