Table 4.

Therapeutic strategies to target microbiota in pancreatic cancer

Agent	Effects	Ref.
bacteriophage therapy	Can be used to target and control specific bacteria such as Klebsiella, Fusobacterium and Acinetobacter baumannii	[126, 127]
ferrichrome	Produced from Lactobacillus casei and can inhibit the growth of pancreatic cancer cells. Altered the expression of p53-associated mRNAs.	[138]
caerulein	Reduced Smad3 and phosphorylated Smad3 expression in mice. Reducing the proliferation and viability of cancer cells, inhibiting PanIN progression, and metastasis. Improved patient’s tolerance of chemotherapy. Inhibitory effect on PanIN changes and serum liver enzyme elevation.	[54, 139]
butyrate	proliferation and enhancing gemcitabine effectiveness. Reduced cancer-associated stromatogenesis, preserved intestinal mucosa integrity, affected fecal microbiota composition, and ameliorated some markers of kidney and liver damage	[140]
Megasphaera	Improved anti-PD-1 treatment	[141]
Resistant starches	influence microbial community, increase short chain fatty acids synthesis, and protects against DNA damage	[54, 140]
UA in conjunction with GEM	Suppression of the RAGE/NF-κB/MDR1 cascade and restriction of the growth of subcutaneous tumors in mice	[155]
Ciprofloxacin	Removes Gammaproteobacteria which can metabolize and deactivate gemcitabine	[152]
Gemcitabine	Decreased the proportion of Firmicutes and Bacteroidetes Increased Proteobacteria, Verrucomicrobia, with a rise in bacteria associated with inflammation in mice	[157]
Vancomycin, Neomycin, Metronidazole, Ampicillin and Amphotericin B	increase in interferon gamma-producing T cells, and a decrease in interleukin 17A and interleukin 10-producing T cells	[158]