BAB IV - Potensi Pengembangan Gut-Brain Axis di Masa Depan

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Mikrobiota Usus Nutrisi, Kesehatan dan Kebugaran
Gut-Brain Axis Dalam Kesehatan Anak: Tinjauan Komprehensif

Pengembangan penelitian mikrobiota usus membuka peluang untuk memahami hubungan antara sistem imun tubuh, mikrobiota usus, dan gut-brain axis. Mikrobiota usus memiliki potensi sebagai biomarker untuk mendeteksi penyakit seperti diabetes tipe 2, kanker kolon, sirosis hati, dan karsinoma hepatoseluler. Profil mikrobiota usus dapat memprediksi respons individu terhadap pengobatan dan digunakan untuk menilai keberhasilan pengobatan. Dalam bidang pediatri, diversitas mikrobiota dapat memengaruhi respon terhadap vaksin, yang dapat membuka peluang untuk peningkatan efektivitas vaksin. Fecal Microbiota Transplant (FMT) adalah metode yang sedang diteliti untuk mengembalikan komposisi mikrobiota dan memiliki potensi dalam pengobatan berbagai kondisi, termasuk infeksi C.difficile, resistensi insulin, penyakit hati, dan gangguan autisme. Pengembangan pemahaman tentang mikrobiota usus dapat membuka peluang baru dalam pengembangan terapi yang lebih presisi dan spesifik untuk berbagai penyakit.

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GBA 4Gambar 4. Potensi pemanfaatan mikrobiota di masa depan (dimodifikasi dari Gulliver et al, 2022).

Perkembangan pada bidang mikrobiota usus telah membuka peluang untuk lebih memahami hubungan antara sistem imun tubuh, mikrobiota usus, dan gut brain axis. Hal ini juga membuka kesempatan baru bagi peneliti agar dapat menelaah lebih jauh terkait potensi mikrobiota sebagai metode diagnosis, pencegahan serta pengobatan penyakit yang didasari oleh disbiosis.102

Salah satu potensi arah penelitian mikrobiota adalah mengetahui apakah pola mikroba dapat menjadi biomarker untuk mendeteksi suatu penyakit tertentu seperti diabetes tipe 2, kanker kolon, sirosis hati dan karsinoma hepatoseluler. Adanya perubahan atau disbiosis yang spesifik pada setiap jenis penyakit tersebut dapat membantu dalam proses diagnosis.103 Sebagai contoh, pada pasien dengan diabetes tipe 2, ditemukan keberlimpahan yang berkurang pada bakteri penghasil butirat.103

Selain sebagai biomarker, profil mikrobiota usus juga berpotensi memprediksi respons seseorang terhadap tatalaksana yang diberikan. Tidak hanya itu, pemeriksaan mikrobiota juga dapat digunakan sebagai indikator untuk menilai keberhasilan suatu pengobatan. Potensi pemanfaatan mikrobiota dapat dilihat pada Gambar 4.103

Pada akhirnya, melalui pemahaman yang mendalam mengenai profil mikrobiota diharapkan klinisi dapat memberikan pengobatan yang lebih presisi dan spesifik untuk setiap individu sehingga dapat memperbaiki luaran terapi serta meminimalkan efek samping.103

Beberapa strain probiotik seperti Bifidobacterium longum subsp. longum telah terbukti mengurangi stres psikologis yang dirasakan pada orang dewasa sehat. Dalam uji klinis eksploratif, suplementasi dengan Bifidobacterium longum subsp. longum secara signifikan mengurangi stres yang dirasakan dan meningkatkan kualitas tidur. Hal ini menunjukkan bahwa probiotik berpotensi berperan dalam meningkatkan kualitas tidur, yang sering terganggu pada individu dengan depresi dan tingkat stres tinggi.103

Namun, perlu dicatat bahwa temuan ini masih awal dan penelitian lebih lanjut diperlukan untuk memahami sepenuhnya mekanisme di mana probiotik mempengaruhi kesehatan mental serta menetapkan dosis dan strain optimal untuk berbagai kondisi kesehatan mental.104

Pada bidang pediatri, mulai berkembang penelitian terkait peranan mikrobiota usus terhadap efektivitas suatu vaksin.105,106 Beberapa penelitian berhasil membuktikan pada anak dengan diversitas mikrobiota yang lebih tinggi didapatkan adanya respon imun yang lebih baik terhadap vaksin rotavirus, polio, hepatitis B dan vaksin BCG.106 Perubahan jumlah pada jenis bakteri spesifik juga dikaitkan dengan produksi antibodi pada saat vaksinasi. Sebagai contoh, peningkatan keberlimpahan filum Firmicutes dan Actinobacteria dapat berdampak terhadap tingginya produksi antibodi sementara peningkatan keberlimpahan Proteobacteria dan Bacteroidetes berkaitan dengan lebih rendahnya produksi antibodi.107 Hal ini tentu menarik untuk dikembangkan lebih lanjut terutama mengenai pemanfaatan mikrobiota dalam menentukan respons imun terhadap vaksin serta kemungkinan dibutuhkan booster pada kelompok anak tertentu.

Fecal Microbiota Transplant (FMT) merupakan salah satu upaya yang banyak diteliti untuk mengembalikan komposisi dan diversitas mikrobiota. Sejauh ini, keberhasilan FMT telah dibuktikan dapat mengurangi kejadian reinfeksi pada kasus infeksi C.difficile.108 Selain pada saluran cerna, FMT juga sedang diteliti efeknya terhadap resistensi insulin, penyakit liver serta gangguan spektrum autisme.108 Pemberian FMT dikategorikan aman, selama dilakukan skrining yang menyeluruh untuk mencegah adanya transfer multi-drug resistant patogen atau spesies berbahaya lainnya yang dapat mengakibatkan sepsis.108

Ke depan, penting untuk disadari bahwa mikrobiota usus dapat menjadi kontributor utama dalam pencegahan, pengembangan, pengobatan, dan pengelolaan berbagai penyakit, dimana sesuatu yang sederhana seperti pola makan sehari-hari dapat memberikan potensi terapeutik yang signifikan terutama bila dikombinasikan dengan terapi yang ada. Selain itu, dengan meningkatnya pengetahuan tentang mikrobiota usus, dapat pula diciptakan suatu strategi baru dalam pemanfaatan mikrobiota sebagai prediktor prognosis non-invasif dan biomarker untuk berbagai jenis penyakit. Pada akhirnya, pemahaman mengenai mikrobiota usus dapat menjanjikan potensi dan harapan yang menarik untuk membuka peluang baru dalam tatalaksana penyakit yang lebih presisi dan spesifik untuk setiap individu.

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Muzal Kadim, MD, Ph.D, Sp.A(K)

Muzal Kadim, MD, Ph.D, Sp.A(K)

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