1 2731 88 EXPLORING THE COMPLEX RELATIONSHIP BETWEEN MICROBIOTA AND SYSTEMIC LUPUS ERYTHEMATOSUS. PURPOSE OF REVIEW: SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) IS A CHRONIC AUTOIMMUNE DISEASE CHARACTERIZED BY VARIOUS AUTOANTIBODIES AND MULTI-ORGAN. MICROBIOTA DYSBIOSIS IN THE GUT, SKIN, ORAL, AND OTHER SURFACES HAS A SIGNIFICANT IMPACT ON SLE DEVELOPMENT. THIS ARTICLE SUMMARIZES RELEVANT RESEARCH AND PROVIDES NEW MICROBIOME-RELATED STRATEGIES FOR EXPLORING THE MECHANISMS AND TREATING PATIENTS WITH SLE. RECENT FINDINGS: SLE PATIENTS HAVE DISRUPTIONS IN MULTIPLE MICROBIOMES, WITH THE GUT MICROBIOTA (BACTERIA, VIRUSES, AND FUNGI) AND THEIR METABOLITES BEING THE MOST THOROUGHLY RESEARCHED. THIS DYSBIOSIS CAN PROMOTE SLE PROGRESSION THROUGH MECHANISMS SUCH AS THE LEAKY GUT, MOLECULAR MIMICRY, AND EPIGENETIC REGULATION. NOTWITHSTANDING STUDY CONSTRAINTS ON THE RELATIONSHIP BETWEEN MICROBIOTA AND SLE, SPECIFIC INTERVENTIONS TARGETING THE GUT MICROBIOTA, SUCH AS PROBIOTICS, DIETARY MANAGEMENT, AND FECAL MICROBIOTA TRANSPLANTATION, HAVE EMERGED AS PROMISING SLE THERAPEUTICS. 2023 2 2662 28 EPSTEIN-BARR VIRUS AND MULTIPLE SCLEROSIS: A CONVOLUTED INTERACTION AND THE OPPORTUNITY TO UNRAVEL PREDICTIVE BIOMARKERS. SINCE THE EARLY 1980S, EPSTEIN-BARR VIRUS (EBV) INFECTION HAS BEEN DESCRIBED AS ONE OF THE MAIN RISK FACTORS FOR DEVELOPING MULTIPLE SCLEROSIS (MS), AND RECENTLY, NEW EPIDEMIOLOGICAL EVIDENCE HAS REINFORCED THIS PREMISE. EBV SEROCONVERSION PRECEDES ALMOST 99% OF THE NEW CASES OF MS AND LIKELY PREDATES THE FIRST CLINICAL SYMPTOMS. THE MOLECULAR MECHANISMS OF THIS ASSOCIATION ARE COMPLEX AND MAY INVOLVE DIFFERENT IMMUNOLOGICAL ROUTES, PERHAPS ALL RUNNING IN PARALLEL (I.E., MOLECULAR MIMICRY, THE BYSTANDER DAMAGE THEORY, ABNORMAL CYTOKINE NETWORKS, AND COINFECTION OF EBV WITH RETROVIRUSES, AMONG OTHERS). HOWEVER, DESPITE THE LARGE AMOUNT OF EVIDENCE AVAILABLE ON THESE TOPICS, THE ULTIMATE ROLE OF EBV IN THE PATHOGENESIS OF MS IS NOT FULLY UNDERSTOOD. FOR INSTANCE, IT IS UNCLEAR WHY AFTER EBV INFECTION SOME INDIVIDUALS DEVELOP MS WHILE OTHERS EVOLVE TO LYMPHOPROLIFERATIVE DISORDERS OR SYSTEMIC AUTOIMMUNE DISEASES. IN THIS REGARD, RECENT STUDIES SUGGEST THAT THE VIRUS MAY EXERT EPIGENETIC CONTROL OVER MS SUSCEPTIBILITY GENES BY MEANS OF SPECIFIC VIRULENCE FACTORS. SUCH GENETIC MANIPULATION HAS BEEN DESCRIBED IN VIRALLY-INFECTED MEMORY B CELLS FROM PATIENTS WITH MS AND ARE THOUGHT TO BE THE MAIN SOURCE OF AUTOREACTIVE IMMUNE RESPONSES. YET, THE ROLE OF EBV INFECTION IN THE NATURAL HISTORY OF MS AND IN THE INITIATION OF NEURODEGENERATION IS EVEN LESS CLEAR. IN THIS NARRATIVE REVIEW, WE WILL DISCUSS THE AVAILABLE EVIDENCE ON THESE TOPICS AND THE POSSIBILITY OF HARNESSING SUCH IMMUNOLOGICAL ALTERATIONS TO UNCOVER PREDICTIVE BIOMARKERS FOR THE ONSET OF MS AND PERHAPS FACILITATE PROGNOSTICATION OF THE CLINICAL COURSE. 2023 3 4272 32 MICROBIOME AND BEHCET'S DISEASE: A SYSTEMATIC REVIEW. THE AIM OF THIS REVIEW WAS TO DESCRIBE THE CHANGES IN THE MICROBIOTA OF PATIENTS WITH BEHCET'S DISEASE (BD) AND THE MECHANISMS INVOLVED IN THE RELATIONSHIP BETWEEN THE MICROBIOME AND IMMUNITY IN BD. A SYSTEMATIC SEARCH FOR RELEVANT ARTICLES WAS MADE ON PUBMED AND THE COCHRANE LIBRARY DATABASE USING THE FOLLOWING TERMS: "MICROBIOTA AND BEHCET'S DISEASE" OR "MICROBIOME AND BEHCET'S DISEASE". SIXTEEN ARTICLES WERE INCLUDED IN A QUALITATIVE SYNTHESIS. THIS SYSTEMATIC REVIEW ON THE MICROBIOME AND BEHCET'S DISEASE UNDERLINES THE PRESENCE OF GUT DYSBIOSIS IN BD PATIENTS. THIS DYSBIOSIS IS MARKED BY (I) A DECREASE IN BUTYRATE-PRODUCING BACTERIA, WHICH COULD AFFECT T CELL DIFFERENTIATION AND EPIGENETIC REGULATION OF IMMUNE-RELATED GENES, (II) A MODIFICATION OF TRYPTOPHAN-METABOLISING BACTERIA, WHICH COULD BE LINKED TO DYSREGULATED IL-22 SECRETION, AND (III) A DECREASE IN BACTERIA KNOWN TO HAVE ANTI-INFLAMMATORY PROPERTIES. REGARDING ORAL MICROBIOTA, THIS REVIEW UNDERLINES THE POSSIBLE ROLE OF STREPTOCOCCUS SANGUINIS THROUGH MOLECULAR MIMICRY AND NETOSIS. CLINICAL STUDIES OF BD HAVE SHOWN THAT (I) NEED FOR DENTISTRY IS ASSOCIATED WITH A MORE SEVERE COURSE IN BD, AND (II) ANTIBIOTIC-SUPPLEMENTED MOUTHWASH REDUCES PAIN AND ULCERS. FECAL TRANSPLANTATION OF BD PATIENTS' MICROBIOTA INTO MOUSE MODELS LED TO DECREASED SCFA PRODUCTION, NEUTROPHIL ACTIVATION, AND TH1/TH17 RESPONSES.RECIPIENT MICE SHOWED EXACERBATED EXPERIMENTAL AUTOIMMUNE UVEITIS (EAU) AND EXPERIMENTAL AUTOIMMUNE ENCEPHALOMYELITIS (EAE). IN HERPES VIRUS SIMPLEX-1 (HSV-1) INFECTED MICE MIMICKING BD, ADMINISTRATION OF BUTYRATEPRODUCING BACTERIA IMPROVED SYMPTOMS AND IMMUNE VARIABLES. THE MICROBIOME MAY THUS BE INVOLVED IN BD THROUGH IMMUNITY REGULATION AND EPIGENETIC MODIFICATIONS. 2023 4 6604 26 TYPE 1 DIABETES AND VIRAL INFECTIONS: WHAT IS THE RELATIONSHIP? TYPE 1 DIABETES (T1D) IS THE MOST COMMON CHRONIC METABOLIC DISORDER IN CHILDREN. EPIGENETIC AND ENVIRONMENTAL FACTORS CAPABLE OF ALTERING THE PENETRANCE OF MAJOR SUSCEPTIBILITY GENES OR CAPABLE OF INCREASING THE PENETRANCE OF LOW-RISK GENES ARE CURRENTLY THOUGHT TO PLAY A ROLE IN TRIGGERING AUTOIMMUNITY AND T1D DEVELOPMENT. THIS PAPER DISCUSSES THE CURRENT KNOWLEDGE OF THE ROLE OF VIRUSES IN T1D. MOST STUDIES THAT HAVE EVALUATED THE POTENTIAL ASSOCIATION BETWEEN VIRAL INFECTIONS AND T1D HAVE INDICATED THAT IT IS HIGHLY LIKELY THAT SOME OF THESE INFECTIOUS AGENTS PLAY A ROLE IN T1D DEVELOPMENT. HOWEVER, MOST T1D CASES ARE IMMUNE-MEDIATED, AND IT IS SUPPOSED THAT THE INITIAL VIRAL INFECTION IS CAPABLE OF CREATING, IN GENETICALLY PREDISPOSED SUBJECTS, A PARTICULAR CONDITION IN WHICH CHRONIC LOCAL INFLAMMATION OCCURS THROUGH THE PERSISTENCE OF THE INFECTING VIRUS IN PANCREATIC TISSUE AND THE ACTIVATION OF AUTOIMMUNITY BY MEANS OF MOLECULAR MIMICRY, BYSTANDER ACTIVATION, OR BOTH. THEORETICALLY, THIS KNOWLEDGE COULD LEAD TO POSSIBLE PROPHYLAXIS AND THERAPY FOR T1D. FURTHER STUDIES DEVOTED TO EVALUATING WHICH INFECTIOUS AGENTS ARE LINKED TO T1D AND WHICH IMMUNE MECHANISMS INDUCE OR PROTECT AGAINST THE DISEASE ARE NEEDED BEFORE ADEQUATE PROPHYLACTIC AND THERAPEUTIC MEASURES CAN BE DEVELOPED. 2017 5 3223 31 HELICOBACTER PYLORI INFECTION AND AUTOIMMUNE DISEASES; IS THERE AN ASSOCIATION WITH SYSTEMIC LUPUS ERYTHEMATOSUS, RHEUMATOID ARTHRITIS, AUTOIMMUNE ATROPHY GASTRITIS AND AUTOIMMUNE PANCREATITIS? A SYSTEMATIC REVIEW AND META-ANALYSIS STUDY. AUTOIMMUNE DISEASES ARE CONSIDERED AS ONE OF THE MOST IMPORTANT DISORDERS OF THE IMMUNE SYSTEM, IN WHICH THE PROLONGED AND CHRONIC PROCESSES ELIMINATE SELF-TOLERANCE TO THE AUTO-ANTIGENS. THE PREVALENCE OF AUTOIMMUNE DISEASES HAS BEEN INCREASING WORLDWIDE IN THE RECENT YEARS. ACCORDING TO THE LITERATURE, BIOLOGICAL PROCESSES SUCH AS THE HOST GENOME, EPIGENETIC EVENTS, ENVIRONMENTAL CONDITION, DRUG CONSUMPTION, AND INFECTIOUS AGENTS ARE THE MOST IMPORTANT RISK FACTORS THAT MAKE THE HOST SUSCEPTIBLE TO THE DEVELOPMENT OF AUTOIMMUNE DISEASES. IN THE RECENT YEARS, THE ROLE OF HELICOBACTER PYLORI IN THE INDUCTION OF AUTOIMMUNE DISEASES HAS ATTRACTED EXTENSIVE ATTENTION. VIA MOLECULAR MIMICRY, EPITOPE SPREADING, BYSTANDER ACTIVATION, POLYCLONAL ACTIVATION, DYSREGULATION IN IMMUNE RESPONSE, AND HIGHLY IMMUNE-DOMINANT VIRULENCE, SUCH AS CAGA, H. PYLORI CAUSES TISSUE DAMAGE, POLARITY, AND PROLIFERATION OF THE HOST CELLS LEADING TO THE MODULATION OF HOST IMMUNE RESPONSES. MOREOVER, GIVEN THE LARGE POPULATION WORLDWIDE INFECTED WITH H. PYLORI, IT SEEMS LIKELY THAT THE BACTERIUM MAY DEVELOP INTO AUTOIMMUNE DISEASES THROUGH DYSREGULATION OF THE IMMUNE RESPONSE. THE FREQUENCY AND RELATIONSHIP BETWEEN H. PYLORI INFECTION AND SYSTEMIC LUPUS ERYTHEMATOSUS, RHEUMATOID ARTHRITIS, AUTOIMMUNE ATROPHY GASTRITIS, AND AUTOIMMUNE PANCREATITIS WERE EVALUATED USING THE DATA FROM 43 STUDIES INVOLVING 5052 PATIENTS. ACCORDING TO STATISTICAL ANALYSIS IT IS PROBABLE THAT INFECTION WITH MORE VIRULENT STRAINS OF H. PYLORI (SUCH AS H. PYLORI CAGA POSITIVE) CAN INCREASE THE RISK OF AUTOIMMUNE DISEASES. IN ADDITION, IT WAS SHOWN THAT INFECTION WITH H. PYLORI CAN PREVENT THE DEVELOPMENT OF ATROPHIC GASTRITIS BY STIMULATING INFLAMMATION IN THE GASTRIC ANTRUM. HOWEVER, FUTURE STUDIES SHOULD CONFIRM THE VALIDITY OF THIS STUDY. 2021 6 4274 37 MICROBIOTA IN INFLAMMATORY BOWEL DISEASE PATHOGENESIS AND THERAPY: IS IT ALL ABOUT DIET? INFLAMMATORY BOWEL DISEASE (IBD), INCLUDING ULCERATIVE COLITIS, CROHN'S DISEASE, AND UNCLASSIFIED IBD, CONTINUES TO CAUSE SIGNIFICANT MORBIDITY. WHILE ITS INCIDENCE IS INCREASING, NO CLEAR ETIOLOGY AND NO CURE HAVE YET BEEN DISCOVERED. RECENT FINDINGS SUGGEST THAT IBD MAY HAVE A MULTIFACTORIAL ETIOLOGY, WHERE COMPLEX INTERACTIONS BETWEEN GENETICS, EPIGENETICS, ENVIRONMENTAL FACTORS (INCLUDING DIET BUT ALSO INFECTIONS, ANTIBIOTICS, AND SANITATION), AND HOST IMMUNE SYSTEM LEAD TO ABNORMAL IMMUNE RESPONSES AND CHRONIC INFLAMMATION. OVER THE PAST YEARS, THE ROLE OF ALTERED GUT MICROBIOTA (IN BOTH COMPOSITION AND FUNCTION) IN IBD PATHOGENESIS HAS EMERGED AS AN OUTSTANDING AREA OF INTEREST. ACCORDING TO NEW FINDINGS, GUT DYSBIOSIS MAY APPEAR AS A KEY ELEMENT IN INITIATION OF INFLAMMATION IN IBD AND ITS COMPLICATIONS. MOREOVER, COMPLEX METAGENOMIC STUDIES PROVIDE POSSIBILITIES TO DISTINGUISH BETWEEN IBD TYPES AND APPRECIATE SEVERITY AND PROGNOSIS OF THE DISEASE, AS WELL AS RESPONSE TO THERAPY. THIS REVIEW PROVIDES AN UPDATED KNOWLEDGE OF RECENT FINDINGS LINKING ALTERED BACTERIAL COMPOSITION AND FUNCTIONS, VIRUSES, AND FUNGI TO IBD PATHOGENESIS. IT ALSO HIGHLIGHTS THE COMPLEX GENETIC, EPIGENETIC, IMMUNE, AND MICROBIAL INTERACTIONS IN RELATION TO ENVIRONMENTAL FACTORS (INCLUDING DIET). WE OVERVIEW THE ACTUAL OPTIONS TO MANIPULATE THE ALTERED MICROBIOTA, SUCH AS MODIFIED DIET, PROBIOTICS, PREBIOTICS, SYNBIOTICS, ANTIBIOTICS, AND FECAL TRANSPLANTATION. FUTURE POSSIBLE THERAPIES ARE ALSO INCLUDED. TARGETING ALTERED MICROBIOTA COULD BE THE NEXT THERAPEUTIC PERSONALIZED APPROACH, BUT MORE RESEARCH AND WELL-DESIGNED COMPARATIVE PROSPECTIVE STUDIES ARE REQUIRED TO FORMULATE ADEQUATE DIRECTIONS FOR PREVENTION AND THERAPY. 2015 7 3209 25 HEALTH DISPARITIES IN SYSTEMIC LUPUS ERYTHEMATOSUS. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) IS A CHRONIC MULTISYSTEM AUTOIMMUNE DISEASE CHARACTERIZED BY AUTOANTIBODY PRODUCTION AND DIVERSE CLINICAL MANIFESTATIONS. THE MANY COMPLEX, OVERLAPPING, AND CLOSELY ASSOCIATED FACTORS THAT INFLUENCE SLE SUSCEPTIBILITY AND OUTCOMES INCLUDE ETHNIC DISPARITIES, LOW ADHERENCE TO MEDICATIONS, AND POVERTY, AND GEOGRAPHY. EPIGENETIC MECHANISMS MAY PROVIDE THE LINK BETWEEN THESE ENVIRONMENTAL EXPOSURES AND BEHAVIORS AND THE DISPROPORTIONATE BURDEN OF SLE SEEN IN ETHNIC MINORITIES. ATTENTION TO THESE MODIFIABLE SOCIAL DETERMINANTS OF HEALTH WOULD NOT ONLY IMPROVE OUTCOMES FOR VULNERABLE PATIENTS WITH SLE BUT LIKELY REDUCE SUSCEPTIBILITY TO SLE AS WELL THROUGH EPIGENETIC CHANGES. 2020 8 3689 24 INFLAMMATORY AUTO-IMMUNE DISEASES OF THE INTESTINE AND THEIR MANAGEMENT BY NATURAL BIOACTIVE COMPOUNDS. AUTOIMMUNE DISEASES ARE CAUSED BY THE OVERACTIVITY OF THE IMMUNE SYSTEM TOWARDS SELF-CONSTITUENTS. RISK FACTORS OF AUTOIMMUNE DISEASES ARE MULTIPLE AND INCLUDE GENETIC, EPIGENETIC, ENVIRONMENTAL, AND PSYCHOLOGICAL. AUTOIMMUNE CHRONIC INFLAMMATORY BOWEL DISEASES, INCLUDING CELIAC AND INFLAMMATORY DISEASES (CROHN'S DISEASE AND ULCERATIVE COLITIS), CONSTITUTE A SIGNIFICANT HEALTH PROBLEM WORLDWIDE. BESIDES THE COMPLEXITY OF THE SYMPTOMS OF THESE DISEASES, THEIR TREATMENTS HAVE ONLY BEEN PALLIATIVE. NUMEROUS INVESTIGATIONS SHOWED THAT NATURAL PHYTOCHEMICALS COULD BE PROMISING STRATEGIES TO FIGHT AGAINST THESE AUTOIMMUNE DISEASES. IN THIS RESPECT, PLANT-DERIVED NATURAL COMPOUNDS SUCH AS FLAVONOIDS, PHENOLIC ACIDS, AND TERPENOIDS EXHIBITED SIGNIFICANT EFFECTS AGAINST THREE AUTOIMMUNE DISEASES AFFECTING THE INTESTINE, PARTICULARLY BOWEL DISEASES. THIS REVIEW FOCUSES ON THE ROLE OF NATURAL COMPOUNDS OBTAINED FROM MEDICINAL PLANTS IN MODULATING INFLAMMATORY AUTO-IMMUNE DISEASES OF THE INTESTINE. IT COVERS THE MOST RECENT LITERATURE RELATED TO THE EFFECT OF THESE NATURAL COMPOUNDS IN THE TREATMENT AND PREVENTION OF AUTO-IMMUNE DISEASES OF THE INTESTINE. 2022 9 4271 29 MICROBIAL DYSBIOSIS-INDUCED OBESITY: ROLE OF GUT MICROBIOTA IN HOMOEOSTASIS OF ENERGY METABOLISM. THE GLOBAL OBESITY EPIDEMIC HAS NECESSITATED THE SEARCH FOR BETTER INTERVENTION STRATEGIES INCLUDING THE EXPLOITATION OF THE HEALTH BENEFITS OF SOME GUT MICROBIOTA AND THEIR METABOLIC PRODUCTS. THEREFORE, WE EXAMINED THE GUT MICROBIAL COMPOSITION AND MECHANISMS OF INTERACTION WITH THE HOST IN RELATION TO HOMOEOSTATIC ENERGY METABOLISM AND PATHOPHYSIOLOGY OF DYSBIOSIS-INDUCED METABOLIC INFLAMMATION AND OBESITY. WE ALSO DISCUSSED THE EUBIOTIC, HEALTH-PROMOTING EFFECTS OF PROBIOTICS AND PREBIOTICS AS WELL AS EPIGENETIC MODIFICATIONS ASSOCIATED WITH GUT MICROBIAL DYSBIOSIS AND RISK OF OBESITY. HIGH-FAT/CARBOHYDRATE DIET PROGRAMMES THE GUT MICROBIOTA TO ONE PREDOMINATED BY FIRMICUTES (CLOSTRIDIUM), PREVOTELLA AND METHANOBREVIBACTER BUT DEFICIENT IN BENEFICIAL GENERA/SPECIES SUCH AS BACTEROIDES, BIFIDOBACTERIUM, LACTOBACILLUS AND AKKERMANSIA. ALTERED GUT MICROBIOTA IS ASSOCIATED WITH DECREASED EXPRESSION OF SCFA THAT MAINTAIN INTESTINAL EPITHELIAL BARRIER INTEGRITY, REDUCE BACTERIAL TRANSLOCATION AND INFLAMMATION AND INCREASE EXPRESSION OF HUNGER-SUPPRESSING HORMONES. REDUCED AMOUNTS OF BENEFICIAL MICRO-ORGANISMS ALSO INHIBIT FASTING-INDUCED ADIPOCYTE FACTOR EXPRESSION LEADING TO DYSLIPIDAEMIA. A LOW-GRADE CHRONIC INFLAMMATION (METABOLIC ENDOTOXAEMIA) ENSUES WHICH CULMINATES IN OBESITY AND ITS CO-MORBIDITIES. THE SYNERGY OF HIGH-FAT DIET AND DYSBIOTIC GUT MICROBIOTA INITIATES A RECIPE THAT EPIGENETICALLY PROGRAMMES THE HOST FOR INCREASED ADIPOSITY AND POOR GLYCAEMIC CONTROL. INTERESTINGLY, THESE OBESOGENIC MECHANISTIC PATHWAYS THAT ARE TRANSMITTABLE FROM ONE GENERATION TO ANOTHER CAN BE MODULATED THROUGH THE ADMINISTRATION OF PROBIOTICS, PREBIOTICS AND SYNBIOTICS. THOUGH THE INFLUENCE OF GUT MICROBIOTA ON THE RISK OF OBESITY AND SEVERAL INTERVENTION STRATEGIES HAVE BEEN EXTENSIVELY DEMONSTRATED IN ANIMAL MODELS, APPLICATION IN HUMANS STILL REQUIRES FURTHER ROBUST INVESTIGATION. 2020 10 1226 27 CRITICAL ROLE OF GUT MICROBIOTA AND EPIGENETIC FACTORS IN THE PATHOGENESIS OF BEHCET'S DISEASE. BEHCET'S DISEASE (BD) IS A CHRONIC REFRACTORY MULTISYSTEM AUTOINFLAMMATORY DISEASE, CHARACTERIZED BY TYPICAL CLINICAL FEATURES OF NON-SPECIFIC VASCULITIS, ORAL AND GENITAL ULCERS, UVEITIS, AS WELL AS SKIN LESIONS. THE EXACT ETIOPATHOGENESIS OF BD REMAINS UNKNOWN, EXISTING STUDIES HAVE INDICATED THAT GENETICS AND ENVIRONMENTAL FACTORS CONTRIBUTE TO THE INCREASED DEVELOPMENT OF BD. RECENTLY, SEVERAL STUDIES HAVE SHOWN THAT EXTERNAL ENVIRONMENTAL FACTORS CAN AFFECT THE PROCESS OF EPIGENETIC MODIFICATION, AND ABNORMALITIES OF EPIGENETIC FACTORS HAVE BEEN CONFIRMED TO BE INVOLVED IN THE OCCURRENCE OF BD. AT THE SAME TIME, ABNORMALITIES OF GUT MICROBIOTA (GM) IN THE BODY, HAVE ALSO BEEN CONFIRMED TO PARTICIPATE IN THE PATHOGENESIS OF BD BY REGULATING THE BALANCE OF TH17/TREGS. THIS ARTICLE REVIEWS THE PATHOGENESIS OF BD AND SUMMARIZES NUMEROUS CLINICAL STUDIES, FOCUSING ON THE MECHANISM OF GM AND EPIGENETIC FACTORS IMPACTING ON BD, AND PROVIDING NEW IDEAS FOR FURTHER ELUCIDATING THE PATHOGENESIS OF BD. 2021 11 1933 24 ENVIRONMENTAL FACTORS ASSOCIATED WITH TYPE 1 DIABETES. TYPE 1 DIABETES (T1D) IS A CHRONIC AUTOIMMUNE DISORDER THAT LEADS TO PROGRESSIVE PANCREATIC SS-CELL DESTRUCTION AND CULMINATES IN ABSOLUTE INSULIN DEFICIENCY AND STABLE HYPERGLYCAEMIA. IT IS VERY LIKELY THAT ENVIRONMENTAL FACTORS PLAY A ROLE IN TRIGGERING ISLET AUTOIMMUNITY. KNOWING WHETHER THEY HAVE TRUE RELEVANCE IN FAVORING T1D DEVELOPMENT IS ESSENTIAL FOR THE EFFECTIVE PREVENTION OF THE DISEASE. MOREOVER, PREVENTION COULD BE OBTAINED DIRECTLY INTERFERING WITH THE DEVELOPMENT OF AUTOIMMUNITY THROUGH AUTOANTIGEN-BASED IMMUNOTHERAPY. IN THIS NARRATIVE REVIEW, THE PRESENT POSSIBILITIES FOR THE PREVENTION OF T1D ARE DISCUSSED. PRESENTLY, INTERVENTIONS TO PREVENT T1D ARE GENERALLY MADE IN SUBJECTS IN WHOM AUTOIMMUNITY IS ALREADY ACTIVATED AND AUTOANTIBODIES AGAINST PANCREATIC CELL COMPONENTS HAVE BEEN DETECTED. PRACTICALLY, THE GOAL IS TO SLOW DOWN THE IMMUNE PROCESS BY PRESERVING THE NORMAL STRUCTURE OF THE PANCREATIC ISLETS FOR AS LONG AS POSSIBLE. UNFORTUNATELY, PRESENTLY METHODS ABLE TO AVOID THE RISK OF AUTOIMMUNE ACTIVATION ARE NOT AVAILABLE. ELIMINATION OF ENVIRONMENTAL FACTORS ASSOCIATED WITH T1D DEVELOPMENT, REVERSE OF EPIGENETIC MODIFICATIONS THAT FAVOR INITIATION OF AUTOIMMUNITY IN SUBJECTS EXPOSED TO ENVIRONMENTAL FACTORS AND USE OF AUTOANTIGEN-BASED IMMUNOTHERAPY ARE POSSIBLE APPROACHES, ALTHOUGH FOR ALL THESE MEASURES DEFINITIVE CONCLUSIONS CANNOT BE DRAWN. HOWEVER, THE ROAD IS TRACED AND IT IS POSSIBLE THAT IN A NOT SO DISTANT FUTURE AN EFFECTIVE PREVENTION OF THE DISEASE TO ALL THE SUBJECTS AT RISK CAN BE OFFERED. 2019 12 5317 27 PSYCHOLOGICAL STRESS, INTESTINAL BARRIER DYSFUNCTIONS, AND AUTOIMMUNE DISORDERS: AN OVERVIEW. AUTOIMMUNE DISORDERS (ADS) ARE MULTIFACTORIAL DISEASES INVOLVING, GENETIC, EPIGENETIC, AND ENVIRONMENTAL FACTORS CHARACTERIZED BY AN INAPPROPRIATE IMMUNE RESPONSE TOWARD SELF-ANTIGENS. IN THE PAST DECADES, THERE HAS BEEN A CONTINUOUS RISE IN THE INCIDENCE OF ADS, WHICH CANNOT BE EXPLAINED BY GENETIC FACTORS ALONE. INFLUENCE OF PSYCHOLOGICAL STRESS ON THE DEVELOPMENT OR THE COURSE OF AUTOIMMUNE DISORDERS HAS BEEN DISCUSSED FOR A LONG TIME. INDEED, BASED ON EPIDEMIOLOGICAL STUDIES, STRESS HAS BEEN SUGGESTED TO PRECEDE AD OCCURRENCE AND TO EXACERBATE SYMPTOMS. FURTHERMORE, COMPILING DATA SHOWED THAT MOST OF ADS ARE ASSOCIATED WITH GASTROINTESTINAL SYMPTOMS, THAT IS, MICROBIOTA DYSBIOSIS, INTESTINAL HYPERPERMEABILITY, AND INTESTINAL INFLAMMATION. INTERESTINGLY, SOCIAL STRESS (ACUTE OR CHRONIC, IN ADULT OR IN NEONATE) IS A WELL-DESCRIBED INTESTINAL DISRUPTING FACTOR. TAKEN TOGETHER, THOSE OBSERVATIONS QUESTION A POTENTIAL ROLE OF STRESS-INDUCED DEFECT OF THE INTESTINAL BARRIER IN THE ONSET AND/OR THE COURSE OF ADS. IN THIS REVIEW, WE AIM TO PRESENT EVIDENCES SUPPORTING THE HYPOTHESIS FOR A ROLE OF STRESS-INDUCED INTESTINAL BARRIER DISRUPTION IN THE ONSET AND/OR THE COURSE OF ADS. WE WILL MAINLY FOCUS ON AUTOIMMUNE TYPE 1 DIABETES, MULTIPLE SCLEROSIS AND SYSTEMIC LUPUS ERYTHEMATOSUS, ADS FOR WHICH WE COULD FIND SUFFICIENT CIRCUMSTANTIAL DATA TO SUPPORT THIS HYPOTHESIS. WE EXCLUDED GASTROINTESTINAL (GI) ADS LIKE COELIAC DISEASE TO PRIVILEGE ADS NOT FOCUSED ON INTESTINAL DISORDERS TO AVOID CONFOUNDING FACTORS. INDEED, GIADS ARE CHARACTERIZED BY ANTIBODIES DIRECTED AGAINST INTESTINAL BARRIER ACTORS. 2020 13 6254 27 THE MICROBIOME AND IRRITABLE BOWEL SYNDROME - A REVIEW ON THE PATHOPHYSIOLOGY, CURRENT RESEARCH AND FUTURE THERAPY. IRRITABLE BOWEL SYNDROME (IBS) IS A FUNCTIONAL DISORDER WHICH AFFECTS A LARGE PROPORTION OF THE POPULATION GLOBALLY. THE PRECISE ETIOLOGY OF IBS IS STILL UNKNOWN, ALTHOUGH CONSENSUS UNDERSTANDING PROPOSES IBS TO BE OF MULTIFACTORIAL ORIGIN WITH YET UNDEFINED SUBTYPES. GENETIC AND EPIGENETIC FACTORS, STRESS-RELATED NERVOUS AND ENDOCRINE SYSTEMS, IMMUNE DYSREGULATION AND THE BRAIN-GUT AXIS SEEM TO BE CONTRIBUTING FACTORS THAT PREDISPOSE INDIVIDUALS TO IBS. IN ADDITION TO FOOD HYPERSENSITIVITY, TOXINS AND ADVERSE LIFE EVENTS, CHRONIC INFECTIONS AND DYSBIOTIC GUT MICROBIOTA HAVE BEEN SUGGESTED TO TRIGGER IBS SYMPTOMS IN TANDEM WITH THE PREDISPOSING FACTORS. THIS REVIEW WILL SUMMARIZE THE PATHOPHYSIOLOGY OF IBS AND THE ROLE OF GUT MICROBIOTA IN RELATION TO IBS. CURRENT METHODOLOGIES FOR MICROBIOME STUDIES IN IBS SUCH AS GENOME SEQUENCING, METAGENOMICS, CULTUROMICS AND ANIMAL MODELS WILL BE DISCUSSED. THE MYRIAD OF THERAPY OPTIONS SUCH AS IMMUNOGLOBULINS (IMMUNE-BASED THERAPY), PROBIOTICS AND PREBIOTICS, DIETARY MODIFICATIONS INCLUDING FODMAP RESTRICTION DIET AND GLUTEN-FREE DIET, AS WELL AS FECAL TRANSPLANTATION WILL BE REVIEWED. FINALLY THIS REVIEW WILL HIGHLIGHT FUTURE DIRECTIONS IN IBS THERAPY RESEARCH, INCLUDING IDENTIFICATION OF NEW MOLECULAR TARGETS, APPLICATION OF 3-D GUT MODEL, GUT-ON-A-CHIP AND PERSONALIZED THERAPY. 2019 14 6169 25 THE GUT MICROBIOTA AND HEALTHY AGING: A MINI-REVIEW. THE GUT MICROBIOTA SHOWS A WIDE INTER-INDIVIDUAL VARIATION, BUT ITS WITHIN-INDIVIDUAL VARIATION IS RELATIVELY STABLE OVER TIME. A FUNCTIONAL CORE MICROBIOME, PROVIDED BY ABUNDANT BACTERIAL TAXA, SEEMS TO BE COMMON TO VARIOUS HUMAN HOSTS REGARDLESS OF THEIR GENDER, GEOGRAPHIC LOCATION, AND AGE. WITH ADVANCING CHRONOLOGICAL AGE, THE GUT MICROBIOTA BECOMES MORE DIVERSE AND VARIABLE. HOWEVER, WHEN MEASURES OF BIOLOGICAL AGE ARE USED WITH ADJUSTMENT FOR CHRONOLOGICAL AGE, OVERALL RICHNESS DECREASES, WHILE A CERTAIN GROUP OF BACTERIA ASSOCIATED WITH FRAILTY INCREASES. THIS HIGHLIGHTS THE IMPORTANCE OF CONSIDERING BIOLOGICAL OR FUNCTIONAL MEASURES OF AGING. STUDIES USING MODEL ORGANISMS INDICATE THAT AGE-RELATED GUT DYSBIOSIS MAY CONTRIBUTE TO UNHEALTHY AGING AND REDUCED LONGEVITY. THE GUT MICROBIOME DEPENDS ON THE HOST NUTRIENT SIGNALING PATHWAYS FOR ITS BENEFICIAL EFFECTS ON HOST HEALTH AND LIFESPAN, AND GUT DYSBIOSIS DISRUPTING THE INTERDEPENDENCE MAY DIMINISH THE BENEFICIAL EFFECTS OR EVEN HAVE REVERSE EFFECTS. GUT DYSBIOSIS CAN TRIGGER THE INNATE IMMUNE RESPONSE AND CHRONIC LOW-GRADE INFLAMMATION, LEADING TO MANY AGE-RELATED DEGENERATIVE PATHOLOGIES AND UNHEALTHY AGING. THE GUT MICROBIOTA COMMUNICATES WITH THE HOST THROUGH VARIOUS BIOMOLECULES, NUTRIENT SIGNALING-INDEPENDENT PATHWAYS, AND EPIGENETIC MECHANISMS. DISTURBANCE OF THESE COMMUNICATIONS BY AGE-RELATED GUT DYSBIOSIS CAN AFFECT THE HOST HEALTH AND LIFESPAN. THIS MAY EXPLAIN THE IMPACT OF THE GUT MICROBIOME ON HEALTH AND AGING. 2018 15 1398 35 DIET, GUT MICROBIOME AND EPIGENETICS: EMERGING LINKS WITH INFLAMMATORY BOWEL DISEASES AND PROSPECTS FOR MANAGEMENT AND PREVENTION. INFLAMMATORY BOWEL DISEASES (IBD) REPRESENT A GROWING PUBLIC HEALTH CONCERN DUE TO INCREASING INCIDENCE WORLDWIDE. THE CURRENT NOTION ON THE PATHOGENESIS OF IBD IS THAT GENETICALLY SUSCEPTIBLE INDIVIDUALS DEVELOP INTOLERANCE TO DYSREGULATED GUT MICROFLORA (DYSBIOSIS) AND CHRONIC INFLAMMATION DEVELOPS AS A RESULT OF ENVIRONMENTAL TRIGGERS. AMONG THE ENVIRONMENTAL FACTORS ASSOCIATED WITH IBD, DIET PLAYS AN IMPORTANT ROLE IN MODULATING THE GUT MICROBIOME, INFLUENCING EPIGENETIC CHANGES, AND, THEREFORE, COULD BE APPLIED AS A THERAPEUTIC TOOL TO IMPROVE THE DISEASE COURSE. NEVERTHELESS, THE CURRENT DIETARY RECOMMENDATIONS FOR DISEASE PREVENTION AND MANAGEMENT ARE SCARCE AND HAVE WEAK EVIDENCE. THIS REVIEW SUMMARISES THE CURRENT KNOWLEDGE ON THE COMPLEX INTERACTIONS BETWEEN DIET, MICROBIOME AND EPIGENETICS IN IBD. WHEREAS AN OVERABUNDANCE OF CALORIES AND SOME MACRONUTRIENTS INCREASE GUT INFLAMMATION, SEVERAL MICRONUTRIENTS HAVE THE POTENTIAL TO MODULATE IT. IMMUNONUTRITION HAS EMERGED AS A NEW CONCEPT PUTTING FORWARD THE IMPORTANCE OF VITAMINS SUCH AS VITAMINS A, C, E, AND D, FOLIC ACID, BETA CAROTENE AND TRACE ELEMENTS SUCH AS ZINC, SELENIUM, MANGANESE AND IRON. HOWEVER, WHEN ASSESSED IN CLINICAL TRIALS, SPECIFIC MICRONUTRIENTS EXERTED A LIMITED BENEFIT. BEYOND NUTRIENTS, AN ANTI-INFLAMMATORY DIETARY PATTERN AS A COMPLEX INTERVENTION APPROACH HAS BECOME POPULAR IN RECENT YEARS. HENCE, EXCLUSIVE ENTERAL NUTRITION IN PAEDIATRIC CROHN'S DISEASE IS THE ONLY NUTRITIONAL INTERVENTION CURRENTLY RECOMMENDED AS A FIRST-LINE THERAPY. OTHER NUTRITIONAL INTERVENTIONS OR SPECIFIC DIETS INCLUDING THE SPECIFIC CARBOHYDRATE DIET (SCD), THE LOW FERMENTABLE OLIGOSACCHARIDES, DISACCHARIDES, MONOSACCHARIDES, AND POLYOL (FODMAP) DIET AND, MOST RECENTLY, THE MEDITERRANEAN DIET HAVE SHOWN STRONG ANTI-INFLAMMATORY PROPERTIES AND SHOW PROMISE FOR IMPROVING DISEASE SYMPTOMS. MORE WORK IS REQUIRED TO EVALUATE THE ROLE OF INDIVIDUAL FOOD COMPOUNDS AND COMPLEX NUTRITIONAL INTERVENTIONS WITH THE POTENTIAL TO DECREASE INFLAMMATION AS A MEANS OF PREVENTION AND MANAGEMENT OF IBD. 2017 16 105 33 A REVIEW OF MICROBIOTA AND IRRITABLE BOWEL SYNDROME: FUTURE IN THERAPIES. IRRITABLE BOWEL SYNDROME (IBS), ONE OF THE MOST FREQUENT DIGESTIVE DISORDERS, IS CHARACTERIZED BY CHRONIC AND RECURRENT ABDOMINAL PAIN AND ALTERED BOWEL HABIT. THE ORIGIN SEEMS TO BE MULTIFACTORIAL AND IS STILL NOT WELL DEFINED FOR THE DIFFERENT SUBTYPES. GENETIC, EPIGENETIC AND SEX-RELATED MODIFICATIONS OF THE FUNCTIONING OF THE NERVOUS AND IMMUNE-ENDOCRINE SUPERSYSTEMS AND REGULATION OF BRAIN-GUT PHYSIOLOGY AND BILE ACID PRODUCTION AND ABSORPTION ARE CERTAINLY INVOLVED. ACQUIRED PREDISPOSITION MAY ACT IN CONJUNCTION WITH INFECTIOUS, TOXIC, DIETARY AND LIFE EVENT-RELATED FACTORS TO ENHANCE EPITHELIAL PERMEABILITY AND ELICIT MUCOSAL MICROINFLAMMATION, IMMUNE ACTIVATION AND DYSBIOSIS. NOTABLY, STRONG EVIDENCE SUPPORTS THE ROLE OF BACTERIAL, VIRAL AND PARASITIC INFECTIONS IN TRIGGERING IBS, AND TARGETING MICROBIOTA SEEMS PROMISING IN VIEW OF THE POSITIVE RESPONSE TO MICROBIOTA-RELATED THERAPIES IN SOME PATIENTS. HOWEVER, THE LACK OF HIGHLY PREDICTIVE DIAGNOSTIC BIOMARKERS AND THE COMPLEXITY AND HETEROGENEITY OF IBS PATIENTS MAKE MANAGEMENT DIFFICULT AND UNSATISFACTORY IN MANY CASES, REDUCING PATIENT HEALTH-RELATED QUALITY OF LIFE AND INCREASING THE SANITARY BURDEN. THIS ARTICLE REVIEWS SPECIFIC ALTERATIONS AND INTERVENTIONS TARGETING THE GUT MICROBIOTA IN IBS, INCLUDING PREBIOTICS, PROBIOTICS, SYNBIOTICS, NON-ABSORBABLE ANTIBIOTICS, DIETS, FECAL TRANSPLANTATION AND OTHER POTENTIAL FUTURE APPROACHES USEFUL FOR THE DIAGNOSIS, PREVENTION AND TREATMENT OF IBS. 2018 17 5231 23 PROBIOTICS AND AMELIORATION OF RHEUMATOID ARTHRITIS: SIGNIFICANT ROLES OF LACTOBACILLUS CASEI AND LACTOBACILLUS ACIDOPHILUS. RHEUMATOID ARTHRITIS IS A CHRONIC AUTOIMMUNE DISORDER THAT CAN LEAD TO DISABILITY CONDITIONS WITH SWOLLEN JOINTS, PAIN, STIFFNESS, CARTILAGE DEGRADATION, AND OSTEOPOROSIS. GENETIC, EPIGENETIC, SEX-SPECIFIC FACTORS, SMOKING, AIR POLLUTION, FOOD, ORAL HYGIENE, PERIODONTITIS, PREVOTELLA, AND IMBALANCE IN THE GASTROINTESTINAL MICROBIOTA ARE POSSIBLE SOURCES OF THE INITIATION OR PROGRESSION OF RHEUMATOID ARTHRITIS, ALTHOUGH THE DETAILED MECHANISMS STILL NEED TO BE ELUCIDATED. PROBIOTICS CONTAINING LACTOBACILLUS SPP. ARE COMMONLY USED AS ALLEVIATING AGENTS OR FOOD SUPPLEMENTS TO MANAGE DIARRHEA, DYSENTERY, DEVELOP IMMUNITY, AND MAINTAIN GENERAL HEALTH. THE MECHANISM OF ACTION OF LACTOBACILLUS SPP. AGAINST RHEUMATOID ARTHRITIS IS STILL NOT CLEARLY KNOWN TO DATE. IN THIS NARRATIVE REVIEW, WE RECAPITULATE THE FINDINGS OF RECENT STUDIES TO UNDERSTAND THE OVERALL PATHOGENESIS OF RHEUMATOID ARTHRITIS AND THE ROLES OF PROBIOTICS, PARTICULARLY L. CASEI OR L. ACIDOPHILUS, IN THE MANAGEMENT OF RHEUMATOID ARTHRITIS IN CLINICAL AND PRECLINICAL STUDIES. 2021 18 3283 32 HIDDEN ROLE OF GUT MICROBIOME DYSBIOSIS IN SCHIZOPHRENIA: ANTIPSYCHOTICS OR PSYCHOBIOTICS AS THERAPEUTICS? SCHIZOPHRENIA IS A CHRONIC, HETEROGENEOUS NEURODEVELOPMENTAL DISORDER THAT HAS COMPLEX SYMPTOMS AND UNCERTAIN ETIOLOGY. MOUNTING EVIDENCE INDICATES THE INVOLVEMENT OF GENETICS AND EPIGENETIC DISTURBANCES, ALTERATION IN GUT MICROBIOME, IMMUNE SYSTEM ABNORMALITIES, AND ENVIRONMENTAL INFLUENCE IN THE DISEASE, BUT A SINGLE ROOT CAUSE AND MECHANISM INVOLVED HAS YET TO BE CONCLUSIVELY DETERMINED. CONSEQUENTLY, THE IDENTIFICATION OF DIAGNOSTIC MARKERS AND THE DEVELOPMENT OF PSYCHOTIC DRUGS FOR THE TREATMENT OF SCHIZOPHRENIA FACES A HIGH FAILURE RATE. THIS ARTICLE SURVEYS THE ETIOLOGY OF SCHIZOPHRENIA WITH A PARTICULAR FOCUS ON GUT MICROBIOTA REGULATION AND THE MICROBIAL SIGNALING SYSTEM THAT CORRELATES WITH THE BRAIN THROUGH THE VAGUS NERVE, ENTERIC NERVOUS SYSTEM, IMMUNE SYSTEM, AND PRODUCTION OF POSTBIOTICS. GUT MICROBIALLY PRODUCED MOLECULES MAY LAY THE GROUNDWORK FOR FURTHER INVESTIGATIONS INTO THE ROLE OF GUT MICROBIOTA DYSBIOSIS AND THE PATHOPHYSIOLOGY OF SCHIZOPHRENIA. CURRENT TREATMENT OF SCHIZOPHRENIA IS LIMITED TO PSYCHOTHERAPY AND ANTIPSYCHOTIC DRUGS THAT HAVE SIGNIFICANT SIDE EFFECTS. THEREFORE, ALTERNATIVE THERAPEUTIC OPTIONS MERIT EXPLORATION. THE USE OF PSYCHOBIOTICS ALONE OR IN COMBINATION WITH ANTIPSYCHOTICS MAY PROMOTE THE DEVELOPMENT OF NOVEL THERAPEUTIC STRATEGIES. IN VIEW OF THE INDIVIDUAL GUT MICROBIOME STRUCTURE AND PERSONALIZED RESPONSE TO ANTIPSYCHOTIC DRUGS, A TAILORED AND TARGETED MANIPULATION OF GUT MICROBIAL DIVERSITY NATURALLY BY NOVEL PREBIOTICS (NON-DIGESTIBLE FIBER) MAY BE A SUCCESSFUL ALTERNATIVE THERAPEUTIC FOR THE TREATMENT OF SCHIZOPHRENIA PATIENTS. 2021 19 3692 35 INFLAMMATORY BOWEL DISEASES: THE ROLE OF GUT MICROBIOTA. INFLAMMATORY BOWEL DISEASES (IBD) ARE CHRONIC MULTIFACTORIAL DISEASES CHARACTERIZED BY PARTIALLY UNCLEAR PATHOGENIC MECHANISMS INCLUDING CHANGES IN INTESTINAL MICROBIOTA. DESPITE THE MICROBIOTA, ALTERATION IS WELL ESTABLISHED IN IBD PATIENTS, AS REPORTED BY 16RNA SEQUENCING ANALYSIS, AN IMPORTANT GOAL IS TO DEFINE IF IT IS JUST A CONSEQUENCE OF THE DISEASE PROGRESSION OR A TRIGGER FACTOR OF THE DISEASE ITSELF. TO DATE, GUT MICROBIOTA COMPOSITION AND GUT MICROBIOTA-RELATED METABOLITES SEEM TO AFFECT THE HOST HEALTHY STATE BOTH BY MODULATING METABOLIC PATHWAYS OR ACTING ON THE EXPRESSION OF DIFFERENT GENES THROUGH EPIGENETIC EFFECTS. BECAUSE OF THIS, IT HAS BEEN SUGGESTED THAT INTESTINAL MICROBIOTA MIGHT REPRESENT A PROMISING THERAPEUTIC TARGET FOR IBD PATIENTS. THE AIM OF THIS REVIEW IS TO SUMMARIZE BOTH THE MOST RECENT ACQUISITIONS IN THE FIELD OF GUT MICROBIOTA AND ITS INVOLVEMENT IN INTESTINAL INFLAMMATION TOGETHER WITH THE AVAILABLE STRATEGIES FOR THE MODULATION OF MICROBIOTA, SUCH AS PREBIOTICS AND/OR PROBIOTICS ADMINISTRATION OR FECAL MICROBIOTA TRANSPLANTATION. 2020 20 3173 19 GUT MICROBIOTA-MICRORNA INTERACTIONS IN ANKYLOSING SPONDYLITIS. ANKYLOSING SPONDYLITIS (AS) IS A CHRONIC AUTOIMMUNE INFLAMMATORY DISABILITY THAT IS PART OF THE RHEUMATIC DISEASE GROUP OF SPONDYLOARTHROPATHIES. AS COMMONLY INFLUENCES THE JOINTS OF THE AXIAL SKELETON. THE CONTRIBUTIONS TO AS PATHOGENESIS OF GENETIC SUSCEPTIBILITY (PARTICULARLY HLA-B27 AND ERAP-1) AND EPIGENETIC MODIFICATIONS, LIKE NON-CODING RNAS, AS WELL AS ENVIRONMENTAL FACTORS, HAVE BEEN INVESTIGATED OVER THE LAST FEW YEARS. BUT THE FUNDAMENTAL ETIOLOGY OF AS REMAINS ELUSIVE TO DATE. THE EVIDENCE SUMMARIZED HERE INDICATES THAT IN THE IMMUNOPATHOGENESIS OF AS, MICRORNAS AND THE GUT MICROBIOME PERFORM CRITICAL FUNCTIONS. WE DISCUSS SIGNIFICANT ADVANCES IN THE IMMUNOLOGICAL MECHANISMS UNDERLYING AS AND ADDRESS POTENTIAL CROSS-TALK BETWEEN THE GUT MICROBIOME AND HOST MICRORNAS. THIS CRITICAL INTERACTION IMPLICATES A CO-EVOLUTIONARY SYMBIOTIC LINK BETWEEN HOST IMMUNITY AND THE GUT MICROBIOME. 2021