The microbiome: Manipulation, application and reaction.
A report from Kate Lawrence who was also a speaker on the day.
On June 19th I attended a fascinating day of talks at the Royal Society of Medicine organised by Dr Sarah Rae, Consultant Rheumatologist for Bedford Hospital and Dr John Nichols, GP researcher based at the University of Surrey: ‘The microbiome: Manipulation, application and reaction.’
Drs Rae and Nichols began the day with an excellent introduction to the microbiome, bringing into focus these trillions of bacteria that reside happily within our gastrointestinal tract. Research into the microbiome has been increasing at an almost exponential rate in the 21st century, with an explosion in studies exploring both the underpinning biological workings of these bacteria and those looking at the relevance of these bacteria to medical science in a more applied way.
However the gulf, at the present time, between our ability to map the microbiome and our knowledge of how to manipulate this clinically remains significant. However, given that many of the conditions in which microbiome is implicated are chronic and have huge impacts of quality of life, patients are eager to experiment with relatively risk-free interventions such as probiotics and diet.
Indeed, I would not be surprised to see medical knowledge progress in an bottom-up manner with anecdotal success stories and case-reports driving forward more rigorous clinical trials. During the panel discussion at the end of the conference, Dr Rae asked the audience if they currently took probiotic supplements – the vast show of hands was startling. It's an exciting time for microbiome research.
Dr Rae summed up the current state of microbiome medicine: “Manipulating the microbiome is the next great challenge for medicine. Our scientific colleagues are delivering major breakthroughs to us and patients in almost every specialty can benefit. We must gear up trials to develop optimum delivery systems and doses.”
Further details on all presentations are given below.
The microbiome and mental health – Dr Kate Lawrence
I had the honour of taking the stand and discussing the important role the microbiome plays in mental health. We have long understood that the mind (and in particular stress) can influence what goes on within our gut – we’ve all experienced feeling ‘butterflies’ when we are nervous or needing to rush to the loo before an exam. However, research is now beginning to suggest that this relationship also operates in the reverse direction with the gut having a dramatic ability to influence the workings of our brain via the gut-brain-axis. The microbiome likely plays a key role in this communication. Mice with altered gut bacteria, display altered anxiety and depressive like behaviour and, in animals and humans, the administration of probiotics can lead to diminished anxiety. I finished by suggesting that the changes in the microbiome may help to explain why some dietary approaches might be successful in ADHD and outlining a new research project I am involved in, exploring a dietary intervention (designed to manipulate gut bacteria) in children with ADHD.
How to maintain metabolic health through manipulation of the microbiome – Dr Carl Hulston
Research discussed by Dr Carl Hulston, of Loughborough University, suggested that metabolic health may be manipulated via the microbiome. He described how the microbiome may differ in those with obesity and Type II diabetes. Furthermore it was proposed that a disrupted microbiome could play a causative role in metabolic disease mediated by changes in gut permeability and low grade inflammation. Dr Hulston described an ingenious study he had conducted in which human volunteers were over-fed on a high fat diet. This elicited changes in insulin sensitivity but this effect was diminished in those subjects who simultaneously took probiotics. Targeted nutritional approaches may therefore be a useful tool for fighting insulin resistance and type II diabetes.
Symbiosis, evolution and the human microbiome – Dr John Nichols
Dr John Nichols captivated the audience with his eloquent description of the importance and complexity of symbiosis, evolution and the human microbiome. It was discussed how humans have co-evolved with these minute organisms and bacteria that live within us and actually, just as they benefit from us, we too receive many benefits from them. The immune system would seem to depend heavily on the cross-talk with our microbiome and it is suggested that this probably has evolved as a side effect of our evolving tolerance to these inhabitants living within us. The role of the human host in controlling the microbiome seems to have been widely underestimated and is yet to be fully understood but understanding this continually evolving symbiotic relationship may be key to discovering more about why the microbiome is so important in health and disease.
The microbiome: Applications for rheumatology – Dr Sarah Rae
A fascinating presentation on the role of the microbiome in rheumatology. In 2001, probiotics were defined by the World Health Organisation and the Food and Agriculture Organisation of the United Nations as, ‘Live microorganisms which when administered in adequate amounts confer a health benefit on the host’. Since then Dr Rae has been recommending these to her patients who suffer from arthritis with ‘modest anti-arthritic benefits’. Evidence of dysbiosis (an atypical gut microbiome) in rheumatic diseases was described whereby the balance between different strains of bacteria may be sub-optimal. A high carbohydrate diet may be provocative for arthritis and a low starch diet potentially beneficial in reducing symptoms. Particular strains of probiotics, such as Lactobacillus Casei, have been found to significantly decrease symptoms in Rheumatoid Arthritis
The relevance of gut infections to the microbiome and disease and the impact of probiotics – Prof Colin Hill
Professor Colin Hill, Professor of Microbiology at University College Cork, gave an evidence-packed talk considering the role the microbiome might play in helping us to predict the response to an infection. We heard about the different components of the microbiome, which is comprised not only of bacteria, but also bacteriophages, archeas, yeasts and viruses. The potential of the microbiome to be harnessed as a tool to prevent or limit infection was put forward based on some intriguing animal research. We know that mice that have had their gut bacteria eliminated are incredibly vulnerable to infection. Particular strains of probiotics have been demonstrated to be as an effective as current antibiotic treatments in treating certain infections. For example, in cattle with recurrent mastitis, Lactococcus Lactis proved to be as effective as antibiotics in treating the condition. The potential of phage therapy was also discussed, in particular the ability of this therapy to destroy detrimental biofilms. There was also some very interesting discussion on the possible involvement of fungi and yeasts in inflammatory bowel disease, together with the atypical balance of bacteria species within individuals suffering with this condition.
The role of the microbiome in Parkinson’s disease and metabolic syndrome – Dr David Moyes
It was interesting to hear from Dr David Moyes, Lecturer in Host-Microbiome Interactions at King’s College London Dental Institute, about the ever-growing body of research connecting the microbiome to Parkinson’s disease and metabolic disease. His research investigates how changes in microbial communities can lead to chronic diseases, including oral disease. Studies have shown that alterations in the bacterial and fungal communities of the gut are associated with obesity and type 2 diabetes. Newer studies are also uncovering the critical role these microorganisms may play in neurodegenerative diseases such as Parkinson’s disease. Again it was mentioned that fungi (such as candida and aspergillus) might have a particular role to play in Inflammatory Bowel Disease, as they are particularly good at forming potentially detrimental biofilms.
A surgical perspective on the microbiome and improving outcomes of colorectal cancer - Mr James Kinross
Being a Senior Lecturer at Imperial College London and a Colorectal Surgeon at St Mary’s Hospital has given Mr James Kinross important insights into considerations that need to be made about the microbiome during colorectal surgery. The typical preparation for such surgery involves bowel preparation (to clear the bowel) and antibiotics which, in combination, wipe out much of the bacteria in the gut. Given what we understand about the importance of the microbiome to health, this may not be best state to be inducing pre-operatively. Having a healthy microbiome may play a critical role in recovering from such surgery and more needs to be understood about what can be done to create an optimal environment for the surgery to have the best chance of success. Interesting cross-cultural research was also discussed where findings consistently suggest differences in human microbiomes that are dependent on where they live in the world, their environment and diet. For example, Native Africans have been found to have a higher ratio of Prevotella bacteria. Understanding these global variations will be key to take into account when exploring the association between the microbiome and health and disease.