06272301

November 24, 2023, 14:31

Reader’s expertise on the topic of the manuscript

Does the reader have a conflict of interest?

The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories

Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.

The authors of this review explore the intricate relationship between gut microbiome and type 2 diabetes, shedding light on a novel and intriguing field. In recent years, an increasing body of research has been dedicated to unraveling the connection between gut microbiome, or gut flora, and various diseases. As a metabolic chronic condition, type 2 diabetes poses a significant threat to public health. This review succinctly summarizes the involvement of gut microbes in the development of type 2 diabetes while providing comprehensive explanations for these theories. Importantly, the authors propose strategies for leveraging gut microbiota as potential therapeutic interventions for type 2 diabetes. The perspectives presented in this review not only serve as a valuable reference for further research but also offer insightful guidance for clinicians in managing type 2 diabetes and empowering individuals to combat it through regulation of their gut flora. This review exhibits logical coherence, meticulous detail, substantial content depth, and profound academic insight that reflect the authors' rigorous scholarly style and extensive academic foundation.

First, thank you very much for your professional comments on the article published in World Journal of Clinical Cases. Second, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor and submit it online to World Journal of Clinical Cases at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for a Letter to the Editor. In addition, the article processing charge will be exempted for this Letter to the Editor. As with all articles published by the Baishideng Publishing Group, the Letter to the Editor will be published online after completing peer review. The guidelines for a Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219. Finally, we look forward to receiving your high-quality Letter to the Editor, which will promote academic communication and lead the development of this discipline.

07415446

November 23, 2023, 15:51

Reader’s expertise on the topic of the manuscript

Does the reader have a conflict of interest?

The overall quality of the manuscript, based on the above-listed criteria, should be evaluated and classified according to the following five categories

Language quality (style, grammar, and spelling) should be evaluated and classified according to the following five categories.

We read with interest the review article on "Gut microbiome: New perspectives for type 2 diabetes prevention and treatment" by Shu-Xiao Li et al. We affirm the authors' view that gut microbiota is involved in the occurrence and development of type 2 diabetes mellitus (T2DM), and that regulation of gut microbiota is a new approach to T2DM treatment. We are very grateful to the authors for their dedication to the study of intestinal flora in T2DM, which helps to elucidate the mechanism affecting blood glucose level from a new perspective, and provides new treatment ideas for T2DM and its complications. Intestinal flora is the largest microecosystem in the human body and has a significant impact on the body's material and energy metabolism. Recent studies have shown that in addition to obesity, genetics and islet dysfunction, intestinal flora disturbance may be an important factor causing T2DM. However, long-term consumption of high-sugar and high-fat diet can lead to intestinal flora disorder in the host, and the increase of opportunistic bacteria; intestinal epithelial mucosal and barrier functions are damaged, and inflammatory factors and harmful metabolites enter the blood. We strongly agree with Shu-Xiao Li et al. on the pathogenesis of intestinal flora in T2DM, including bile acid theory, the theory of short-chain fatty acids and Endotoxin theory. In fact, the relationship between intestinal flora and bile acid metabolism is not one-way. Guo et al. believe that intestinal flora regulates the metabolism, synthesis and reabsorption of bile acids, and bile acids control the growth and diversity of intestinal flora. This important bidirectional imbalance may be a key factor leading to the occurrence of various diseases such as T2DM. In addition, short-chain fatty acids (SCFAs), a derivative of the gut microbiota, also play an important role in T2DM. In addition to the role of SCFAs described in Shu-Xiao Li et al., SCFAs also plays an important role in regulating liver glycogen metabolism and improving skeletal muscle insulin resistance. Hepatic insulin resistance is an early symptom of T2DM. Zhao et al. found that G protein-coupled receptor 43 (GPR43)-β-arrestin2-AMPK-PGC1-α signaling pathway plays an important role in the regulation of liver glycogen metabolism by butyric acid. Skeletal muscle insulin resistance is one of the indicators to evaluate the severity of T2DM. Yang et al. found that exercise had an effect on the distribution of intestinal microbiota in T2DM model rats, mainly because acetic acid improved insulin resistance by increasing the autophagy of skeletal muscle, which may involve the SCFAs/GPR43 signaling axis. In addition, metabolic endotoxemia with altered microbiota induces systemic inflammatory responses by stimulating the immune system through bacterial translocation. Lipopolysaccharide, as one of the endotoxins, is an important factor in inducing T2DM and its complications. Diabetes is a risk factor for Alzheimer's disease (AD). Liu et al. found that the C/EBP-β/AEP signaling pathway of neurons activated by inflammation is associated with diabetes and AD, and induces AD pathology and cognitive impairment. In view of the important influence of intestinal flora on the onset of T2DM, regulation of intestinal flora has also become an important means to treat T2DM, such as diet regulation, probiotics, prebiotics, and fecal bacteria transplantation. Shu-Xiao Li et al. focused on the relationship between intestinal flora and T2DM in basic experiments, and clinical studies have also become a hot topic in recent years. The clinical study of Larsen et al. confirmed for the first time that intestinal flora of T2DM patients was significantly different from that of normal population. Compared with normal people, the number of Bifidobacteria, Clostridium and Firmicutes in the intestinal flora of diabetic patients was significantly reduced. The number of Bacteroides and β-proteus increased significantly. SCFAs can improve blood glucose, body mass, insulin resistance, and glucose tolerance in T2DM patients. Clinical studies found that SCFAs affected the viability of human islet cells in a concentration-dependent manner, prevented streptozotocin induced β cell apoptosis, and prevented streptozotocin induced β cell oxygen consumption by supporting mitochondrial respiratory function. However, the specific mechanism of SCFAs and insulin secretion (GSIS) remains unclear. In animal experiments, acetic acid can promote GSIS by activating parasympathetic nerve, but in clinical studies, acetic acid has not shown a promoting effect on GSIS. Although different results have been produced in human and animal experiments, this may be caused by the pharmacological properties of free fatty acid receptor 2, an important receptor of SCFAs, and the species differences of experimental subjects. It is worth noting that free fatty acid receptor 2 is a promising new therapeutic target for T2DM. Therefore, it is necessary to carry out large-scale clinical trials to promote the clinical transformation of basic research results, so as to better serve patients. In short, T2DM has gradually become an increasingly prominent social health problem worldwide. As a chronic progressive, low-grade inflammatory disease, T2DM seriously affects the functions of human circulation, nervous system, urinary system, digestion and other systems, reduces the quality of life of patients, and consumes a lot of medical resources. Therefore, it is of great significance and urgency to study the pathological mechanism and effective prevention and treatment of T2DM. As the "second genome" of human, intestinal flora is expected to become a new therapeutic target for T2DM in terms of reducing insulin resistance, increasing glucose and lipid metabolism and alleviating inflammatory response, providing theoretical basis for its standardized treatment.

First, thank you very much for your professional comments on the article published in World Journal of Clinical Cases. Second, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor and submit it online to World Journal of Clinical Cases at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for a Letter to the Editor. In addition, the article processing charge will be exempted for this Letter to the Editor. As with all articles published by the Baishideng Publishing Group, the Letter to the Editor will be published online after completing peer review. The guidelines for a Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219. Finally, we look forward to receiving your high-quality Letter to the Editor, which will promote academic communication and lead the development of this discipline.