Cited by 586Gut microbiota and healthProbiotics and Fermented FoodsBacterial Cancer Therapy

The DOI matches its Crossref record; 202 of the 204 references it cites were found in a registry or an index; none of the 207 sources its claims cite is checked for support yet.

Gut Microbiota and Cancer: From Pathogenesis to Therapy

Open access

Abstract

Cancer is a multifactorial pathology and it represents the second leading cause of death worldwide. In the recent years, numerous studies highlighted the dual role of the gut microbiota in preserving host’s health. Gut resident bacteria are able to produce a number of metabolites and bioproducts necessary to protect host’s and gut’s homeostasis. Conversely, several microbiota subpopulations may expand during pathological dysbiosis and therefore produce high levels of toxins capable, in turn, to trigger both inflammation and tumorigenesis. Importantly, gut microbiota can interact with the host either modulating directly the gut epithelium or the immune system. Numerous gut populating bacteria, called probiotics, have been identified as protective against the genesis of tumors. Given their capability of preserving gut homeostasis, probiotics are currently tested to help to fight dysbiosis in cancer patients subjected to chemotherapy and radiotherapy. Most recently, three independent studies show that specific gut resident species may potentiate the positive outcome of anti-cancer immunotherapy. The highly significant studies, uncovering the tight association between gut microbiota and tumorigenesis, as well as gut microbiota and anti-cancer therapy, are here described. The role of the Lactobacillus rhamnosus GG (LGG), as the most studied probiotic model in cancer, is also reported. Overall, according to the findings here summarized, novel strategies integrating probiotics, such as LGG, with conventional anti-cancer therapies are strongly encouraged.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review summarizes the dual role of gut microbiota in cancer, from tumor-suppressive and tumor-promoting mechanisms to modulation of anti-cancer therapy. It highlights probiotics, especially *Lactobacillus rhamnosus* GG (LGG), and the emerging evidence linking specific gut species to immunotherapy response.

Key findings

  • Gut microbiota can be tumor-suppressive or oncogenic: microbial-derived short-chain fatty acids such as butyrate and propionate inhibit histone deacetylases, while dysbiosis-associated pathogens can release toxins causing DNA breaks; microbial pathogens are stated to drive 20% of tumorigenesis.
  • LGG is described as the most studied probiotic model in cancer, with anti-inflammatory effects, attenuation of 5-FU- and radiation-mediated gut epithelial injury in animal models, anti-proliferative/anti-metastatic effects in colorectal, ovary, breast, cervical, hepatic and oral squamous in vitro tumor models, prevention of polyps in a colorectal APC/min mouse model, and reduction of colitis-associated cancer in mice.
  • Inflammasomes are double-edged in tumorigenesis: in colorectal cancer they are protective via IL-18, whereas in lung, skin, breast and pancreatic cancer IL-1β is pro-inflammatory and tumor-promoting; NLRP6 regulates susceptibility to intestinal inflammation through microbiome-modulatory activity.
  • Three independent 2018 studies linked gut microbiome composition to immune checkpoint inhibitor response; anti-PD1 responders were enriched in taxa such as *Akkermansia*, *Alistipes*, *Clostridiales*, *Ruminococcaceae*, *Faecalibacteriae*, *Bifidobacterium longum*, *Enterococcus faecium* and *Collinsella aerofaciens*, and antibiotics were associated with lower survival in melanoma patients treated with anti-PD1/anti-PD-L1.

Methods

  • Narrative review; no systematic search strategy, inclusion criteria, or meta-analysis is stated.
  • Synthesizes preclinical studies (in vitro and mouse models), clinical trials, and translational studies, including three 2018 studies on microbiome and immunotherapy; no primary data are generated.
  • Main analysis is qualitative synthesis of mechanisms and therapeutic implications, with referenced tables of LGG and clinical studies.

Limitations

  • The paper states that microbiome research is at its beginning, associative and functional studies need corroboration by larger clinical studies, no strong bacterial oncogenic driver has been identified, and it is difficult to determine whether microbiota changes affect cancer genesis or vice versa.
  • The paper notes that lifestyle, diet, immune status and anti-cancer treatment itself influence the microbiome, and that larger controlled trials are needed to confirm probiotic efficacy and safety; FMT lacks control because whole microbiota is transferred, and donor health must be carefully controlled.
  • Evident from the text: as a narrative review, it does not describe a systematic literature search, study selection, or risk-of-bias assessment.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/cancers11010038

Cites

202 of 202 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Figure 1 Anti-tumoral effects of the gut microbiota. Probiotics and other gut resident bacteria are able to secrete molecules, capable, in turn, to fight tumor growth and prevent tumorigenesis through several mechanisms. Schematic of the intestinal layers, from top to bottom: mucus and microbiota, gut epithelium. Into the grey boxes are illustrated, from top to bottom, the microorganism species implicated in the anti-cancer process, the molecules produced and the corresponding effects induced within the host. Abbreviations: MPL, monophosphoryl lipid A; LPS, lipopolysaccharide.
Figure 1 Anti-tumoral effects of the gut microbiota. Probiotics and other gut resident bacteria are able to secrete molecules, capable, in turn, to fight tumor growth and prevent tumorigenesis through several mechanisms. Schematic of the intestinal layers, from top to bottom: mucus and microbiota, gut epithelium. Into the grey boxes are illustrated, from top to bottom, the microorganism species implicated in the anti-cancer process, the molecules produced and the corresponding effects induced within the host. Abbreviations: MPL, monophosphoryl lipid A; LPS, lipopolysaccharide.CC BY · PubMed Central
Figure 2 Pro-tumoral effects of the gut microbiota. Bacteria prominent during gut dysbiosis can secrete toxins able to interfere with host cell growth, finally predisposing the host organism to cancer development. Schematic of the intestinal layers, from top to bottom: mucus and microbiota, gut epithelium. Into the grey boxes are illustrated, from top to bottom, the microorganism species implicated in the pro-cancer process, the molecules produced and the corresponding effects induced within the host. Abbreviations: ROS, Reactive Oxygen Species; CTD, cytolethal distending toxin; IpgD, inositol phosphate phosphatase D; VirA, virulence gene A; CagA, cytotoxin associated gene A; FadA, Fusobacterium effector adhesin A; MP Toxin, metalloproteinase toxin; AvrA, avirulence protein A; β-gluc, β-glucuronidase.
Figure 2 Pro-tumoral effects of the gut microbiota. Bacteria prominent during gut dysbiosis can secrete toxins able to interfere with host cell growth, finally predisposing the host organism to cancer development. Schematic of the intestinal layers, from top to bottom: mucus and microbiota, gut epithelium. Into the grey boxes are illustrated, from top to bottom, the microorganism species implicated in the pro-cancer process, the molecules produced and the corresponding effects induced within the host. Abbreviations: ROS, Reactive Oxygen Species; CTD, cytolethal distending toxin; IpgD, inositol phosphate phosphatase D; VirA, virulence gene A; CagA, cytotoxin associated gene A; FadA, Fusobacterium effector adhesin A; MP Toxin, metalloproteinase toxin; AvrA, avirulence protein A; β-gluc, β-glucuronidase.CC BY · PubMed Central
Figure 3 Role of probiotics in anti-cancer therapy. Probiotics and Fecal Microbiome Transplantation (FMT) are currently studied as anti-cancer adjuvants to fight dysbiosis following anti-cancer therapy, to increase chemotherapy and immunotherapy efficacy and to both reduce tumor mass and prevent tumor recurrence.
Figure 3 Role of probiotics in anti-cancer therapy. Probiotics and Fecal Microbiome Transplantation (FMT) are currently studied as anti-cancer adjuvants to fight dysbiosis following anti-cancer therapy, to increase chemotherapy and immunotherapy efficacy and to both reduce tumor mass and prevent tumor recurrence.CC BY · PubMed Central

Verification

Claims the paper makes

138 Not checked yet · 11 Own interpretation

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Show all 88 claims

  • It may state two separate claims as one. 47
  • Probably not a substantial claim. 18
  • The quote only partly states this claim. 1
61 of 61
  • The paper relies on this without support.

    The gut microbial balance is required for the correct fulfilment of the gut microbiota's metabolic functions.

    “The gut microbial balance has a key role in the correct fulfilment of all these pivotal metabolic functions.”
  • The paper relies on this without support.

    Potential pathogens can develop among gut bacteria and could limit or slow down the translation of in vitro and in vivo results to the clinic.

    “Among the gut bacteria can develop potential pathogens and that could limit, or at least slow down, the translation of the in vitro and in vivo results to the clinic.”
  • The paper relies on this without support.

    Each individual inherits a specific gut microbiota footprint since birth, and their intestinal microbiota develops and changes with aging, diet, and lifetime exposure to the heterogeneous environment.

    “Each individual inherited a specific gut microbiota footprint since their birth, and their intestinal microbiota develops and changes with aging, diet and lifetime exposure to the heterogeneous environment.”
3 of 3

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Citations

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Metadata

Authors
Vivarelli, S., Salemi, R., Candido, S., Falzone, L., Santagati, M., Stefani, S., Torino, F., Banna, G. L., Tonini, G., & Libra, M.
Affiliations
  • University of Catania (IT)
  • University of Rome Tor Vergata (IT)
  • Ospedale Cannizzaro (IT)
  • Università Campus Bio-Medico (IT)
Corresponding author
Libra, Massimo
Venue
Cancers
Publisher
MDPI AG
Published
2019-01-03
Volume
11
Issue
1
Pages
38
ISSN
2072-6694 (ISSN-L)
OpenAlex
W2906724057
Cited by
586
References
204
Citations by year
2026: 41 · 2025: 59 · 2024: 84 · 2023: 79 · 2022: 103 · 2021: 92 · 2020: 91 · 2019: 37
FWCI
7.11
Type
journal article
Language
en
Open access
Locations
  • Cancers (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Biotechnology › Bacterial Cancer Therapy
Keywords
gut microbiota, cancer, carcinogenesis, dysbiosis, probiotics, Lactobacillus rhamnosus GG, cancer immunotherapy, chemotherapy, radiotherapy, intestinal homeostasis, inflammation, microbiota metabolites, host-microbe interactions

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