New horizons for the infectious diseases specialist: How gut microflora promote health and disease

The human intestine provides an expansive interface for interactions with the microflora. Increasing data support the hypothesis that host-microflora relationships are markedly dynamic, contributing to host health and disease pathogenesis. Despite outnumbering human cells 10-fold, the microflora most often assist the host through symbiotic relationships. The microflora are involved in maximizing host utilization of nutrients, induction of host immune responses, and promotion of intestinal cell and mucosal development. However, evolving data suggest that disturbances in this symbiotic relationship can lead the microflora to be pathogenic in diverse conditions such as inflammatory bowel disease, irritable bowel disease, obesity, graft-versus-host disease, HIV immunopathogenesis, and possibly cancer. Defining those microflora attributes that result in health and those that trigger disease is key to harnessing the microflora to promote human health.