Microbiota-targeted Therapeutics

The preferred future direction is restoring foundational ecosystem functions rather than taking separate probiotic pills for many separate conditions. Mature probiotic formulations may become targeted ecological interventions rather than generic daily supplements. The review evaluates microbiota-targeted interventions across autoimmune and inflammatory rheumatic diseases because no comprehensive, current review spans all such interventions and diseases. Microbial interventions should consider the whole ecology because removing, adding, or feeding organisms changes the competitive environment. Microbiota-targeted therapies may act through changes in microbial composition and metabolites, gut barrier restoration, and pharmacomicrobiomic effects. A disease-by-disease probiotic supplement stack could become unwieldy if every condition required a separate formulation. Dietary interventions, standalone prebiotics, and probiotics in functional foods are excluded from the review. Eligible microbiota-targeted interventions include probiotics, synbiotics, postbiotics, FMT, live biotherapeutic products, and antibiotics. Targeted probiotic development aims to identify missing microbial functi…