Is there a role for microbiome-based approach in common variable immunodeficiency?

Abstract

Common variable immunodeficiency (CVID) is a primary immunodeficiency characterized by low levels of serum immunoglobulins and increased susceptibility to infections, autoimmune disorders and cancer. CVID embraces a plethora of heterogeneous manifestations linked to complex immune dysregulation. While CVID is thought to be due to genetic defects, the exact cause of this immune disorder is unknown in the large majority of cases. Compelling evidences support a linkage between the gut microbiome and the CVID pathogenesis, therefore a potential for microbiome-based treatments to be a therapeutic pathway for this disorder. Here we discuss the potential of treating CVID patients by developing a gut microbiome-based personalized approach, including diet, prebiotics, probiotics, postbiotics and fecal microbiota transplantation. We also highlight the need for a better understanding of microbiota-host interactions in CVID patients to prime the development of improved preventive strategies and specific therapeutic targets.

Characterization of infectious and non-infectious gastrointestinal disease in common variable immunodeficiency: analysis of 114 patient cohort

“…Given these findings, it is hypothesized that other mechanisms unrelated to H. pylori may promote chronic gastric mucosal inflammation in CVID. These mechanisms could include immune dysregulation and dysbiosis, as previously mentioned ( 52 , 57 ). Pernicious anemia has also been associated with CVID, affecting up to 15% of patients ( 58 ).…”

“…Finally, compelling evidence links chronic treatment with antibiotics, pervasive use of anti-inflammatories, and a dysregulated immune microenvironment to increased likelihood of a perturbed gut microbiome in CVID ( 49 ). Therapeutic approaches are still being examined to modify the composition of the gut microbiome which may prove to be beneficial, such as high fiber diets that can augment the percentage of microbes that product short chain fatty acids, ingestion of bacterial nutrients (prebiotics), and ingestion of probiotics or fecal microbial transplant that introduce “healthy” commensals ( 52 ).…”

The Role of Gut Microbiota and Leaky Gut in the Pathogenesis of Food Allergy

“…Gut bacteria ferment prebiotics and induce the production and release of short-chain fatty acids (SCFAs) in the lumen [ 50 , 160 ]. SCFAs can specifically interact with intestinal epithelial cells and innate/adaptive immune cells to influence cellular differentiation, proliferation, and apoptosis [ 161 ].…”

Management of liver disease and portal hypertension in common variable immunodeficiency (CVID)

“… 113 Poto et al. 114 suggest the administration of A. muciniphila as a live microorganism to preserve epithelial function and thus prevent microbial translocation. Furthermore, dysbiosis is an adverse effect of antibiotics, 115 which are widely used in CVID management.…”

“…Reports of pathogen transmission via FMT 121 emphasize the need for enhanced donor screening and faecal specimen preparation for immunocompromised patients, including those with CVID. 114 …”