Inflamm Bowel Dis. 2023 Mar 1;29(3):470-479. doi: 10.1093/ibd/izac156.

Caitlyn Hsu ¹, Mahmoud Ghannoum ², Fabio Cominelli ^1 3 4, Luca Di Martino ^1 3

Author information

¹Case Digestive Health Research Institute, Case Western University School of Medicine, Cleveland, Ohio, 44106, USA.

²Center for Medical Mycology and Integrated Microbiome Core, Department of Dermatology, Case Western Reserve University, and University Hospitals Cleveland Medical Center, Cleveland, Ohio, 44106, USA.

³Department of Medicine, Case Western University School of Medicine, Cleveland, Ohio, 44106, USA.

⁴Department of Pathology, Case Western University School of Medicine, Cleveland, Ohio, 44106, USA.

Abstract

Inflammatory bowel disease (IBD), a disorder characterized by chronic inflammation of the gastrointestinal (GI) tract and a range of adverse health effects including diarrhea, abdominal pain, vomiting, and bloody stools, affects nearly 3.1 million genetically susceptible adults in the United States today. Although the etiology of IBD remains unclear, genetics, stress, diet, and gut microbiota dysbiosis- especially in immunocompromised individuals- have been identified as possible causes of disease. Although previous research has largely focused on the role of bacteria in IBD pathogenesis, recently observed alterations of fungal load and biodiversity in the GI tract of afflicted individuals suggest interkingdom interactions amongst different gut microbial communities, particularly between bacteria and fungi. These discoveries point to the potential utilization of treatment approaches such as antibiotics, antifungals, probiotics, and postbiotics that target both bacteria and fungi in managing IBD. In this review, we discuss the impact of specific fungi on disease pathogenesis, with a focus on the highly virulent genus Candida and how the presence of certain co-enzymes impacts its virulence. In addition, we evaluate current gut microbiome-based therapeutic approaches with the intention of better understanding the mechanisms behind novel therapies.