Next-Generation Probiotic in Modulating Metabolic Homeostasis:Akkermansia muciniphila

The intestinal microbiota is honored as the key regulator of host homeostasis. The compositional imbalance of microbial communities commonly causes metabolic disorders and exacerbates disease progression. Akkermansia muciniphila (Akk) is a strict anaerobe Gram-negative bacterium which first isolated from human feces in 2004. AKK uses mucin as its sole carbon, nitrogen, and energy source. Akkermansia muciniphila is one of the most abundant single species in the human intestinal microbiota.  Since its discovery in 2004, the role of Akk in human metabolic health and disease therapy has been widely studied and therefore it has been called “next-generation beneficial microbes” and“one of the most promising probiotics”. Up to now, many papers associated with Akermansia muciniphila have been published, with diabetes and obesity as the factors under the greatest focus, and cancer as the hot topic of recent research. In the last decade, it was uncovered that Akermansia muciniphila can prevent and ameliorate metabolic syndrome, obesity, diabetes, aging, inflammation, neurodegenerative diseases, and negative effects of cancer therapy. Although it is comprehensively elaborated on the critical functions of Akermansia muciniphila in the metabolism of human health and nutrient utilization, the exhaustive signaling molecular mechanism of Akermansia muciniphila interacting with the host is still not completely understood. Yet, it is worth noting that several studies found that elevated Akk abundance as a paradigm for “next-generation beneficial microorganisms” is positively associated with aggravated host disease progression.

The Cultivation Characteristics of Akkermansia muciniphila

Akk is strictly anaerobic and mainly grown in mucin medium but also can grow on a limited number of sugars including N-acetylgalactosamine, N-acetylglucosamine or a synthetic medium constituted of glucose, peptone, and threonine that has been confirmed to be safe for human administration.
Glucosamine-6-phosphate (GlcN6P) exists in mucin is also necessary for Akk growth, and promoting adaptation to the mucosal niche. Nowadays, the mucin medium is widely and mainly used
to cultivate Akk, but the risk of animal-derived mucins is incompatible with human administration. The cultivation and growth of Akk need strictly anaerobic conditions, which make its mass production more challenging, and it still needs further investigations for improving its cultivation method and safety for human oral administration.

Akkermansia muciniphila in Preventing and Ameliorating Obesity and Metabolic Disorders

Obesity and type2 diabetes are associated with low-grade inflammation and specific changes in gut microbiota composition such as Akk prevalence. In addition to the genome of Akk, the membrane proteins and extracellular vesicles (EVs) of Akk have attracted more attention in the prevention and treatment of obesity and type 2 diabetes.  Individuals with obesity have a significantly higher
abundance of Firmicutes, whereas the abundance of Akk is significantly decreased in individuals with obesity and diabetes which is inversely associated with body fat mass and glucose intolerance. The abundance of Akk is strongly correlated with body mass index (BMI) and antidiabetic drug usage. Akk alleviates -induced metabolic disorders, including fat mass gain, metabolic endotoxemia, adipose tissue inflammation, and insulin resistance, as well as increases the intestinal levels of endocannabinoids that regulate inflammation, gut barrier and gut peptide secretion. In high fat diet -induced diabetic mice, EV treatment can improve intestinal barrier integrity by increasing tight junction (TJ) protein expression in an AMP-activated protein kinase -dependent manner. Akk also ameliorates chronic low-grade inflammation by decreasing plasma levels of lipopolysaccharide (LPS)-binding protein (LBP) and leptin and inactivating LPS/LBP downstream signaling mediated.

Conclusions and Future strategies

Critical contributions of Akermansia muciniphila toward metabolic health have begun to be elucidated. In particular, more recent studies is revealing how the effects of Akk extend beyond the GI tract, especially for the so-called gut–brain, gut–liver, gut–bone, gut–heart, gut–adipose and gut–muscle tissue axes, and cancer therapy. To date, the primary focus has been on the use of Akk to ameliorate diabetes, obesity, metabolic diseases, neurodegenerative diseases, inflammation, aging, and the negative effects of cancer therapy. The crucial knowledge gaps remain in this area, specifically on how Akk modulates lipid and glucose metabolism, brain metabolism, and the immune response. However, negative effects of Akk and the safe dose are comparatively less well understood.

Prepared by: Dr. Nazila Kassaian

References

probiotic supplements in individuals with T2DM

Genome-wide association studies evaluating the microbiota of type 2 diabetic mellitus (T2DM) patients have pointed to taxonomic, functional, and microbial metabolite imbalances and represent a potential intervention in diabetes management.
Several microbial metabolites and components, such as imidazole propionate, trimethylamine, and
lipopolysaccharides, appear to impair insulin signaling, while short-chain fatty acids, secondary bile
acids, and tryptophan metabolites may improve it. In addition, the use of probiotics with the aim
of transiently restoring the microbial balance or reducing the effects of microbial metabolites that
impair insulin sensitivity has been explored. Current literature indicates that some strains appear to have a beneficial effect in patients with T2DM, but further studies are needed to support the use
of these probiotics as an adjuvant therapy in the management of T2DM.

Conclusions and Future Perspectives

 It is known that the probiotic effects are strain-specific and disease-specific, and in future clinical trials dedicated to evaluating the effect of the most promising strains should be conducted, thereby allowing a better comparison between them.
Many of the bacterial species altered in the T2DM gut microbiota like Akkremansia muciniphila are not cultivable, which represents a challenge for investigating the effects of their supplementation. This fact leads to the possibility that new technological and cultivation techniques may allow for the cultivation of strictly anaerobic strains from the host gut microbiota.
Moreover, SCFA-producing bacteria supplementation should be performed due to its low abundance in the T2DM gut microbiota.
The association of changes in the gut microbiota, both at the compositional and functional levels, and T2DM traits is well documented. Together with microbial metabolites, they play a critical role in the etiology of T2DM. Future research aiming not only at taxonomic changes in the microbiota but also at altered metabolic pathways in T2DM, should be performed in human clinical trials.

References

Ballan R, Saad SM. Characteristics of the Gut Microbiota and Potential Effects of Probiotic Supplements in Individuals with Type 2 Diabetes mellitus. Foods. 2021 Nov; 10(11):2528.

Zhang L, Chu J, Hao W, Zhang J, Li H, Yang C, Yang J, Chen X, Wang H. Gut Microbiota and Type 2 Diabetes Mellitus: Association, Mechanism, and Translational Applications. Mediators of Inflammation. ۲۰۲۱ Aug 17; 2021.