Revista Portuguesa de Endocrinologia, Diabetes e Metabolismo - Online first: 2018-07-29
Changes in the composition of the intestinal microbiota have been linked to multiple features of the metabolic syndrome including obesity and diabetes mellitus. Recent studies suggest that these changes may contribute to the onset of low-grade-inflammation, through mechanisms associated with dysfunction of the intestinal barrier, contributing significantly for subsequent metabolic disorders. In type 1 diabetes, the lowered expression of adhesion proteins, associated with the disruption of junctional organization of the intestinal mucosa, may also constitute a primary location for easy absorption of antigens that provide structural changes in the ? cell. The use of regulators of the intestinal microflora, such as prebiotics, probiotics and other pharmacological agents as metformin, open doors to the possibility of handling the enteric microflora as a treatment for diabetes mellitus, obesity and other metabolic disorders. The present review aims to explain the main pathophysiological mechanisms that contribute to changes in the gut epithelium and altered gut microbiota, and the clinical and metabolic consequences associated; describe the importance and the relation between metabolic endotoxemia and the disorders associated with obesity and diabetes mellitus; demonstrate how therapy with metformin, as well as probiotics, prebiotics and certain bacteria, including Akkermansia muciniphila, may induce mechanisms of regulation of intestinal microbiota.