cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2024-39-1-38-43cardiotomsk-2182Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESМикробиота кишечника – новое звено в патогенезе остеоартрита (обзор литературы)Gut microbiota – a new link in the pathogenesis of osteoarthritis (literature review)https://orcid.org/0000-0002-8080-904XКорневаЮ. С.KornevaYu. S.

Корнева Юлия Сергеевна, канд. мед. наук, доцент кафедры патологической анатомии, СЗГМУ им. И.И. Мечникова; доцент кафедры патологической анатомии, СГМУ Минздрава России; научный сотрудник научного отделения профилактики и лечения раневой инфекции ФГБУ «НМИЦ ТО им. Р.Р. Вредена» Минздрава России

195427, г. Санкт-Петербург, ул. академика Байкова, 8191015, Российская Федерация, Санкт-Петербург, ул. Кирочная, 41214018, Российская Федерация, Смоленск, ул. Крупской, 28

Yulia S. Korneva, Cand. Sci. (Med.), Associate Professor, Department of Pathological Anatomy, North-Western Medical University named after I.I. Mechnikov; Associate Professor, Department of Pathological Anatomy, Smolensk State Medical University; Resercher of the Scientific Department of Treatment and Prophylaxis of Wound infection in Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden

8, Academician Baykova str. 195427, St. Petersburg, Russian Federation41, Kirochnaya str., St. Petersburg, 191015, Russian Federation28, Krupskaya str., Smolensk, 214018, Russian Federation

ksu1546@yandex.ruБорисенкоМ. В.BorisenkoM. V.

Борисенко Марина Владимировна, студент лечебного факультета, СЗГМУ им. И.И. Мечникова

191015, Российская Федерация, Санкт-Петербург, ул. Кирочная, 41

Marina V. Borisenko, Student, North-Western Medical University named after I.I. Mechnikov

41, Kirochnaya str., St. Petersburg, 191015, Russian Federation

marina-borisenko-2000@mail.ruhttps://orcid.org/0000-0001-8389-3841ДеевР. В.DeevR. V.

Деев Роман Вадимович, канд. мед. наук, доцент, первый заместитель директора НИИМЧ им. акад. А.П. Авцына» ФГБНУ «РНЦХ им. акад. Б.В. Петровского

117418, г. Москва, ул. Цюрупы, 3

Roman V. Deev, Cand. Sci. (Med.), Associate Professor, First Deputy Director in Avtsyn Research Institute of Human Morphology of Federal state budgetary scientific institution “Petrovsky National Research Centre of Surgery”

3 Tsyurupy str., Moscow, 117418, Russian Federation

Roman.Deev@szgmu.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр травматологии и ортопедии имени Р.Р. Вредена» Министерства здравоохранения Российской Федерации (ФГБУ «НМИЦ ТО им. Р.Р. Вредена» Минздрава России); Северо-Западный государственный медицинский университет имени И.И. Мечникова Министерства здравоохранения Российской Федерации (СЗГМУ им. И.И. Мечникова); Смоленский государственный медицинский университет Министерства здравоохранения Российской Федерации (СГМУ Минздрава России)РоссияRussian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden; North-Western State Medical University named after I.I. Mechnikov; Smolensk State Medical University of the Ministry of Health of the Russian FederationRussian FederationСеверо-Западный государственный медицинский университет имени И.И. Мечникова Министерства здравоохранения Российской Федерации (СЗГМУ им. И.И. Мечникова)РоссияNorth-Western State Medical University named after I.I. MechnikovRussian Federation«Научно-исследовательский институт морфологии человека имени академика А.П. Авцына» Федерального государственного бюджетного научного учреждения «Российский научный центр хирургии имени академика Б.В. Петровского» (НИИМЧ им. акад. А.П. Авцына» ФГБНУ «РНЦХ им. акад. Б.В. Петровского)РоссияAvtsyn Research Institute of Human Morphology of Federal state budgetary scientific institution “Petrovsky National Research Centre of Surgery”Russian Federation2024040420243913843Copyright © Корнева Ю.С., Борисенко М.В., Деев Р.В., 20242024Корнева Ю.С., Борисенко М.В., Деев Р.В.Korneva Y.S., Borisenko M.V., Deev R.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/2182

Кишечная микробиота (КМБ) может опосредованно на системном уровне влиять на протекание остеартрита (ОА) за счет стимуляции хронической неспецифической воспалительной реакции в синовиальной оболочке и субхондральной кости. Ее причиной является повышение количества циркулирующих липополисахаридов (ЛПС) бактериальной стенки. КМБ может также провоцировать развитие метаболического синдрома, что связывает две необходимые составляющие патогенеза ОА. Результатом прямого воздействия КМБ является формирование синдрома повышенной кишечной проницаемости (leaky gut syndrome) с активацией ЛПС бактериальной стенки и слабовыраженного воспаления, провоцирующего выработку провоспалительных цитокинов. Их воздействие активирует синовиоциты и хондроциты с последующей продукцией IL-6 и IL-8, что способствует персистенции воспаления. Корреляционный анализ показал связь трех таксонов с поражением суставов ОА. Порядок Desulfovibrionales и род Ruminiclostridium 5 связан с ОА коленного сустава, семейство Methanobacteriaceae – как с ОА коленного сустава, так и ОА любой локализации. Появление и степень обсемененности родом Streptococcus коррелировали с выраженностью болевого синдрома. Метаболический синдром может как провоцировать развитие дисбактериоза, так и являться его следствием. Изменение состава микробиоты в виде преобладания рода Clostridium и вида Staphylococcus aureus при снижении разнообразия микроорганизмов ассоциировано с увеличением количества жировой ткани в организме, дислипидемией, инсулинорезистентностью с нарушениями углеводного обмена. Низкие уровни ЛПС в крови обнаруживаются у пациентов с ожирением даже при отсутствии явного очага инфекции из-за нарушений в КМБ, они подают сигналы на TLR-4, запуская системное воспаление. В исследованиях было показано положительное влияние назначения прои пребиотиков на течение ОА, что делает КМБ перспективной мишенью лечения и профилактики ОА.

The intestinal microbiota (IMB) can indirectly affect the course of ostearthritis (OA) at the systemic level by stimulating a chronic nonspecific inflammatory reaction in the synovial membrane and subchondral bone, the cause of which is an increase in the amount of circulating lipopolysaccharides (LPS) of the bacterial wall, as well as provoke the development of metabolic syndrome, which links the two necessary components of the pathogenesis of OA. The result of direct exposure is the formation of leaky gut syndrome with the activation of LPS of the bacterial wall of mild inflammation, provoking the production of proinflammatory cytokines, the effect of which on synoviocytes and chondrocytes leads to their activation with subsequent production of IL-6 and IL-8, which contributes to the persistence of inflammation. By correlation analysis, the relationship of three taxa with OA joint damage was proved, namely, the order Desulfovibrionales and the genus Ruminiclostridium 5 – with knee joint OA, Methanobacteriaceae – with knee joint OA, and OA of any localization, and the appearance and degree of contamination with the genus Streptococcus correlated with the severity of pain syndrome. The metabolic syndrome itself can provoke the development of dysbiosis, so it can also be its consequence. A change in the composition of the microbiota in the form of the predominance of the genus Clostridium and the species Staphylococcus aureus with a decrease in the diversity of microorganisms is associated with an increase in the amount of adipose tissue in the body, dyslipidemia, insulin resistance with impaired carbohydrate metabolism. Low levels of LPS in the blood are found in obese patients even in the absence of an obvious focus of infection due to violations in the CMB, they signal TLR-4, triggering systemic inflammation. Studies have shown a positive effect of prescribing proand prebiotics on the course of OA, which makes IMB a promising target for the treatment and prevention of OA.

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The authors declare that there are no conflicts of interest present.