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Background <p>The gut microbiome has long been recognized as a critical regulator of host metabolism, yet the fungal component the mycobiome remains comparatively understudied. Emerging evidence implicates gut fungi in endocrine and metabolic homeostasis through distinct mechanisms including bile acid modification, immune modulation, and cross-kingdom interactions with bacteria.</p> Objective <p>This narrative review synthesizes current evidence on the role of the gut mycobiome in obesity, insulin resistance (IR), and polyendocrine metabolic ovarian syndrome (PMOS), with emphasis on mechanistic pathways, clinical implications, and therapeutic potential.</p> Key Findings <p>The healthy gut mycobiome is characterized by dominance of <i>Candida</i>, <i>Saccharomyces</i>, <i>Cladosporium</i>, and <i>Malassezia</i> genera, though considerable variability exists based on geography, diet, age, and sex. Fungal dysbiosis typically manifesting as reduced diversity and overgrowth of pro-inflammatory taxa such as <i>Candida albicans</i> has been consistently documented in obesity, IR, and PMOS. Mechanistically, fungi influence host metabolism through: (1) production of bioactive metabolites (short-chain fatty acids, tryptophan derivatives); (2) modulation of bile acid pools and farnesoid X receptor (FXR) signaling; (3) immune priming via β-glucan-mediated Th17 responses; and (4) regulation of gut barrier integrity through fungal-bacterial crosstalk. In PMOS specifically, mycobiome alterations correlate with hyperandrogenemia, insulin resistance, and chronic inflammation, with emerging evidence implicating the gut-brain-ovary axis. Therapeutic strategies under investigation include probiofungals (<i>Saccharomyces boulardii</i>), dietary modulation, and selective antifungal interventions.</p> Conclusion <p>The gut mycobiome represents a novel, modifiable determinant of metabolic health with particular relevance to obesity, IR, and PMOS. Future research priorities include longitudinal cohort studies, mechanistic validation in gnotobiotic models, and randomized controlled trials of mycobiome-targeted interventions. Integration of mycobiome assessment into clinical practice may enable personalized approaches to metabolic disease management.</p>

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The gut mycobiome in endocrine and metabolic disorders: mechanistic insights and clinical implications in obesity, insulin resistance, and PMOS: a narrative review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月21日

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  • Eslam Abady,
  • Hazem AbuEl-Enien,
  • Noor ul Ain Saleem,
  • Shams Samih Ahmad Albarari,
  • Karrar Naem Karam,
  • Yahya Samadi,
  • Gaaitri Lohano,
  • Zarqa Yasin

摘要

Background

The gut microbiome has long been recognized as a critical regulator of host metabolism, yet the fungal component the mycobiome remains comparatively understudied. Emerging evidence implicates gut fungi in endocrine and metabolic homeostasis through distinct mechanisms including bile acid modification, immune modulation, and cross-kingdom interactions with bacteria.

Objective

This narrative review synthesizes current evidence on the role of the gut mycobiome in obesity, insulin resistance (IR), and polyendocrine metabolic ovarian syndrome (PMOS), with emphasis on mechanistic pathways, clinical implications, and therapeutic potential.

Key Findings

The healthy gut mycobiome is characterized by dominance of Candida, Saccharomyces, Cladosporium, and Malassezia genera, though considerable variability exists based on geography, diet, age, and sex. Fungal dysbiosis typically manifesting as reduced diversity and overgrowth of pro-inflammatory taxa such as Candida albicans has been consistently documented in obesity, IR, and PMOS. Mechanistically, fungi influence host metabolism through: (1) production of bioactive metabolites (short-chain fatty acids, tryptophan derivatives); (2) modulation of bile acid pools and farnesoid X receptor (FXR) signaling; (3) immune priming via β-glucan-mediated Th17 responses; and (4) regulation of gut barrier integrity through fungal-bacterial crosstalk. In PMOS specifically, mycobiome alterations correlate with hyperandrogenemia, insulin resistance, and chronic inflammation, with emerging evidence implicating the gut-brain-ovary axis. Therapeutic strategies under investigation include probiofungals (Saccharomyces boulardii), dietary modulation, and selective antifungal interventions.

Conclusion

The gut mycobiome represents a novel, modifiable determinant of metabolic health with particular relevance to obesity, IR, and PMOS. Future research priorities include longitudinal cohort studies, mechanistic validation in gnotobiotic models, and randomized controlled trials of mycobiome-targeted interventions. Integration of mycobiome assessment into clinical practice may enable personalized approaches to metabolic disease management.