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Darmmikrobiom und Anorexia nervosa

Der Zusammenhang von Mikrobiom und Darm-Gehirn-Interaktion im Kontext der Anorexia nervosa

Gut microbiome and anorexia nervosa

The relationship between microbiome and gut-brain interaction in the context of anorexia nervosa

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Zusammenfassung

In den letzten Jahren haben das Darmmikrobiom und seine Interaktion mit dem Gehirn zunehmendes Interesse geweckt. Längst sind die im Zuge dieser Forschung gewonnenen Erkenntnisse nicht mehr nur für Grundlagenwissenschaftler, sondern auch für Kliniker von Relevanz, da Studien einen Zusammenhang zwischen einem veränderten Mikrobiom und unterschiedlichen somatischen (z. B. chronisch entzündlichen Darmerkrankungen, Adipositas und Diabetes) wie auch psychischen Erkrankungen (z. B. Angststörungen, Depressionen) nahelegen. Hierbei scheinen neben einem direkten Einfluss des Mikrobioms auf Gehirn und Verhalten verschiedene Mechanismen relevant zu sein, u. a. eine veränderte Energieaufnahme aus der Nahrung, hormonelle Veränderungen, möglicherweise eine erhöhte Darmdurchlässigkeit sowie entzündliche und immunologische Prozesse. Die Anorexia nervosa (AN) ist die dritthäufigste chronische Erkrankung im Jugendalter und weist unter allen psychischen Störungen die höchste Mortalität auf. Neben einem restriktiven Essverhalten, Gewichtsverlust und komorbiden Angst- und Depressionssymptomen sind endokrine Veränderungen sowie Autoimmun- und Entzündungsphänomene charakteristisch. Da die AN besonders stark mit Essverhalten und Ernährung verbunden ist, scheint die Erforschung des Mikrobioms gerade in Bezug auf diese Krankheit sehr vielversprechend. Dieser Artikel gibt einen ersten Einblick in die zugrunde liegenden Prozesse, die bei der Darm-Gehirn-Interaktion im Kontext der AN eine Rolle spielen und fasst die bisherigen empirischen Befunde zu diesem Themenfeld zusammen. Abschließend wird ein Ausblick auf zukünftige Forschung und mögliche Implikationen für die therapeutische Praxis und Behandlung der AN gegeben.

Abstract

In recent years the intestinal microbiome and its interaction with the brain has aroused a growing interest. The findings gained in the course of this research are of great relevance not only to basic scientists but also to clinicians, as studies suggest an association between an altered microbiome and various somatic (e.g. chronic inflammatory intestinal diseases, obesity and diabetes) as well as psychiatric diseases (e.g. anxiety disorders, depression). In addition to a direct influence of the microbiome on the brain and behavior, various mechanisms seem to be relevant, including altered energy intake from food, hormonal changes, probably increased intestinal permeability as well as inflammatory and immunological processes. Anorexia nervosa (AN) is the third most common chronic disease in adolescence and has the highest mortality rate among all mental disorders. In addition to extremely restrictive eating habits, weight loss and comorbid anxiety and depression symptoms, endocrine changes and an increased autoimmune and inflammatory response are characteristic. Since AN is particularly strongly linked to eating behavior and nutrition, research into the microbiome seems very promising, especially with respect to this disease. This article gives a first insight into the underlying processes that play a role in gut-brain interaction in the context of AN and summarizes the previous empirical findings on this topic. Finally, an outlook on future research and possible implications for the therapeutic practice and treatment of AN is given.

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Förderung

Diese Arbeit wurde von der Medizinischen Fakultät der RWTH Aachen (START 108/17), der Schweizer Anorexia Nervosa Stiftung (80-17) und dem Bundesministerium für Bildung und Forschung (BMBF) zusammen mit der Europäischen Union (ERA-NET NEURON 01EW1906A) unterstützt.

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Authors and Affiliations

  1. Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Uniklinik RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Deutschland

    J. Seitz, L. Keller & B. Herpertz-Dahlmann

  2. Institut für Neuroanatomie, Uniklinik RWTH Aachen, Aachen, Deutschland

    S. Trinh

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  1. J. Seitz
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  2. L. Keller
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  3. S. Trinh
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  4. B. Herpertz-Dahlmann
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Correspondence to J. Seitz.

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Interessenkonflikt

J. Seitz, L. Keller, S. Trinh und B. Herpertz-Dahlmann geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Die Autoren J. Seitz und L. Keller haben zu gleichen Teilen zum Manuskript beigetragen.

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Seitz, J., Keller, L., Trinh, S. et al. Darmmikrobiom und Anorexia nervosa. Nervenarzt 91, 1115–1121 (2020). https://doi.org/10.1007/s00115-020-01003-x

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