Microbiota Alterations in Patients with Mucous Membrane Pemphigoid and Pemphigus Vulgaris: A Systematic Review

Abstract

The human oral cavity comprises an extensive range of microorganisms, viruses, bacteria, fungi, archaea, and protozoa, each having a particular role and interacting with each other and with the host in sickness or health. Changes in the microbiome composition can be crucial in balancing health and disease, locally and systemically. Various microbial species in commensal relationships form the oral microbiota, and when this commensalism undergoes variations the immune system can be pushed towards the activation of inflammatory and autoimmune processes. Through a systematic review of the literature, we set out to investigate the role that the oral microbiota can play in the development and evolution of pemphigus vulgaris and mucous membrane pemphigoid. We performed our systematic review by searching “microbiome OR microbiota” AND “pemphigus OR pemphigoid” on Medline, ISI Web of science and Embase, and we included randomized controlled trials (RCTs), prospective comparison studies, retrospective cohort studies, case–control studies, and case series. These autoimmune diseases need a genetic basis to develop, but as multifactorial pathologies they are influenced by environmental factors and the dysbiosis of the oral microbiota can be a trigger. If the human microbiome plays a critical role in the pathogenesis and manifestation of oral autoimmune diseases, the next step could be new and promising therapeutic approaches such as probiotics or prebiotics.

Analysis of a Combination Therapy Protocol for the Treatment of Oral Mucous Membrane Pemphigoid: A Retrospective Case Series Study

“…In a recent pilot study, it was observed that in subjects with pemphigus and BP, there is an imbalance in the oral microbiota, characterized by a reduction in Bacteroidetes and an increase in the phylum Firmicutes and the genus Staphylococcus [ 30 ]. Based on this evidence are new and promising therapeutic approaches, such as probiotics or prebiotics, especially in the adjuvant and prolonged treatment of MMP [ 31 ]. To rebalance the oral microbiota, oral probiotics could be important adjuvant factors to first-line therapies in the long-term management of MMP patients [ 32 ].…”

Alterations of circulating free fatty acids in patients with pemphigus vulgaris

“…7 It is well established that intestinal bacteria and their metabolites exert an active role in modulating adaptive immune responses 8,9 ; alterations of the gut microbiota (GM) composition and function have been shown to influence systemic inflammation in several autoimmune diseases, including psoriasis, atopic dermatitis, vitiligo and PV. 10 There is evidence that alterations of the GM influence pemphigus pathology: in one study, enriched Flavonifractor spp. were shown to correlate positively with serum levels of interleukin (IL) IL-17A and IL-21; in the same study, serum levels of IL-17A correlated negatively with both Lachnospiracea_incertae_sedis and Coprococcus genera.…”