Will the manipulation of the gut microbiota be effective for the treatment of metabolic diseases?

The gut microbiota is a complex ecosystem of microorganisms, including bacteria, viruses, fungi and other microbes, that colonize our gastrointestinal tract. These microorganisms play a fundamental role in digestion, nutrient absorption and the functioning of the immune system. In addition, they contribute to maintaining body homeostasis and preventing the proliferation of pathogens. The composition of the gut microbiota varies between individuals and is influenced by multiple factors, such as diet, genetics, environment and lifestyle [ [1] Lynch S.V. Pedersen O. The human intestinal microbiome in health and disease. N Engl J Med. 2016; 375: 2369-2379 Crossref PubMed Scopus (2048) Google Scholar ]. Studies from the last two decades have revealed that the composition, function and imbalances of the gut microbiota may have a significant impact on the development and progression of several metabolic diseases, including obesity, type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD). In this issue of the European Journal of Internal Medicine Portincasa et al. explore, in a comprehensive review, the connections between the gut microbiota, obesity, T2D and MASLD, and discuss the potential use of microbiota modulation as a promising therapeutic strategy to manage these metabolic conditions [ [2] Portincasa P. Khalil M. Graziani A. Frühbeck G. Baffy G. Garruti G. et al. Gut microbes in metabolic disturbances. Promising role for therapeutic manipulations?. Eur J Intern Med. 2023; 119: 13-30 Google Scholar ].