Gut microbiome and nutritional strategies in gastrointestinal cancers: Clinical implications and therapeutic perspectives

Table 1 Therapeutic approaches related to the gut microbiome in colorectal cancer

Therapeutic approach	Description	Key findings
Bacterial eradication	Targeting CRC-associated bacteria using antimicrobial agents	Colibactin-producing E. coli inhibited by ClbP inhibitors, reducing tumor growth in mice[169]
		F. nucleatum targeted with metronidazole, lowering bacterial load and tumor proliferation[140]
Probiotics	Using beneficial bacteria to modulate gut microbiome for CRC prevention and chemotherapy support[20,133,170]	Lactobacillus and Bifidobacterium species reduced preneoplastic lesions in animal models[171,172]
		VSL3 probiotic mix reduced adenoma formation and chemotherapy side effects[173]
		Human studies show mixed results on probiotics’ protective effects against CRC[174-176]
FMT	Transplanting healthy microbiome to modify gut composition and potentially prevent CRC[177]	FMT from wild mice improved CRC resistance and inflammation markers in recipient mice[177]
		Clinical evidence remains limited, requiring further studies[178]
Microbiome and chemotherapy resistance	Gut bacteria influence drug resistance and efficacy in CRC treatment[166]	F. nucleatum linked to resistance against 5-FU and oxaliplatin via immune signaling[166]
		Mycoplasma hyorhinis and Gammaproteobacteria impair gemcitabine by enzymatic deactivation[179]
		Ciprofloxacin restored gemcitabine sensitivity[179]
		Antibiotic use may reduce chemotherapy efficacy in some cases[180]
Microbiome and immunotherapy	Gut bacteria influence immune responses to CRC therapies[27]	Microbiome impact responses to immune checkpoint inhibitors (e.g., Ipilimumab)[181]
		Antibiotic-treated mice showed reduced immunotherapy effectiveness[181]
Microbiome and drug toxicity	Bacteria alter drug metabolism, affecting side effects and toxicity	E. coli β-glucuronidase reactivates irinotecan, increasing toxicity[182,183]
		Irinotecan alters microbiome, increasing inflammatory bacteria (Fusobacteria, Proteobacteria)[182]
		Antibiotic treatment reduced oxaliplatin-induced neuropathy in mice[184]

CRC: Colorectal cancer; ClbP: Colibactin precursor peptidase P; 5-FU: 5-fluorouracil; FMT: Fecal microbiome transplantation; E. coli: Escherichia coli; F. nucleatum: Fusobacterium nucleatum.