Antibiotics, the microbiome and gastrointestinal cancers: A causal interference?

The human gut microbiome (GM) is a complex community made of approximately 500 different species of bacteria, archaea, viruses, and eukaryotes [1]. The gut microbiota influences numerous physiologic processes such as digestion, metabolism, cognitive development, and immune system development and function. Moreover, microorganisms in the gastrointestinal (GI) tract can contribute to the development of different diseases, including inflammatory bowel diseases (IBD) and cancer [1,2].

Colorectal cancer (CRC) associated-mucosa is characterized by a hyperproliferative and pro-inflammatory phenotype which can be attributed to an imbalanced gut microflora composition [3]. Indeed, microorganisms commonly living in the gut that become harmful under certain circumstances, the so called “pathobionts,” can lead to variations in tumor microenvironment by inducing DNA damages through the production of genotoxins [4]. On the other hand, there are also emerging evidences supporting that the gut microbiota is an important player inthe efficiency of cancer therapies. In particular, the gut microbiota has been shown to hold a predictive and prognostic role in the therapeutic response to immunotherapy [2]. For this reason, new microbiome-based treatment strategies designed to modify patients’ gut microbiota and its function are important [2]. Antibiotic administration is one of the most aggressive methods to manipulate gut microbiota composition. However, the use of antibiotics has been controversial in its role in cancer management. As a matter of fact, although gut microbiome depletion has been shown to inhibit cancer progression, antibiotics can affect gut homeostasis by also eradicating health-promoting bacteria and reducing its application in CRC management [5, 6∗, 7].

With this review, we focused on the bacterial microbiome of GI tract cancers, possible approaches to manipulate the host gut microbiota for cancer prevention, treatment, and alterations of the microbiome due to the use of antibiotics.

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