The potential of gut microbiome profiling for personalized management of patients with chronic obstructive pulmonary disease: a review

Abstract

Chronic obstructive pulmonary disease (COPD) remains a major global health challenge due to the unmet need for early prediction of the disease course and therapy results. Exploring the potential of gut microbiome profiling to develop targeted interventions for COPD could help take a significant step toward implementing precision medicine into clinical practice. Our aim was to analyze recent data regarding gut microbiome profiling for the personalized management of COPD patients based on an assessment of articles from the MEDLINE database. The gut microbiome profiles of various cohorts of COPD patients differed significantly. Several studies report reduced microbial diversity in COPD. Patients with stable COPD had higher levels of Firmicutes and lower levels of Bacteroidetes compared to healthy individuals. COPD exacerbations were accompanied by increased intestinal and pulmonary epithelium permeability, which promoted lung colonization by Enterobacteriaceae. A decreased abundance of the Bacteroidetes genus Prevotellawas associated with a significantly greater risk of recent severe exacerbation and severe or very severe airflow limitation. COPD patients with predominant emphysema showed increased intestinal endothelial permeability, indicated by higher blood zonulin levels, and reduced commensal bacteria such as Lactobacilli, Bifidobacteria, and Bacteroides subspecies. Corticosteroids and antibiotics significantly impact the gut microbial dysbiosis. Supplementation with dietary fibers and gut microbiome- targeted interventions showed some benefits in improving symptoms and slowing the progression of COPD. However, these preliminary findings have not yet been widely used due to the lack of clinical trials. Thus, the gut microbiome is a promising tool for stratifying COPD patients. Future research should clarify the mechanisms and therapeutic effectiveness of restoring the gut microbiome in COPD.