Перспективы создания новых лечебно-профилактических средств на основе симбиотических штаммов бактерий для коррекции нарушений иммунной регуляции, опосредованной кишечной микробиотой при COVID-19

Современные исследования роли кишечной микробиоты у животных и человека показывают, что микроорганизмы являются важным фактором, определяющим здоровье хозяина, и участвуют в патогенезе различных инфекционных и неинфекционных заболеваний. В настоящее время активно исследуются механизмы формирования функциональной оси «кишечник – легкие» при новой коронавирусной инфекции COVID-19, где желудочно-кишечный тракт может являться входными воротами инфекции, указывая на вовлечение кишечной микробиоты в инфекционный процесс. С одной стороны, изменение микробиоты пациентов (дисбиоз), инфицированных вирусом SARS-CoV-2, является одним из факторов развития вторичной бактериальной инфекции, сепсиса, системного воспаления и полиорганной недостаточности. С другой стороны, нарушение микробиоты кишечника способствует развитию тяжелого течения и летального исхода у пациентов из-за двунаправленной связи кишечной микробиоты через систему иммунитета посредством цитокинов. Показана связь степени тяжести COVID-19 у пациентов с уровнем цитокинов и выявлением в кишечном биотопе определенных видов «провоспалительных» или «противовоспалительных» бактерий. Иммунологические нарушения у пациентов с COVID-19 также опосредованы изменением профиля метаболома на фоне дисбиотических нарушений микробиоты. Связь между составом микробиоты кишечника, уровнями цитокинов и воспалительными маркерами позволяет предположить, что микробиом кишечника влияет на развитие и течение коронавирусной инфекции, а «симбиотический потенциал» нормобиоты может быть использован для разработки мер профилактики и реабилитации пациентов. Этому может способствовать развитие исследований в направлении проблемы симбиоза человека и микробиоты. Ряд ключевых механизмов изучения интеграции бифидобактерий и лактобацилл с хозяином, опосредованные системой иммунитета, гормонов и нейромедиаторов, открывают новые перспективы для медицины, включая получение новых пробиотических штаммов различной целевой установки для лечебно-профилактической коррекции нарушенных функций организма. Изучение микросимбиоценоза, как одного из векторов ассоциативного симбиоза, позволило разработать метод межмикробного распознавания «свой-чужой», где в качестве тестовой распознающей культуры используются бифидобактерии, т. к. для «своих» штаммов характерен синергизм (поддержка), тогда как при встрече с «чужой клеткой» – антагонизм. Именно этот фундаментальный механизм можно использовать при отборе «своих» для хозяина штаммов, пригодных для создания пробиотической композиции.

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