JBJS - 2026-08-05 - Journal Article; Review
Heading Toward a Different Future: The Microbiome, Dysbiosis, Microbial Translocation, and Beyond.
He M, Ferrini A, Chisari E, Kolhoff F, Sehgal P, Parvizi J
Topics
Key Takeaway
Microbial translocation through a compromised gut epithelial barrier and immune cell-mediated pathogen transport are proposed mechanisms linking gut dysbiosis to joint and spinal infections, though no quantitative clinical data are presented.
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Summary
This narrative review synthesizes current evidence on the gut-joint axis, proposing that endogenous gut microbiome dysbiosis and microbial translocation through a compromised epithelial barrier drive joint and spinal infections. The authors outline immune cell-mediated pathogen transport as a secondary mechanism and propose organoids and next-generation sequencing as future investigative tools. No original data, pooled statistics, or clinical outcomes are reported.
Key Limitation
No primary clinical data, effect sizes, or patient outcomes are presented, rendering all mechanistic claims hypothesis-generating rather than evidence-based.
Original Abstract
➢ The relationship between the gastrointestinal tract and joint diseases has garnered increased attention over recent decades, leading to the introduction of the gut-joint axis concept. ➢ Infections at sites such as joints and the spine may originate endogenously from the gut microbiome. ➢ The idea of microbial translocation through a compromised epithelial barrier, resulting in the circulation of pathogens or their byproducts, and the idea of immune cell-mediated transport of pathogens to various sites are gaining further attention. ➢ By understanding the interaction between the immune system and gut microbiota, potential therapeutic strategies, such as the use of organoids, can be developed to restore the gut barrier integrity, to replenish gut microbiota, and to provide biodiversity. ➢ To better understand the mechanisms linking gut health and joint diseases, future basic-science research and well-designed clinical trials, exploiting advanced next-generation sequencing techniques, are needed.