La disbiosis de la microbiota oral, gastrointestinal y cutánea como factor asociado al LES: una revisión de alcance

Abstract

Introduction: Autoimmune diseases have a wide field of action from the different fronts of health care. Decision-making from the jurisdiction of each of the health professionals becomes a challenge for optimal health care, the decision-making capacity of the doctor and for patients to receive optimal clinical treatment. Part of the challenge in the approach to autoimmune pathologies, among which is Systemic Lupus Erythematosus (SLE), is to give more and more clarity to its etiology, and what factors may be associated with its development, among which the alteration arises of the microbiota as a possible risk factor. Our objective was to review the relationship between oral, gastrointestinal, and skin microbiota dysbiosis as a factor associated with SLE in adults. Methodology: Scoping Review which seeks to identify relevant studies on dysbiosis and its relationship and interaction with SLE. The articles were searched in the MEDLINE / Pubmed, ScienceDirect, LILACS databases in English and Spanish, published between 2010 and 2020. A complete evaluation of the articles was carried out applying the methodology recommended by the Joanna Briggs Institute (JBI ), with verification against the PRISMA ScR checklist. Observational cohort, case-control, and cross-sectional studies were included in the literature search. The review and analysis of the quality of the studies was carried out by 3 researchers and a referee. Results: initially 153 articles were found. After verifying inclusion, exclusion and quality criteria, 8 articles were chosen: 1 in the US, 2 in Asturias, 1 in China, 1 in Spain, 1 in Brazil, 1 in the Netherlands, and 1 in France-Italy. The design of the studies included in this review is: 7 of cases and controls and 1 cross-sectional study. According to the type of microbiota: oral 2, gastrointestinal 4, 1 oral / gastrointestinal and 1 cutaneous. The main results showed that in SLE the Firmicutes / Bacteroidetes ratio (ratio) is decreased given by an increase in Bacteroidetes phyla up to 2.5 times with a p <0.002, while in cutaneous Lupus the Firmicutes / Bacteroidetes ratio (ratio) is However, the immune response is similar, since the antigens of these microorganisms are capable of mediating Th17-type responses that in turn produce pro-inflammatory cytokines, which could explain some of the clinical manifestations of the disease. Likewise, microbial diversity was not affected by individual factors such as sex, age and diet. Other studies showed that the intestinal microbiota presents greater variability, while the skin microbiota is more stable despite external aggressions; however, said skin microbiota may show alteration in pathological processes such as SLE. Discussion and conclusions: our scope review allowed to reveal, the difference in the composition of the microbiota according to the location in the body, and in turn, a decreased relationship between the ratio (ratio) of Firmicutes / Bacteroidetes in gastrointestinal region, while in skin the ratio of Firmicutes / Bacteroidetes bacteria is increased, but the diversity is decreased. The findings made it possible to show that dysbiosis plays an important role in SLE, opening the opportunity to deepen these alterations, as a study strategy and approach for patients with SLE, it would be worthwhile to delve even more, if the treatment of dysbiosis with Modifiable factors such as the individual's diet and habits could become a potential treatment to prevent, delay or reduce the manifestations of the complications of the disease.